Bladder neck strictures


It is due to a loss in elasticity of the prostatic urethra, which is not able to open properly during urination (but prostate is, anyway, of a normal size).

Symptomatology:
1 Pollakiuria
2 Dysuria
3 Strangury
4 Nycturia.

Pharmacologic therapy:
Alpha blocking medicines.

Surgery therapy:
TUIP (Trans Urethral Incision of the Prostate).
TULIP (Trans Urethral Laser Incision of the Prostate): This is the technique we prefer because it allows the use of Holmium laser and of Thulium laser granting a lesser bleeding, a preservation of ejaculation and a shorter period of catheterism (less than 24 hours).
Photoselective vaporization of the prostate by using KTP laser.
The technology meets Italian urological surgery with laser Tullio 120 Watt.




This short video was produced by the equipe of Urology Laser Center of Arezzo (IT)






2016 Nov 18;83(4):204-206. doi: 10.5301/uro.5000175. Epub 2016 May 6.
Single laser incision for treatment of congenital bladder neck sclerosis: new technique.
       
Mattioli S,   Picinotti A,   Burgio A.    -   

Department of Laser Urology, Centro Chirurgico Toscano, Arezzo - Italy.

Abstract
INTRODUCTION:
The primary bladder neck obstruction (PBNO) has been recognized in 41-45% of young men suffering from a chronic lower urinary tract symptom (LUTS). Few studies are published in the literature about the use of laser devices in the surgical treatment of PBNO and none about the use of Thulium laser. The aim of our study is to report the results of our follow-up in the endoscopic treatment of PBNO with Thulium laser.

MATERIALS AND METHODS:
From January 2012 to January 2015, we treated 214 patients using Thulium laser for primary bladder neck sclerosis. All patients had symptoms suggestive of LUTS or prostatism: filling or irritative symptoms and voiding or obstructive symptoms. In 157 patients, the incision was performed unilaterally at 7 o'clock of the bladder neck. In 57 cases, bilateral incision was performed at 5 and 7 o' clock without vaporizing the tissue between the two incisions. We chose to make the incision bilaterally in cases wherein a single incision was not enough to solve the obstruction from the bladder neck and prevent a recurrence. Bladder irrigation was used overnight in all cases, and the catheter was removed after 24 hours.

RESULTS:
One hundred ninety-six patients enrolled completed 1-year follow-up: 157 patients underwent unilaterally incision and 39 bilateral incision. In 179 cases (91.3%), there was unchanged antegrade ejaculation, while reduced semen volume was reported by 14 men (7.1%) and retrograde ejaculation by only 3 (1.5%), but these patients underwent bilateral incision. The quality of orgasm and sexual satisfaction was not permanently changed by the operation.

CONCLUSIONS:
In patients with PBNO, it is possible to perform endoscopic treatment with Thulium laser that we think is an effective and safe procedure, not affecting sexual functioning and particularly retrograde ejaculation.

PMID:
27174536
DOI: 
10.5301/uro.5000175

[PubMed - in process]

More info and images. 

 

 

Urethra stenosis


The urethra stenosis is a narrowing of the urethral width which can concern any segment of urethra.
Front urethra: meatus, penile urethra, bulbar urethra
Back urethra: membranous and prostatic urethra

Causes:
1 Congenital
2 Traumatic
3 Infective
4 Iatrogenic.

Surgery therapy:
1 Urethroplasty: reconstruction of the stenotic section by using buccal mucosa graft or penile skin graft
2 Thulium laser or Holmium laser: incision of the stenotic section that allows postponing the surgery treatment which requires a long catheterism.


Abstract:
Transurethral incision of the bladder neck using KTP in the treatment of bladder neck obstruction in women. 
Ho:YAG-laser: treatment of vesicourethral strictures after radical prostatectomy. 
Transurethral 2-microm laser in the treatment of urethral stricture. 
Safety and efficacy of laser and cold knife urethrotomy for urethral stricture. 
Holmium laser urethrotomy for treatment of traumatic stricture urethra: a review of 78 patients. 
Low-power holmium:YAG laser urethrotomy for urethral stricture disease: comparison of outcomes with the cold-knife technique. 
Comparison of treatment results between holmium laser endourethrotomy and optical internal urethrotomy forurethral stricture. 
Holmium laser urethrotomy for urethral stricture. 
Holmium laser core-through urethrotomy for traumatic obliterative stricures of urethra: initial experience. 
High-power thulium fiber laser ablation of urinary tissues at 1.94 microm. 
Low-power holmium:YAG laser urethrotomy for treatment of urethral strictures: functional outcome and quality of life. 
Expanding the role of photoselective vaporization of the prostate. 
The Next Generation in Laser Treatments and the Role of the GreenLight High-Performance System Laser. 
Bladder neck incision using a 70 W 2 micron continuous wave laser RevoLix. 


Conferences:
CONFERENCE SIU, ROMA 2008 E CONGRESSO AURO, TAORMINA 2008
USE OF LASER TREATMENT IN TULLIO SCLEROSIS OF THE BLADDER NECK FROM 2005 TO 2007
Dr A. PICINOTTI, Dr S. MATTIOLI, Dr.ssa M. SBRAGI
CENTRE UROLOGIALASER.IT

WCE 2002, 19-22 Settembre, Genova (IT)
PHOTOSELECTIVE LASER VAPORIZATION OF THE PROSTATE (PVP), TRATTAMENTO LASER DELL'IPB
Mattioli S., Cremona M., Pozzoni F.
Istituto Clinico S. Ambrogio - Milano (IT)


Photographic references: