From the Guidelines
Perineal laser ablation is not a recommended treatment for bladder neck issues, as the current evidence suggests that other procedures such as bladder neck reconstruction, artificial sphincter implantation, or autologous fascial sling are more effective in addressing outlet issues and incontinence. For bladder neck problems, other treatments are usually recommended:
- Medications: Alpha blockers can help relax the bladder neck muscles, but the provided evidence does not discuss this in detail 1.
- Physical therapy: Pelvic floor exercises can strengthen muscles supporting the bladder neck, although this is not mentioned in the provided study 1.
- Minimally invasive procedures: The study does not discuss transurethral incision of the prostate (TUIP) or transurethral resection of the prostate (TURP), but it does mention the creation of a long and narrow channel at the bladder neck to increase outlet resistance 1.
- Surgery: Bladder neck reconstruction surgery might be necessary, and the study discusses the use of autologous fascial sling to narrow the outlet, creation of a long and narrow channel at the bladder neck, and implantation of an artificial sphincter 1. The choice of treatment depends on the specific bladder neck issue and its underlying cause, and it is essential to consult with a urologist for a proper diagnosis and personalized treatment plan. The provided evidence highlights the importance of carefully tailoring the procedure to the anatomy of the patient and the potential need for a catheterizable channel to facilitate reliable bladder emptying 1. It also discusses the controversy regarding concomitant enterocystoplasty at bladder neck procedure, with some advocating for a combined procedure to prevent a secondary procedure, while others argue that avoidance of enterocystoplasty is paramount due to significant complications 1.
From the Research
Perineal Laser Ablation for Bladder Neck Issues
- The provided studies do not directly address the use of perineal laser ablation for bladder neck issues, but rather focus on its application for benign prostatic obstruction (BPO) and lower urinary tract symptoms (LUTS) due to benign prostatic enlargement (BPE) 2, 3, 4, 5, 6.
- Transperineal laser ablation (TPLA) has been shown to be a safe and feasible treatment option for men with LUTS due to BPO, with significant improvements in functional outcomes and quality of life 3, 4, 5.
- TPLA can be performed under local anesthesia in an outpatient setting, making it a minimally invasive alternative to traditional surgical treatments 2, 3, 4, 5.
- The studies suggest that TPLA can improve urinary flow rates, reduce post-void residual volume, and alleviate LUTS symptoms, but do not specifically address its effectiveness for bladder neck issues 2, 3, 4, 5, 6.
- Further research is needed to determine the efficacy of perineal laser ablation for bladder neck issues, as the current evidence is limited to its application for BPO and BPE.