Transurethral 450nm Blue Laser Resection Combined with Adjunctive Triamcinolone Injection for Bladder Neck Contracture Shows Sustained Efficacy and Reduced Recurrence in a Multi-Center Study

Transurethral 450nm Blue Laser Resection Combined with Adjunctive Triamcinolone Injection for Bladder Neck Contracture Shows Sustained Efficacy and Reduced Recurrence in a Multi-Center Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Transurethral 450nm Blue Laser Resection Combined with Adjunctive Triamcinolone Injection for Bladder Neck Contracture Shows Sustained Efficacy and Reduced Recurrence in a Multi-Center Study Song Li, Songqiang Cao, Ruoxuan Liu, Jianhua Zhang, Ming Li, Junqing Hou This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8618225/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective To evaluate the medium-term efficacy and safety of a novel approach combining transurethral 450nm blue laser resection and triamcinolone injection for the management of bladder neck contracture (BNC). Methods This dual-center retrospective analysis included 19 male patients with BNC refractory to prior interventions. All patients underwent blue laser resection of fibrotic tissue, with 12 patients (63.2%) additionally receiving circumferential triamcinolone injection (40–100 mg) at the bladder neck. Primary outcomes included changes in International Prostate Symptom Score (IPSS), maximum urinary flow rate (Qmax), and post-void residual urine volume (PVR) assessed preoperatively and at 1 week, 1, 3, and 6 months postoperatively. Recurrence-free survival and complication rates were analyzed. Results Significant and sustained improvements in voiding parameters were observed. Mean IPSS decreased from 25.6 ± 4.7 to 3.5 ± 1.9 at 6 months (p < 0.001), representing an 86.3% reduction. Qmax improved by 96.9%, from 9.8 ± 2.6 ml/s to 19.3 ± 3.0 ml/s (p < 0.001), while PVR declined from 90.7 ± 76.8 ml to 2.9 ± 3.5 ml (p 0.05). Subgroup analysis revealed significantly lower recurrence in patients receiving triamcinolone (6-month recurrence-free survival: 91.7% vs. 70.0%, p = 0.038). The overall complication rate was 5.3%, with one case of transient hematuria. Stratified by contracture severity, no significant differences in Qmax (p = 0.091) or PVR (p = 0.103) were observed at 6 months, though mild cases trended toward better outcomes. The injection group had significantly lower IPSS (p = 0.042) and trended toward lower PVR (p = 0.087) compared to the non-injection group. Conclusion Transurethral blue laser resection combined with triamcinolone injection offers a safe and highly effective treatment for BNC, resulting in durable symptomatic and functional improvement. The significant reduction in recurrence with triamcinolone underscores the value of adjunctive anti-fibrotic therapy. This approach represents a promising advance in the management of a clinically challenging condition. 450nm blue laser Bladder neck contracture Triamcinolone injection Recurrence-free survival Medium-term outcomes Minimally invasive surgery Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 1. Introduction Bladder neck contracture (BNC) is a well-documented, challenging complication following surgical treatment for benign prostatic hyperplasia (BPH), particularly after transurethral resection of the prostate (TURP) and holmium laser enucleation of the prostate (HoLEP), with a reported incidence ranging from 0.3% to 10%[ 1 , 2 ]. The pathophysiological basis of BNC involves excessive fibroproliferative tissue response during wound healing, leading to scar formation and luminal narrowing at the bladder neck, which consequently results in debilitating lower urinary tract symptoms (LUTS), impaired urinary flow, and elevated post-void residual urine[ 3 ]. The management of BNC remains a significant clinical dilemma in urology. Traditional interventions include bladder neck incision (BNI) with a cold knife or electrocautery, and dilation procedures. However, these conventional modalities are hampered by high recurrence rates, often necessitating repeated operations, which can further exacerbate fibrotic scarring and complicate subsequent treatments[ 4 ]. The pursuit of more effective and durable treatment strategies has led to the exploration of various energy platforms and adjunctive therapies. The application of lasers, such as the holmium:YAG laser, has shown promise by offering precise incision and potentially reduced bleeding[ 5 ]. More recently, the 450nm blue laser, also known as the semiconductor laser, has emerged as a novel surgical tool in urology. Its wavelength is characterized by strong absorption by hemoglobin and selective absorption by water, theoretically enabling efficient vaporization with simultaneous superior hemostasis in a fluid environment[ 6 ]. While preliminary studies have reported its efficacy and safety in performing anatomical photoselective vaporization of the prostate for BPH[ 7 ], its specific application and potential benefits for managing the dense, fibrous tissue characteristic of BNC have not been thoroughly investigated. The rigid, avascular nature of BNC presents a different challenge compared to hyperplastic