Endoscopic Management of Bladder Neck Contracture Following Radical Prostatectomy

Bladder neck contracture (BNC) occurs after radical prostatectomy in less than 5% of cases in modern series. Urinary extravasation, operative time and blood loss, radiotherapy, surgeon experience, prior outlet procedures, tobacco usage, age, comorbidities and body mass index (BMI) have all been suggested as risk factors for the development of BNC. BNC typically occurs within six months of prostatectomy and is defined as the inability to pass a flexible cystoscope across the bladder neck. Initial treatment is often balloon dilation. Incision of the bladder neck can be performed through a variety of methods (cold knife, knife with electrocautery, holmium laser) with or without the injection of antifibrotic agents (mitomycin C). Success rates vary widely, however, and with each additional procedure the chance of success diminishes. If multiple attempts at endoscopic management fail, open reconstruction may be required.