Akademik Veri Yönetim Sistemi
ESGURS-ESAU25, Turin, İtalya, 2 - 03 Ekim 2025, ss.1, (Özet Bildiri)
Bladder neck stenosis (BNS) is a rare late complication of BPH surgery, with an incidence of 0–9.6%. Endoscopic methods (cold knife incision, electrocautery resection, stent, balloon dilatation, laser resection) and reconstructive surgeries (T-plasty, Y-V flap, subtrigonal inlay patch (SIP) technique) are used in treatment. The first case using buccal mucosal graft (BMG) for refractory BNS with robotic approach was published in 2019. In 2021, we introduced the SIP technique with BMG as an open approach in a 3 case series. Then in 2024, we published a report on the long-term results of our 11 patient series. Later a similar technique has been described, involving the combination of TUR and laparoscopic placement of BMG to the bladder neck. In this patient, we aimed to apply our SIP-BMG method laparoscopically.
A 57-year-old male with prior TURP and subsequent cold knife incision and resection for BNS presented with recurrent LUTS. His Qmax was 2 ml/sec and retrograde urethrography+voiding cystogram revealed the recurrence of bladder neck stenosis. Laparoscopic BMG-SIP was planned; a suprapubic catheter was placed for urethral preparation. Patients position in surgery was lithotomy with 15° Trendelenburg. Cystoscopy confirmed near-complete obstruction. After guidewire placement and port insertion, vertical cystotomy was performed and stay sutures were placed. Ureteral orifices were identified. Using electrocautery, two separate incisions from the nearly obliterated bladder neck at 4 and 8 o’clock positions towards the ipsilateral ureter orifices with 1–1.5 cm safety margin were done. Patency of bladder neck was verified with a 16 Fr catheter. A 2.5×2 cm BMG was harvested from the left cheek, defatted, and patched into the subtrigonal area using 5/0 monofilament absorbable sutures. A 20 Fr Foley was gently placed to compress the graft to prevent bulging of graft. The bladder was closed with 3/0 absorbable wound closure device and the procedure is completed.
The patient is discharged uneventfully on postoperative day 3. Catheter is removed at 4 weeks. At 6 months, Qmax increased to 35 ml/sec.
Endoscopic treatment is first-line in BNS, with success rates of 72–86%, but decrease with repeated procedures. Minimally invasive reconstructive options are gaining favor due to 87–91% success, <10% incontinence, and low recurrence. If endoscopic methods fail, reconstructive methods should be used. YV-plasty, T-plasty or SIP with oral mucosal grafts are all available methods that recommended. SIP technique have been reported to be successful in case series but further studies with larger sample sizes are needed. This video article demonstrates laparoscopic BMG-SIP technique. It may be recommended in patients with >2 failed endoscopic attempts or failed open surgeries. We believe it is a viable minimally invasive option for refractory BNS.