title: Outcomes of the Endoscopic Treatment of Bladder Neck Contractures in the Orthotopic Neobladder.
abstract: OBJECTIVE
  To examine the outcomes of endoscopic procedures for bladder neck contracture (BNC) in the orthotopic neobladder (ONB) after radical cystectomy focusing on success rates for patients who require multiple treatments.
  
  
  METHODS
  Patients who underwent treatment for cystoscopically confirmed BNC in an ONB from 2007 to 2014 were studied. Treatment information included procedure type, use of adjuvant clean intermittent catheterization (CIC), and follow-up procedures. Procedures followed by additional interventions were categorized as failures. Success was defined as no additional surgical procedure with at least 1 year of follow-up. Procedures were classified by a number of prior endoscopic treatments.
  
  
  RESULTS
  Seventy-one patients underwent 155 individual endoscopic procedures (146 urethrotomy, 3 dilation, and 6 transurethral resection of bladder neck). All patients were male without prior radiation. Median follow-up after initial endoscopic treatment was 26.8 months (interquartile range: 16.6-51.7), and time to recurrence was 3.5 months (1.6-6.3). Success was experienced for 50 of 136 individual procedures (37%) after excluding 19 procedures for inadequate follow-up. Success rates remained 25%-43% even after multiple prior interventions. Adjuvant CIC was associated with a higher success rate (14/24 or 58%) compared to procedures without CIC (36/112 or 32%, P = .02). Successful outcomes were seen in 50 of 71 patients (73%) with 2 patients requiring ONB removal.
  
  
  CONCLUSIONS
  Individual endoscopic treatments of BNC in the ONB were met with 37% success. The rate did not decrease with subsequent procedures. Adjuvant CIC improved the outcomes. Overall, a successful outcome was achieved for most patients, but the majority required more than one procedure.
authors.affiliation: Section of Urology, Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, IL. Electronic address: pariserj@gmail.com.
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Pariser
authors.affiliation: Section of Urology, Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, IL.
authors.forename: Gabriel B
authors.initials: GB
authors.lastname: Saltzman
authors.affiliation: Section of Urology, Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, IL.
authors.forename: Gregory T
authors.initials: GT
authors.lastname: Bales
authors.affiliation: Section of Urology, Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, IL.
authors.forename: Gary D
authors.initials: GD
authors.lastname: Steinberg
authors.affiliation: Section of Urology, Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, IL.
authors.forename: Norm D
authors.initials: ND
authors.lastname: Smith
mesh_terms: D000368:Aged; D003286:Contracture; D015653:Cystectomy / Q000379:methods*; D003558:Cystoscopy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D001743:Urinary Bladder / Q000503:physiopathology* / Q000601:surgery; D001748:Urinary Bladder Neck Obstruction / Q000601:surgery*; D014547:Urinary Diversion / Q000379:methods*; D016476:Urinary Reservoirs, Continent; D013520:Urologic Surgical Procedures / Q000379:methods*