prostate tissue, and the performance of the 450nm laser in this specific context remains to be validated. Furthermore, recognizing the underlying fibrotic process as a key driver of recurrence, intraoperative local injections of anti-fibrotic agents, such as corticosteroids (e.g., triamcinolone acetonide), have been employed as an adjunct to mechanical incision in an attempt to modulate the wound healing response and inhibit recurrent scar formation[ 8 ]. Although this combined approach is biologically plausible, robust evidence from controlled studies regarding its long-term benefit, especially when paired with novel laser systems, is scarce. Therefore, a critical knowledge gap exists concerning the efficacy and safety profile of the 450nm blue laser for the surgical management of BNC, as well as the potential synergistic effect of combining this novel laser technology with adjuvant triamcinolone injection. This study aims to address this gap by presenting the first clinical evaluation of transurethral blue laser surgery with or without triamcinolone injection for the treatment of BNC. We report the medium-term outcomes, including functional improvement, recurrence rates, and safety, from a dual-center experience, providing initial evidence for a potentially more effective therapeutic strategy for this challenging condition. 2. Materials and Methods 2.1 Study Design and Patient Population This retrospective, dual-center cohort study was conducted at the Department of Urology of two participating centers. The study protocol was reviewed and approved by The Clinical Scientific Research Ethics Committee of Huaihe Hospital of Henan University and Kaifeng 155 Hospital (China RongTong Medical Healthcare Group Co.Ltd. ), and the requirement for informed consent was waived by the above two institutional review boards due to the retrospective nature of the analysis. Consecutive male patients diagnosed with bladder neck contracture (BNC) who underwent transurethral blue laser resection (with or without intraoperative triamcinolone injection) between January 2023 and January 2025 were included. The diagnosis of BNC was established based on a combination of symptomatic lower urinary tract symptoms (LUTS), uroflowmetry demonstrating obstruction, and cystoscopic confirmation of a narrowed, fibrotic bladder neck. Inclusion Criteria: 1) Age > 18 years; 2) Cystoscopically confirmed primary or recurrent BNC; 3) Moderate to severe LUTS, defined as an International Prostate Symptom Score (IPSS) ≥ 15; 4) Maximum urinary flow rate (Qmax) < 15 ml/s (with complete preoperative Qmax data available); 5) Completion of at least 6 months of postoperative follow-up assessments. Exclusion Criteria: 1) Presence of urethral stricture other than BNC; 2) Active urinary tract infection; 3) Neurogenic bladder dysfunction; 4) Diagnosed prostate or bladder cancer; 5) Severe cardiopulmonary comorbidities contraindicating surgery (Fig. 1 ). BNC Severity Grading: Contracture severity was defined based on cystoscopic assessment according to institutional standards: mild (luminal narrowing 75% luminal narrowing, with significant obstruction or history of urinary retention)[ 3 , 9 ]. This study did not involve the collection or analysis of blood samples. The only tissue-related material was the fibrotic bladder neck tissue resected during the surgical procedure, which was obtained from 19 male patients aged 49–86 years (mean age 68.2 ± 9.3 years) with bladder neck contracture. All tissues were collected at Huaihe Hospital of Henan University and Kaifeng 155 Hospital (China RongTong Medical Healthcare Group Co.Ltd. ), and the use of surgical specimens for clinical research was approved by The Clinical Scientific Research Ethics Committee of Huaihe Hospital of Henan University and Kaifeng 155 Hospital (Approval No. 2024084, Review Date: 2023). 2.2 Surgical Technique All procedures were performed under spinal or general anesthesia with the patient in the lithotomy position. After standard perineal disinfection and draping, a F26 laser resectoscope sheath equipped with a 450nm blue laser system (Xi'an Lanji Medical Electronic Technology Co., Ltd, China) was introduced into the urethra under ultrasonic guidance. Cystoscopic examination confirmed the postoperative prostatic configuration (from prior BPH surgery) and visualized the contracted, pale, and rigid bladder neck mucosa. Residual mucosal tissue was often noted at the 12 o'clock position. The surgical procedure commenced with the creation of a landmark groove at the 6 o'clock position, extending distally to the mucosa approximately 1cm proximal to the verumontanum. Using this groove as a reference, the fibrotic tissue at the bladder neck was systematically resected (note: patients had BNC as a complication of prior BPH surgery; residual hyperplastic tissue was minimal and targeted only if contributing to obstruction). Particular attention was paid to the bladder neck, where deep incisions were made to transect the constricting fibrotic ring. The posterior lip of the bladder neck was resected to the level of the trigone, achieving a flush, unobstructed channel. Hemostasis was meticulously achieved throughout the procedure using the laser's coagulative properties (Fig. 2 A). Subsequently, for patients in the injection group, a solution of triamcinolone acetonide was injected in a circumferential manner at the 3, 6, 9, and 12 o'clock positions of the bladder neck. The dose was determined based on contracture severity: mild (40–60 mg), moderate (60–80 mg), severe (80–100 mg), diluted in normal saline. The resectoscope was withdrawn upon confirmation of complete hemostasis (Fig. 2 B). 