Efficiency and safety of using a urethral catheter with ultrasound-induced drug coating with methylprednisolone for programmed balloon dilation for the prevention of recurrence of bladder neck sclerosis in patients after endoscopic prostatic procedures
DOI: https://dx.doi.org/10.18565/urology.2024.6.101-110
Kamalov A.A., Sorokin N.I., Kadrev A.V., Gorbunov R.M., Mikhalchenko A.P., Koknaev S.G., Nesterova O.Yu., Strigunov A.A., Shaparov B. .M., Tsigura D.A., Osmanov O.A., Kritsky A.A., Sindeeva O.A., Abdurashitov A.S., Proshin P.I., Pyataev N.A., Sukhorukov G.B.
1) Department of Urology and Andrology of Moscow State University by Lomonosov, Moscow, Russia;
2) Medical Scientific and Educational Center of Lomonosov Moscow State University;
3) Center for Neurobiology and Brain Rehabilitation named after Vladimir Zelman, Skolkovo Institute of Science and Technology, Moscow, Russia;
4) LLC Magnetic Drug Delivery, AMT & C Group, Moscow, Russia;
5) National Research Ogarev Mordovia State University named after N.P. Ogarev, Saransk, Russia;
6) GBUZ City Clinical Hospital No. 31 named after academician G.M. Savelieva of Moscow Healthcare Department, Moscow, Russia;
7) GBUZ Chelyabinsk Regional Clinical Hospital, Chelyabinsk, Russia
Introduction. One of the most promising minimally invasive methods for preventing the recurrence bladder neck sclerosis (BNS) is balloon dilatation of the bladder neck under transrectal ultrasound control using a urethral catheter with an ultrasound-induced drug coating with methylprednisolone.
Aim. To evaluate the efficiency and safety of serial balloon dilatation of the bladder neck under transrectal ultrasound control using a urethral catheter with an ultrasound-induced drug coating with methylprednisolone for the prevention of recurrence BNS after endoscopic procedures on the prostate.
Materials and methods. The study involved 30 patients with recurrent BNS who were included in the protocol of serial balloon dilation of the bladder neck. Recurrence of BNS was confirmed in each case by the flexible urethroscopy in the outpatient settings, after which the patient was included in the protocol of serial balloon dilation of the bladder neck. Incision of the bladder neck was performed using a thulium Fiber laser U3 (IRE-Polus) with power settings of 1 J, 30 Hz, 30 W or bipolar energy with the PlasmaNeedle electrode (Olympus). Serial balloon dilation was performed three weeks after repeated incision of the bladder neck. Before each session of balloon dilation, the following parameters were assessed in all patients: the total International Prostate Symptom Score (IPSS) and quality of life (QoL) score, Qmax and postvoid residual.
Results. Contracture stabilization at a urodynamically acceptable level (Qmax is higher than 12 ml/s and QoL is less than 3) was observed in 73.3% (n=22) of patients with a median follow-up of 10 months. Effective treatment required a median of 6 sessions of balloon dilatation. 4 out of 8 patients with recurrent BNS refused further participation in the study, while the remaining 4 underwent re-incision of the bladder neck followed by inclusion in the repeat balloon dilatation program, which was successful, thereby increasing the primary efficiency to 86.7%. Based on the Kaplan-Meier survival analysis, it was found that the longer the time since the start of serial balloon dilation, the lower the chance of recurrence of BNS. In terms of safety, no patient experienced complications associated with serial balloon dilation.
Conclusion. Serial balloon dilatation of the bladder neck under transrectal ultrasound control using a urethral catheter with an ultrasound-induced drug coating with methylprednisolone is an effective and safe technique that can be offered to patients to prevent recurrent BNS.
About the Autors
Corresponding author: B.M. Shaparov – Ph.D., urologist at the Department of Urology of the GBUZ City Clinical Hospital No. 31 named after academician G.M. Savelieva of Moscow Healthcare Department, Moscow, Russia; e-mail: uroboris@mail.ru
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