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Dr. Dean on outcomes with bladder neck incision at the time of HoLEP

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"Of the patients who underwent a prophylactic bladder neck incision... none of those patients developed a bladder neck contracture at 14 months of median follow-up," says Nicholas S. Dean, MD.

In this interview, Nicholas S. Dean, MD, highlights the background and findings of the study, “Short-Term Clinical Outcomes of Bladder Neck Incision at Time of Holmium Laser Enucleation of the Prostate,” for which he served as the lead author. Dean is an endourology fellow at Northwestern University in Chicago, Illinois.

Video Transcript:

Could you describe the background of this study?

In large retrospective cohort studies, the incidence of bladder neck contractures after HoLEP is approximately 2%, maybe a little bit higher. Patients with smaller prostates and lower resected weights appear to have an increased risk of bladder neck contractures. So, it has become a standard of care at our center [, Northwestern University,] to perform a prophylactic bladder neck incision for patients with smaller prostates less than 40 CCs in size or after laser enucleation if it appears that the patient has a relatively narrow bladder neck; then Dr. Krambeck will perform prophylactic bladder neck incisions at that point in time. It was the goal of our study to see if this made any difference [in] decreas[ing] the rate of bladder neck contracture, but also we did it to see if it had any impact on patients post operative recovery as well, in terms of the ability to get them home the same day, [and] in terms of their functional outcomes and safety outcomes as well.

What were some of the notable findings? Were any of these surprising?

The most important finding from this study was that of the patients who underwent a prophylactic bladder neck incision, there were 74 of them out of 421 patients, none of those patients developed a bladder neck contracture at 14 months of median follow-up. That is very interesting to us because these patients had a smaller preoperative prostate volume and a lower resected prostate weight, so theoretically, these patients should be at more risk for bladder neck contracture than our control patients. Another very interesting finding from our study was that the overall rate of bladder neck contracture of our 421 patients was 0.5%, which is lower than the historical retrospective cohorts looking at laser enucleation patients, which is also just very reassuring to both the surgeon and then also future patients as well when you're counseling them for a procedure.

Why is it lower? We're hoping that this is attributed to A) our prophylactic bladder neck incisions for patients with smaller prostates, and then B) contemporary technology and techniques by limiting the amount of energy that's going into the bladder neck.

Other notable findings, as well at that, the procedural efficacy was maintained, despite prophylactic bladder neck incision. It did not have a negative impact on being able to get patients home the same day as their HoLEP procedure. 88% of patients in the prophylactic bladder neck incision cohort were discharged home successfully the same day of their HoLEP without an indwelling catheter, which was not statistically different from the HoLEP control cohort. We also did not identify any difference in rates of emergency department visits, readmissions, or 90-day complications when comparing the prophylactic bladder neck incision cohort to the HoLEP controls. And finally, most importantly, there was no functional difference in terms of both AUA symptom scores and objective incontinence scores as well at 3-month follow up. So, that was very reassuring to see.

This transcription has been edited for clarity.

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