拡張バルーンによる経尿道的前立腺切除術後膀胱頸部狭窄の治療経験

Abstract

Bladder neck stricture is a late complication of transurethral prostatectomy (TUR-P). Two patients with bladder neck stricture after TUR-P were treated by the balloon dilatation method. The procedure was performed with topical anesthesia using 2% viscous lidocaine applied liberally within the urethra. The dilating balloon catheter was inserted over a 0.035 in. (0.09 cm) floppy-tip guidewire and the balloon was inflated by normal saline. The balloon was placed at the level of the prostatic urethra above the external sphincter. The balloon pressure was then increased to 3 atm and maintained for 10 minutes. All maneuvers were conducted under guidance of transrectal longitudinal linear scanning to ensure proper positioning of the catheter. The 18 Fr pelvic catheter was passed over the guidewire into the bladder and the next day the catheter was removed. After the procedure, clinical and uroflowmetric improvements were seen in both cases. They continue to do well. Balloon dilatation can be performed on an outpatient basis and by using only topical anesthesia. Therefore, balloon dilatation seems to be a useful method for treatment of bladder neck stricture after TUR-P. However, it is not clear how dilatation brings about long-term relief of obstructive symptoms.