The Ten Year Re-Treatment Rate after Bladder Neck Incision

1. No. 038 The Ten Year Re-Treatment Rate after Bladder Neck Incision AS. Goolam, T. Dean, P. Bergersen, P. Langdon, HH. Woo Sydney Adventist Hospital, Wahroonga, Sydney Introduction Bladder Neck Incision (BNI) has been described in the 1800’s and refined in the late 1900’s in the surgical management of obstructive lower urinary tract symptoms. In particular, patients with small prostate glands less than 30 grams as evaluated on digital rectal exam or cystoscopy were usually deemed suitable for BNI. 1,2,3 The efficacy of this procedure has also been compared to conventional Transurethral Resection of the Prostate (TURP) with most studies demonstrating an equivalent functional improvement for obstructive lower urinary tract symptoms (LUTS). Most of these studies however have looked at the short term results with none at a follow-up beyond ten years. The longest mean follow-up period for these studies was 96 months. 4 Results A total of 94 patients were identified using the item number 36854. Fourteen patients were identified as having prostate cancer either prior to or after the initial BNI (Figure 1). Of these, 3 had radiation and 6 had surgery as treatment for their cancer. A total of 15 patients underwent prior surgery to prostate and or urethra including the 6 who had prostate cancer. Records were unavailable at the time of publication for a further 7 patients (7.4%) leaving a total of 56 patients eligible for inclusion into the study A total of 5 out of the 56 patients (8.9%) required re-operation for recurrence of their LUTS (Figure 2). The median time to re-operation was 28 months with a range of 6 to 95 months. The median age at the time of their initial BNI being 62 years old. Of the 5 re-operations, 4 patients underwent TURP and 1 underwent further BNI. Pre-operatively, 13 patients had been prescribed alpha-blockers for their LUTS. Only one patient had commenced alpha-blockers for persistent LUTS after their initial BNI. Aim We aim to evaluate the ten year re-treatment rate for men who have undergone a bladder neck incision (BNI) for obstructive lower urinary tract symptoms. Methods The Sydney Adventist Hospital (SAH) records and participating urologist records were reviewed identifying patients having undergone a BNI from January 1995 to December 2001. Further surgery for recurrent lower urinary tract obstruction was assessed as the primary outcome. Patient records were reviewed from hospital and private rooms. Ethics approval was obtained for the study and a questionnaire was sent to patients. Local medical officers were also contacted for information regarding further procedures or commencement of medication for LUTS. Exclusion criteria included patients no longer alive, prostate cancer diagnosed prior or after undergoing the BNI, known bladder neck stricture, pelvic radiation, bladder neck , prostate or urethral surgery. Figure: 1 References 1. Soonawalla, P., Transurethral incision versus transurethral resection of the prostate. A subjective and objective analysis. British journal of urology, 1992. 2. Riehmann, M., et al., Transurethral resection versus incision of the prostate: a randomized, prospective study. Urology, 1995 3. Tkocz, M. and A. Prajsner, Comparison of long-term results of transurethral incision of the prostate with transurethral resection of the prostate, in patients with benign prostatic hypertrophy.Neurourology and Urodynamics, 2002. 21(2): p. 112-116. 4. Suri, A., et al., Endoscopic incision for functional bladder neck obstruction in men: long-term outcome. Urology, 2005. 66(2): p. 323-326 5. Miller, J., K. Edyvane, and G. Sinclair, A comparison of bladder neck incision and transurethral prostatic resection. Australian and New Zealand Journal of Surgery, 1992. 62: p. 116-122 Conclusions The re-treatment rate observed was found to be 8.9%. This is higher than the reported rate of 6.8% in the literature. 5 The median age of patients was 62 years old and a median time to re-operation of 28 months was noted. Acknowledgements We wish to thank the staff in the ethics department and medical records departments at Sydney Adventist Hospitals as well as the staff at the collaborating authors private rooms. Poster presentation sponsor