Transurethral Bladder Neck Resection (TURBN)
TURBN removes fibrotic bladder-neck tissue using a resectoscope loop. EAU guidance supports transurethral resection or hot-knife incision as first-line treatment for nonobliterative bladder-neck stenosis after surgery for benign prostatic obstruction. VUAS after radical prostatectomy is anatomically distinct; visually controlled dilation or incision is an initial option in nonobliterative cases. Complete posterior obliteration should not undergo endoluminal treatment.[1]
Resection and incision
| Feature | Resection | Incision |
|---|---|---|
| Instrument | Electrosurgical loop | Electrocautery Collins knife, cold knife or laser |
| Tissue handling | Removes selected scar tissue | Divides the scar to open the lumen |
| Selection | Scar configuration, safe access and surgeon experience | Scar configuration, safe access and surgeon experience |
No robust comparative evidence establishes superiority or equivalence of these methods. In Rosenbaum's retrospective cohort of 60 patients after benign prostate surgery, 49 underwent resection and 11 incision. No statistically significant outcome difference was found, but the small, nonrandomized groups do not prove equal effectiveness; VUAS patients were excluded.[2]
Operative principles
- Define the stenosis, residual lumen, prior operation, radiation exposure, baseline continence and drainage needs. Identify the bladder and ureteral orifices when safely accessible.
- Resect scar under direct vision with controlled depth. Published protocols describe resection toward the bladder-neck muscle; the extent must be adapted to viable tissue and the patient's anatomy.[3]
- Protect the external sphincter distally, ureteral orifices proximally, rectum posteriorly and pubic tissues anteriorly. Avoid deep posterior-stenosis incisions/resection at 6 and 12 o'clock, especially after radiation. Exposure of perivesical fat is not a universal operative endpoint.[1]
- Confirm hemostasis, outlet patency and an appropriate postoperative drainage plan. Counsel that relieving obstruction can unmask or worsen SUI.
Evidence
| Study | Population | Result and limitation |
|---|---|---|
| Rosenbaum 2021 | 60 post-BPH-surgery patients; 49 resection, 11 incision | 32/60 (53%) success; 28 required further treatment. Earlier presentation was associated with recurrence. The apparent difference between prior HoLEP and TURP came from only 6 versus 54 patients and should not guide procedure selection by itself.[2] |
| Zhang 2021 | 28 highly recurrent post-TURP contractures; resection plus intraoperative and serial postoperative triamcinolone | 26/28 (92.9%) patent outlets at median 2.8 years; 25/28 adequate voiding. No control group establishes the steroid's added benefit.[3] |
Results from these cohorts should not be applied directly to radiated VUAS or completely obliterated outlets. Prior treatments, bladder dysfunction and radiation also affect patient selection and outcomes.[1]
Adjuncts and complications
Corticosteroid injection is an off-label adjunct with limited comparative evidence. Drug details belong in the intralesional corticosteroid hub. EAU advises against mitomycin C for posterior stenosis outside a clinical trial, given uncertain benefit and reports of serious necrosis, osteitis and fistula.[1]
Discuss recurrence, bleeding, infection, extravasation, sphincteric incontinence and fistula. Baseline SUI is common in selected post-prostatectomy referral populations, but the 78% figure from Ramirez's 50-patient incision series is a baseline cohort characteristic, not a TURBN complication rate.[4]
Recurrent stenosis
A further endoscopic procedure may be reasonable for selected nonobliterative recurrence. There is no universal rule to reconstruct after exactly two failures. Refer refractory or obliterative disease for an individualized open or robotic reconstruction assessment; consider radiation injury, residual bladder function, continence goals and the feasibility of durable drainage. Y-V plasty and reanastomosis address different anatomical problems.[1]
Do not use posterior urethral stents as a routine salvage step. EAU discourages them. Continence surgery follows assessment of stable outlet patency; urinary diversion is an option for selected devastated outlets or unsalvageable bladders, not a predetermined percentage of recurrent BNC.[1]
References
1. European Association of Urology. EAU Guidelines on Urethral Strictures. 2026. Disease management in males, sections 6.3.5–6.3.6. Guideline.
2. Rosenbaum CM, Vetterlein MW, Fisch M, et al. Contemporary outcomes after transurethral procedures for bladder neck contracture following endoscopic treatment of benign prostatic hyperplasia. J Clin Med. 2021;10(13):2884. doi:10.3390/jcm10132884.
3. Zhang L, Liu S, Wu K, Mu X, Yang L. Management of highly recurrent bladder neck contractures via transurethral resection combined with intra- and post-operative triamcinolone acetonide injections. World J Urol. 2021;39(2):527-532. doi:10.1007/s00345-020-03224-w.
4. Ramirez D, Zhao LC, Bagrodia A, et al. Deep lateral transurethral incisions for recurrent bladder neck contracture: promising 5-year experience using a standardized approach. Urology. 2013;82(6):1430-5. doi:10.1016/j.urology.2013.08.018.