Abstract：
OBJECTIVE: Bladder neck contracture (BNC) is a rare but intolerant complication after transurethral surgery of prostate. The present study aims to investigate the incidence and risk factors of BNC in patients diagnosed benign prostate hyperplasia (BPH) and following transurethral resection or enucleation of the prostate (TURP/TUEP).
METHODS: This retrospective study included 1008 BPH individuals who underwent transurethral surgery of the prostate between January 2017 and January 2022. Patients\' demographics, medical comorbidities, urologic characteristics, perioperative parameters, and the presence of BNC were documented. Univariate and multivariate analyses were conducted to identify the risk factors.
RESULTS: A total of 2% (20/1008) BPH patients developed BNC postoperatively and the median occurring time was 5.8 months. Particularly, the incidences of BNC were 4.7% and 1.3% in patients underwent Bipolar-TURP and TUEP respectively. Preoperative urinary tract infection (UTI), elevated PSA, smaller prostate volume (PV), bladder diverticulum (BD), and B-TURP were significantly associated with BNC in the univariate analysis. Further multivariate logistic regression demonstrated preoperative UTI (OR 4.04, 95% CI 2.25 to 17.42, p < 0.001), BD (OR 7.40, 95% CI 1.83 to 31.66, p < 0.001), and B-TURP (OR 3.97, 95% CI 1.55 to 10.18, p = 0.004) as independent risk factors. All BNC patients were treated with transurethral incision of the bladder neck (TUIBN) combined with local multisite injection of betamethasone. During a median follow-up of 35.8 months, 35% (7/20) of BNC patients recurred at a median time of 1.8 months.
CONCLUSIONS: BNC was a low-frequency complication following transurethral surgery of prostate. Preoperative UTI, BD, and B-TURP were likely independent risk factors of BNC. TUIBN combined with local multisite injection of betamethasone may be promising choice for BNC treatment.
METHODS: This retrospective study included 1008 BPH individuals who underwent transurethral surgery of the prostate between January 2017 and January 2022. Patients\' demographics, medical comorbidities, urologic characteristics, perioperative parameters, and the presence of BNC were documented. Univariate and multivariate analyses were conducted to identify the risk factors.
RESULTS: A total of 2% (20/1008) BPH patients developed BNC postoperatively and the median occurring time was 5.8 months. Particularly, the incidences of BNC were 4.7% and 1.3% in patients underwent Bipolar-TURP and TUEP respectively. Preoperative urinary tract infection (UTI), elevated PSA, smaller prostate volume (PV), bladder diverticulum (BD), and B-TURP were significantly associated with BNC in the univariate analysis. Further multivariate logistic regression demonstrated preoperative UTI (OR 4.04, 95% CI 2.25 to 17.42, p < 0.001), BD (OR 7.40, 95% CI 1.83 to 31.66, p < 0.001), and B-TURP (OR 3.97, 95% CI 1.55 to 10.18, p = 0.004) as independent risk factors. All BNC patients were treated with transurethral incision of the bladder neck (TUIBN) combined with local multisite injection of betamethasone. During a median follow-up of 35.8 months, 35% (7/20) of BNC patients recurred at a median time of 1.8 months.
CONCLUSIONS: BNC was a low-frequency complication following transurethral surgery of prostate. Preoperative UTI, BD, and B-TURP were likely independent risk factors of BNC. TUIBN combined with local multisite injection of betamethasone may be promising choice for BNC treatment.
摘要：
目的：膀胱颈挛缩症（BNC）是经尿道前列腺电切术后罕见但不能耐受的并发症。本研究旨在探讨良性前列腺增生（BPH）患者以及经尿道前列腺电切或前列腺摘除（TURP/TUEP）后BNC的发生率和危险因素。
方法：这项回顾性研究包括2017年1月至2022年1月接受经尿道前列腺手术的1008例BPH患者。患者人口统计学，医疗合并症,泌尿外科特征，围手术期参数,并记录了BNC的存在。进行单因素和多因素分析以确定危险因素。
结果：共有2%(20/1008)的BPH患者术后发生BNC，中位发生时间为5.8个月。特别是,BNC的发生率分别为4.7%和1.3%。术前尿路感染(UTI),PSA升高,较小的前列腺体积（PV），膀胱憩室(BD),单因素分析中B-TURP与BNC显著相关。进一步的多变量逻辑回归显示术前UTI（OR4.04，95％CI2.25至17.42，p<0.001），BD（OR7.40，95%CI1.83至31.66，p<0.001），B-TURP(OR3.97,95%CI1.55~10.18,p=0.004)为独立危险因素。所有BNC患者均采用经尿道膀胱颈电切术（TUIBN）联合局部多部位注射倍他米松治疗。在35.8个月的中位随访中，35％（7/20）的BNC患者在1.8个月的中位时间复发。
结论：BNC是经尿道前列腺手术后的低频并发症。术前UTI,BD,B-TURP可能是BNC的独立危险因素。TUIBN联合局部多点注射倍他米松可能是BNC治疗的有希望的选择。
方法：这项回顾性研究包括2017年1月至2022年1月接受经尿道前列腺手术的1008例BPH患者。患者人口统计学，医疗合并症,泌尿外科特征，围手术期参数,并记录了BNC的存在。进行单因素和多因素分析以确定危险因素。
结果：共有2%(20/1008)的BPH患者术后发生BNC，中位发生时间为5.8个月。特别是,BNC的发生率分别为4.7%和1.3%。术前尿路感染(UTI),PSA升高,较小的前列腺体积（PV），膀胱憩室(BD),单因素分析中B-TURP与BNC显著相关。进一步的多变量逻辑回归显示术前UTI（OR4.04，95％CI2.25至17.42，p<0.001），BD（OR7.40，95%CI1.83至31.66，p<0.001），B-TURP(OR3.97,95%CI1.55~10.18,p=0.004)为独立危险因素。所有BNC患者均采用经尿道膀胱颈电切术（TUIBN）联合局部多部位注射倍他米松治疗。在35.8个月的中位随访中，35％（7/20）的BNC患者在1.8个月的中位时间复发。
结论：BNC是经尿道前列腺手术后的低频并发症。术前UTI,BD,B-TURP可能是BNC的独立危险因素。TUIBN联合局部多点注射倍他米松可能是BNC治疗的有希望的选择。
