Outcomes of the prevention and treatment of bladder neck contracture, with complication severity assessed using the Clavien-Dindo classification

Bladder neck contracture is one of the most common complications following surgical treatment of benign prostatic hyperplasia. It impairs lower urinary tract urodynamics and carries a high risk of repeat surgery. This study aimed to improve the outcomes of the prevention and treatment of bladder neck contracture, with the severity of postoperative complications assessed using an adapted Clavien-Dindo classification. The study included 106 patients with bladder neck contracture who underwent surgery between 2020 and 2025. The main group comprised 56 patients who received local postoperative administration of Longidaza® according to the protocol developed by the authors, while the control group included 50 patients who received the drug intramuscularly. The effectiveness of prevention and treatment was evaluated using urodynamic and instrumental examinations and by assessing the severity of postoperative complications according to the Clavien-Dindo classification adapted for the surgical treatment of bladder neck contracture. Treatment was effective in 92.9% of patients in the main group and 66.0% of those in the control group, while recurrence rates were 7.1% and 34.0%, respectively. During the first postoperative month, bladder function improved relative to preoperative values in both groups, with statistically significant differences also observed between the groups (p < 0.05). At one year, the maximum urinary flow rate (Qmax) reached 22.45 ± 2.78 mL/s in the main group, compared with 15.62 ± 1.54 mL/s in the control group. Residual urine volume decreased to 20.02 ± 8.48 mL and 70.34 ± 11.25 mL, respectively. Postoperative complications corresponded to Grades I-III of the adapted Clavien-Dindo classification; no Grade IV or V complications were recorded. In 44.3% of cases, postoperative complications were classified as minor and were managed conservatively; 36.2% of these cases occurred in the main group and 63.8% in the control group. Disease recurrence was confirmed in 19.8% of cases and required repeat surgery; 19.0% of recurrent cases occurred in the main group and 81.0% in the control group. When recurrent bladder neck contracture was diagnosed, repeat surgery was performed between six months and one year after the initial procedure. Treatment consisted of transurethral resection followed by local and intramuscular administration of the antifibrotic agent according to the protocol developed by the authors. No further recurrence was recorded during the subsequent 6-12 months