Bladder neck stenosis is a known complication following surgery for benign prostatic hyperplasia (BPH), with an incidence that can reach 9% after transurethral resection (TURP) and approximately 2% after holmium laser enucleation (HoLEP). In these cases, endoscopic bladder neck incision (BNI) is the standard of care, with reported success rates of around 80%.
To better understand which factors influence the outcome of the procedure, our researchers analyzed data from 110 patients treated with BNI after developing stenosis following surgery for benign prostatic hypertrophy. Data were collected during a median follow-up of 13 months through clinical and laboratory evaluations and telephone interviews. The results show a favorable picture, with approximately two out of three patients achieving significant clinical improvement after endoscopic treatment for bladder neck sclerosis: 3 months after the procedure, 64% of patients had mild symptoms, while approximately 31% reported moderate symptoms and only 5% had severe symptoms; the latter cases were already burdened by other underlying comorbidities that complicated their clinical picture.
The safety profile is also reassuring. Complications within 30 days occur in 12.7% of cases and mainly include urinary retention in 6% and urinary tract infections in 4%, while urinary incontinence, observed in 4% of patients, is temporary in most cases and resolves within three months of surgery. The success of the treatment is demonstrated by the fact that only about 7% of patients develop a new stricture within one year and less than 5% require a repeat procedure.
The statistical analysis also identified two key factors associated with poorer treatment outcomes. Specifically, patients who develop symptoms within 6 months of prostate surgery have an almost fourfold higher risk of treatment failure, while a prostate volume of less than 50 grams is associated with an approximately three-and-a-half-fold increased risk.
Overall, these findings confirm that BNI is an effective and safe procedure, but they also highlight how a better understanding of risk factors now makes it possible to tailor treatment and optimize clinical outcomes.
Quarta L, Bandini M, Corsini C, et al. Assessing predictors of failure after bladder neck incision in patients who developed bladder neck stenosis following transurethral surgery for benign prostatic hyperplasia. The Prostate. 2025.
