Secondary sclerosis of the bladder neck, first described in 1958 by DANSLOW, is defined as a fibrous scarring of the bladder neck following endoscopic treatment or open surgery for benign prostatic hyperplasia [1] [2] . Secondary sclerosis of bladder neck is a well-described complication that may occur following the surgical treatment of benign and malignant prostate conditions. Unfortunately, secondary sclerosis of bladder neck, recurrence after treatment is a common problem even though many series report early success [1] . Synonymous with vesicourethral stenosis, sclerosis of bladder neck can range in complexity from simple, short, annular contractures to obliterative stenoses refractory to repeated treatments. It is a rare late complication but is serious because it is obstructive, recurrent and progressive. Its treatment is essentially endoscopic [3] [4] , but since the introduction of endoscopic surgery into the therapeutic arsenal in Côte d’Ivoire, this minimally invasive technique has been used in our practices in Bouaké since 2020. In other words, 40 years after its introduction.

We conducted a primary study with the aim of reporting our results of endoscopic management of secondary sclerosis of the bladder neck in a series of 23 cases.

We conducted a cross-sectional study from 1 January 2021 to 1 December 2022. Twenty-three patients with a mean age of 61.7 years, ranging from 53 to 76 years, presenting with secondary sclerosis of the bladder neck were treated by endoscopic resection of the sclerosis. Diagnosis was based on clinical and radiological data. All patients with secondary sclerosis of the bladder neck and operated on by endoscopic resection were included in our research work, those with primary or congenital sclerosis or patients operated on by conventional surgery were not included in our study. The data was collected on a survey sheet including the different parameters studied. The parameters studied were time to onset of signs, clinical data, results of urine cytobacteriological examination (UCAE), results of retrograde uretrocystography (RUC), endoscopic procedure performed, duration of the operation, duration of postoperative urinary drainage, duration of hospitalisation, postoperative follow-up and morbidity and mortality. The data collected was entered using the word software. The data analysis was done using the Epi Info 7 software.

Secondary sclerosis of the bladder neck is a rare late complication of endoscopic or surgical treatment of benign prostatic hyperplasia (BPH), due to excessive fibrous scarring of the prostatic lodge, transforming it into a stenosing fibrous block. It is a rare complication of surgery for benign prostatic hyperplasia, the frequency varying in the literature from 0.78% according to MOUDOUNI [4] to 2.8% according to HERRANDO [5] . The average age of patients reported in the literature is well above fifty [1] [2] [3] [6] . These results show that secondary sclerosis of the bladder neck is a disease of the elderly.

Secondary sclerosis of the bladder neck is a pathology that occurs after open or endoscopic surgery for benign prostatic hyperplasia [3] [4] . For some authors, such as SATAA [1] , sclerosis of the bladder neck occurs early after transurethral resection of the prostate. In our series, the sclerosis occurred after high approach adenomectomy, since all the patients in our series had only undergone open surgery for the treatment of benign prostatic hyperplasia.

In our study, clinical symptoms were dominated by dysuria (73.9%). This finding has been reported by SATAA [1] , ANTAOUI [7] and DESCAZEAUD [8] . The high frequency of obstructive disorders of the lower urinary tract confirms the obstructive nature of fibrous scarring of the bladder neck after prostatic adenomectomy. The time to onset of signs after prostatic adenomectomy was 35 months, with extremes of 30 and 39 months. This result is similar to that of SATAA [1] who, in his study of secondary sclerosis of the bladder neck after surgical or endoscopic treatment of benign prostatic hyperplasia, reported a mean time to onset of signs of 46.5 months. These results support the view that secondary sclerosis of the bladder neck is a late complication of adenomectomy.

From a diagnostic point of view, retrograde uretrocystography (RUC) with voiding films was used to diagnose secondary sclerosis of the bladder neck in all our patients. The typical steam jet image was found in 69.6% of cases. UCR also revealed complications of secondary sclerosis of the bladder neck. These complications were dominated by dilatation of the upper urinary tract in the form of ureterohydronephrosis in 47.8% of cases. Our results corroborate those reported in the literature [1] [2] [3] . However, the occurrence of complications in our patients could be explained by the delay in consultation on the one hand and by the long evolution of sclerosis after prostatic adenomectomy on the other.

The post-micturition residue was greater than 150 ml in 73.9% of patients, and the cytobacteriological study of urine found a urinary infection in 17.4%. Urethral stricture was present in 13% of patients and bladder lithiasis in 8.7%. Urinary tract infection and bladder lithiasis in our series could be explained by the presence of significant post-micturition residue in our patients, which more often than not constitutes a germ culture medium, and also by the proliferation of certain so-called ureasic germs, a source of bladder lithiasis formation. Urethral stenosis associated with secondary sclerosis of the cervix could be explained by the relatively long period spent wearing a urinary catheter after adenomectomy.

In our work, the average duration of the procedure was 53 minutes, with extremes of 43 and 60 minutes. Our results corroborate those reported in the literature [6] [9] . The mean duration of postoperative urinary drainage was 3 days, with extremes of 2 to 5 days. The average length of hospitalisation in our series was 5.4 days, ranging from 3 to 7 days. Our length of stay is longer than that reported in the literature [1] [6] [9] [10] . During the post-operative follow-up period, retrograde uretrocystography (RUC) performed at 3 and 6 months showed good patency of the bladder neck and urethra, with a post-void residual of less than 30 ml.

We noted no recurrence or complication such as urinary incontinence. Our results corroborate those of MARTOV, who reported a 97% success rate without recurrence or complication. However, other authors such as SATAA have reported 27% recurrence and three (3) urinary incontinences [1] [11] [12] . The limit of this study is in the size of the sampling, however it could be understandable since it is an inaugural study. Further studies with more significant series will come to compare our results.

Secondary sclerosis of the bladder neck following prostatic adenomectomy is a late but serious complication due to its obstructive and recurrent nature. The best treatment is endoscopic resection, which has produced satisfactory results in our study. It must be diagnosed early in order to avoid serious complications affecting the upper urinary tract.

AVION Kouassi Patrice, AKASSIMADOU N’diamoi, AGUIA Brice: Statistical analysis and re-reading of the article as well as its drafting.

ZOUAN Freddy, ALLOKA Venance, KAMARA Sadia, DJE Koffi: Documentary research and editing.

We protected the confidentiality of the information collected during the survey. An anonymity number was assigned to each survey form, with authorisation obtained from the administrative and health authorities.

The authors declare that they have no conflicts of interest.

Avion, K.P., Akassimadou, N., Aguia, B., Zouan, F., Alloka, V., Kamara, S. and Dje, K. (2023) Endoscopic Management of Secondary Sclerosis of the Bladder Neck in Bouaké: Our Experience with 23 Cases. Open Journal of Urology, 13, 251-258. https://doi.org/10.4236/oju.2023.137029