Table 3.
Summary of studies utilizing endoscopic management of BNC/VUAS with adjunctive therapies.
| Publication (Year) |
Etiology of BNC/VUAS | N | Treatment of BNC | Dose | Mean (*)/Median (#) Follow-Up | Success Rates: Cystoscopic Documentation of Stable Bladder Neck |
|---|---|---|---|---|---|---|
| Eltahawy (2008) [2] |
RP | 24 | -Holmium laser incision at 3 and 9 o’clock -Injection of triamcinolone |
80 mg | 24 mo (*) | 19/24 (83%) |
| Vanni (2011) [7] |
RP, radiation, TURP | 18 | -Tri- or quadrant CKI of bladder neck -Injection of MMC at each incision site |
0.3–0.4 mg/mL | 12 mo (#) | -1 procedure |
| 13/18 (72%) | ||||||
| -2 procedures | ||||||
| 16/18 (89%) | ||||||
| Redshaw (2015) [6] |
RP, radical cystectomy w/neobladder, radiation, simple prostatectomy, TURP, pelvic fracture | 55 | -3 or 4 deep bladder neck incisions until fat seen; either CKI or Collins knife | Range: dose from 0.4 to 10 mg | 9.2 mo (#) | -1 procedure 32/55 (58%) |
| -MMC injection into wound bed | Concentration from 0.1 to 1.0 mg/mL | -2 procedures 41/55 (75%) | ||||
| Farrell (2015) [5] |
Radiation- and non-radiation-induced strictures | 37 | -CKI at 3, 6, 9, 12 o’clock followed by MMC injections | 4 mg/ | 23 mo (#) | 28/37 (75.7%) |
| -CIC once daily to maintain patency | 10 mL | |||||
| Nagpal (2015) [12] |
Highly recurrent BNC (≥1 prior incision procedure) | 40 | -CKI of bladder neck followed by MMC injections at each incision site | 0.3–0.4 mg/mL | 20.5 mo (*) | -1 procedure |
| 30/40 (75%) | ||||||
| -2 procedures | ||||||
| 35/40 (87.5%) | ||||||
| Sourial (2017) [13] | RP for localized prostate cancer | 29 | -MMC injected at 3, 6, and 9 o’clock -Serial urethral dilation to 26 Fr |
0.05 mg/mL | 12 mo (#) | -1 procedure |
| 23/29 (79.3%) | ||||||
| -2 procedures | ||||||
| 25/29 (86.2%) | ||||||
| Zhang (2020) [14] |
Highly recurrent BNC (≥2 prior procedures) after TURP | 28 | -TUR bladder neck at 2–3 o’clock followed by triamcinolone injection at 3, 6, 9, 12 o’clock -Office cysto with triamcinolone every 4 weeks × 3 |
80 mg | 33.6 mo (#) | 26/28 (92.9%) |
| Mann (2021) [1] |
RP, +/− radiation | 30 | -Triamcinolone injection into scar at 3, 6, 9, 12 o’clock -Holmium laser ablation at injection sites |
40 mg/2 mL | 33.3 mo (*) | -1 procedure 21/30 (70%) |
| -2 procedures | ||||||
| 25/30 (83.3%) | ||||||
| Rozanski (2021) [8] |
RP, benign prostate surgery, radiation Recurrent BNC after failed DVIU or catheterization |
86 | -CKI at 3 and 9 o’clock if EUS involved or CKI at 3, 6, 9, 12 o’clock if EUS not involved -MMC injected at each incision site |
0.3–0.4 mg/mL | 21 mo (#) | -1 procedure 56/86 (65%) |
| -2 procedures 71/86 (83%) | ||||||
| -3 procedures 77/86 (90%) | ||||||
| Selvaraj (2021) [15] |
TURP Recurrent BNC after ≥3 prior procedures |
10 | -TUR bladder neck -10-point MMC injection in resection site |
2 mg | 24 mo (*) | 8/10 (80%) |
| Hacker (2022) [4] | RP, EBRT, or RP-EBRT | 51 | -Plasma cut at 3 and 9 o’clock -MMC injection to incisions |
2 mg/5 mL | 32 mo (#) | -1 procedure 23/51 (45%) |
| -2 procedures 35/51 (69%) | ||||||
| -3 procedures 40/51 (78%) | ||||||
| -4 procedures 43/51 (84%) | ||||||
| Current Series | Varied etiologies | 123 | Deep bilateral bladder neck incisions with Collins knife at 3 and 9 o’clock | NA | 12 mo (#) | -1 procedure 101/123 (82.1%) |
| -2 procedures 116/123 (94.2%) |
BNC—bladder neck contracture, CKI—cold knife incision, MMC—mitomycin C, CIC—clean intermittent catheterization, TURP—transurethral resection of prostate, DVIU—direct vision internal urethrotomy, EUS—external urinary sphincter, VUAS—vesicourethral anastomotic stenosis, RP—radical prostatectomy, EBRT—external beam radiation therapy, *—mean, #—median.