title: Transurethral front-firing Greenlight bladder autoaugmentation for bladder contracture: technique and clinical outcomes.
abstract: OBJECTIVE
  To describe a novel transurethral front-firing Greenlight bladder autoaugmentation for the treatment of bladder contracture and report initial clinical outcomes.
  
  
  METHODS
  Between April 2014 and August 2015, five patients diagnosed with contracted bladder were all refractory to conservative treatment and received novel transurethral autoaugmentation. CT scan and urodynamics examination were conducted before operation for disease assessment. Mucosal and muscular layers of bladder wall in fundus were incised vertically and horizontally with front-firing Greenlight laser to enlarge bladder capacity in the operation. Imaging examination and periodical urodynamics study were performed to evaluate the clinical outcomes of the procedure in postoperative follow-up.
  
  
  RESULTS
  Transurethral front-firing Greenlight bladder autoaugmentation was performed successfully on all the patients. The mean operative time was 59 min (range 52-65 min) with no significant blood loss. Urodynamic parameters of these patients after operation improved significantly compared with those before operation. Average maximum cystometric capacity (Vmax) increased from 91.2 to 333 ml (p < 0.01), average maximum flow rate (Qmax) ascended from 12.6 to 18.62 ml/min (p < 0.01), and average flow rate (Q(ave)) also increased from 5.74 to 13.18 ml/min (p < 0.01). At the last follow-up, all the patients could void spontaneously with good bladder emptying and their symptoms improved significantly.
  
  
  CONCLUSIONS
  Our novel transurethral front-firing Greenlight bladder autoaugmentation is a safe and effective treatment for contracted bladders. Future studies with larger sample size and long-term follow-up are needed to confirm our findings.
authors.affiliation: Department of Urology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China.
authors.forename: Ji-Ming
authors.initials: JM
authors.lastname: Bao
authors.affiliation: Department of Urology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China.
authors.forename: Wan-Long
authors.initials: WL
authors.lastname: Tan
authors.affiliation: Department of Urology, Guangdong No. 2 Provincial People's Hospital, Southern Medical University, Guangzhou, 510317, China.
authors.forename: Bing-Wei
authors.initials: BW
authors.lastname: Wang
authors.affiliation: Department of Urology, Guangdong No. 2 Provincial People's Hospital, Southern Medical University, Guangzhou, 510317, China.
authors.forename: Xiao-Fu
authors.initials: XF
authors.lastname: Qiu
authors.affiliation: Department of Urology, Guangdong No. 2 Provincial People's Hospital, Southern Medical University, Guangzhou, 510317, China.
authors.forename: Bai-Chuan
authors.initials: BC
authors.lastname: Liu
authors.affiliation: Department of Urology, Guangdong No. 2 Provincial People's Hospital, Southern Medical University, Guangzhou, 510317, China.
authors.forename: Rui-Lun
authors.initials: RL
authors.lastname: Zhong
authors.affiliation: Department of Urology, Guangdong No. 2 Provincial People's Hospital, Southern Medical University, Guangzhou, 510317, China.
authors.forename: Gao-Yuan
authors.initials: GY
authors.lastname: Li
authors.affiliation: Department of Urology, Guangdong No. 2 Provincial People's Hospital, Southern Medical University, Guangzhou, 510317, China. 2008yangguosheng@sina.com.
authors.forename: Guo-Sheng
authors.initials: GS
authors.lastname: Yang
mesh_terms: D000328:Adult; D003286:Contracture / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053685:Laser Therapy / Q000295:instrumentation*; D008297:Male; D008875:Middle Aged; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods*; D061646:Operative Time; D012189:Retrospective Studies; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014521:Urethra; D001743:Urinary Bladder / Q000000981:diagnostic imaging / Q000601:surgery*; D001745:Urinary Bladder Diseases / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D014563:Urodynamics; D013520:Urologic Surgical Procedures / Q000379:methods*
keywords: Bladder autoaugmentation; Bladder contracture; Front-firing Greenlight; Outcomes; Partial detrusorectomy