Posted by C S Loh on February 20, 1998 at 10:37:50:
In Reply to: BPH after posterior urethroplasty posted by CLDing on February 18, 1998 at 10:17:50:
For some reason, the combination of posterior urethroplasty and development of occlusive BPH is very rare. Most of the published series involved fairly young patients and as these procedures have only become popular over the last 20-30 yrs, it may be that a lot of these patients have not entered the risk age for BPH.
It is also important to remember that the finding of areflexic baldders is not uncommon in this group of patients due to associated pelvic plexus injury and these patients should correctly be managed by ISC. Because of this, I would always do a CMG, preferrably a Video CMG on these patients before starting treatment.
This patient's symptoms are moderate and they are due to obstruction, I would try alpha
blockers. In considering surgery, one must assume that the distal sphincter mechanism had
been destroyed or at least impaired. The video study/voiding urethrogram would had
indentified any. A standard TURP will render him incontinence if his distal sphincter had
already been destroyed. I had not come across anyone who had done a bladder neck
preserving TURP on these patients, but imagine that it should be technically straight
forward but I would not know what result such a modification would produce in terms of
both unobstruction and continence preservation.