What is the difference between transurethral resection of the bladder neck (TURBN) and other treatments for bladder neck contraction?

Clarification: The Question Appears to Ask About the Same Procedure

The question as written asks about the difference between "transurethral resection of bladder neck" and "transurethral resection of bladder neck"—which are identical procedures. I will instead address the differences between available treatment options for bladder neck contracture, as this appears to be the intended clinical question.

Treatment Options for Bladder Neck Contracture

For bladder neck contracture following endoscopic prostate procedures, you may choose between dilation, bladder neck incision, or transurethral resection based on surgeon preference, as all yield comparable outcomes. 1

Endoscopic Treatment Options (First-Line)

The 2023 American Urological Association guidelines establish three equivalent endoscopic approaches: 1

• Dilation: Mechanical stretching of the contracture using graduated dilators
• Bladder neck incision (BNI): Single or multiple incisions through the contracted tissue without tissue removal
• Transurethral resection (TUR): Actual removal/resection of contracted bladder neck tissue

Key Point: These endoscopic methods produce comparable outcomes, so selection depends entirely on surgeon experience and preference. 1 Repeat endoscopic treatment is frequently necessary for successful long-term outcomes. 1

Comparative Performance of Endoscopic Techniques

When comparing bladder neck incision versus transurethral resection specifically:

• Bladder neck resection demonstrates advantages over standard TURP in patients with prostates ≤30 grams, including shorter operating time, reduced transfusion requirements, lower irrigation fluid volumes, and decreased postoperative urinary infections 2
• Bladder neck incision (single incision technique) shows shorter catheter stay, less infection, significantly reduced transfusion needs, and satisfactory control with minimal need for further surgery 3
• Both techniques are technically simpler than full TURP and easier to teach 3

When Endoscopic Approaches Fail

For refractory bladder neck contracture that fails repeated endoscopic treatment, proceed to open or laparoscopic reconstructive surgery. 4, 5

Reconstructive options include:

• Extraperitoneal laparoscopic modified Y-V plasty: Provides adequate surgical exposure through extraperitoneal access, uses absorbable barbed sutures for faster anastomosis with reduced leakage, and offers superior post-surgical recovery compared to open approaches 4
• Open Y-V plasty: Traditional approach but with poorer exposure and greater invasiveness 4
• Thermo-expandable metal stents (Memokath 045): May serve as a durable option for complicated cases, with documented success at 21 months follow-up 6

Common Pitfalls to Avoid

• Do not persist with repeated endoscopic procedures indefinitely—after 2-3 failed attempts, transition to reconstructive surgery rather than continuing the same approach 5
• Avoid underestimating the complexity of post-radiation bladder neck contractures, which require more aggressive treatment strategies 5
• Do not perform bladder neck procedures without ensuring the patient can reliably empty their bladder postoperatively—consider concomitant catheterizable channel creation if self-catheterization will be required 1