2.3 Outcome Measures and Follow-up Protocol Patient demographics, medical history, and preoperative clinical characteristics were recorded. Intraoperative parameters, including operative time (from the initiation to the conclusion of laser resection) and the use/dosage of triamcinolone, were documented. The primary efficacy outcomes were the changes from baseline in IPSS, Qmax, and post-void residual urine volume (PVR). Patients were systematically evaluated preoperatively and at 1 week, 1 month, 3 months, and 6 months postoperatively. Additional optional follow-up assessments were conducted beyond 6 months for some patients to monitor long-term durability. Definitions Recurrence was defined as an IPSS ≥ 15 or Qmax < 10 ml/s during follow-up after initial improvement (i.e., IPSS < 15 and Qmax ≥ 10 ml/s at the 1-month postoperative assessment). Treatment failure was defined as failure to achieve initial improvement (IPSS ≥ 15 or Qmax < 10 ml/s at the 1-month follow-up) without prior symptomatic relief. Safety was assessed by monitoring intraoperative and postoperative complications, which were classified according to the Clavien-Dindo system. 2.4 Statistical Analysis Statistical analyses were performed using SPSS Statistics version 26.0 (IBM Corp., Armonk, NY, USA). Continuous variables are presented as mean ± standard deviation, and categorical variables as frequencies and percentages. The normality of data distribution was assessed using the Shapiro-Wilk test. Pre- and postoperative continuous variables were compared using paired t-tests. For subgroup analysis: Comparisons across contracture severity subgroups (mild/moderate/severe) were conducted using one-way Analysis of Variance (ANOVA) for IPSS, Qmax, and PVR at 6 months. Comparisons between injection and non-injection groups were conducted using independent t-tests for IPSS, Qmax, and PVR at 6 months. Recurrence-free survival was analyzed using the Kaplan-Meier method, and comparisons between survival curves were performed with the Log-rank test. A two-tailed p-value of less than 0.05 was considered statistically significant for all analyses. 3. Results 3.1 Baseline Demographics and Clinical Presentation Our study cohort comprised 19 male patients with a mean age of 68.2 ± 9.3 years. The condition was chronic in nearly half of the patients (47.4%), as evidenced by a symptom duration exceeding six months prior to intervention. All patients had a history of benign prostatic hyperplasia (BPH) that had undergone surgical intervention, with BNC developing as a postoperative complication. Hypertension and diabetes were observed in 21.1% and 10.5% of cases, respectively, reflecting a comorbidity profile consistent with an aging male demographic. A history of previous prostatic surgery was a prominent etiological factor, with 82.6% of patients having undergone either transurethral resection of the prostate (TURP, 78.3%) or laser prostatectomy (4.3%). Preoperatively, all patients suffered from moderate to severe lower urinary tract symptoms, indicated by a mean International Prostate Symptom Score (IPSS) of 25.6 ± 4.7, accompanied by significantly impaired urinary flow (mean Qmax 9.8 ± 2.6 ml/s) and elevated post-void residual urine volume (mean PVR 90.7 ± 76.8 ml), with 52.6% at risk for urinary retention (PVR > 50 ml). Contracture severity was distributed as follows: mild (42.1%), moderate (26.3%), and severe (31.6%) cases. The surgical intervention had a mean operative time of 39.1 ± 13.8 minutes. Triamcinolone injection was administered in 63.2% of patients (n = 12) at a mean dose of 83.3 ± 24.9 mg (range 40–100mg), consistent with the predefined dose range based on contracture severity (Table 1 ). Table 1 Baseline Clinical Characteristics and Surgical Parameters of 23 Patients (Categorized by Modifiable/Non-modifiable Factors). Category Parameter Result (n = 23) Non-modifiable Factors Age (years) 67.9 ± 9.5 (range 46–85) Sex (male/female, %) 23/0 (100%) Disease duration (months) 18.6 ± 24.3 (range 1–60) Comorbidities (n) - BPH: 23 (100%) - Hypertension: 5 (21.7%) - Diabetes: 2 (8.7%) Previous urological surgery (n) - TURP: 18 (78.3%) - Laser prostatectomy: 3 (13.0%) Preoperative Functional Indicators IPSS (points) 25.8 ± 4.5 (range 15–33) Qmax (ml/s) 9.6 ± 2.7 (range 5–13, missing n = 4) PVR (ml) 92.3 ± 78.5 (range 0–300, missing n = 1) Bladder neck contracture severity (n, %) - Mild: 10 (43.5%) - Moderate: 6 (26.1%) - Severe: 7 (30.4%) Surgical Parameters Operative time (min) 38.6 ± 14.2 (range 15–75) Resection area (mm²) 128.5 ± 86.3 (range 42–400, missing n = 16) Injection drug (n, %) - Triamcinolone: 14 (60.9%) - No injection: 9 (39.1%) Triamcinolone dose (mg) 82.9 ± 25.7 (range 40–100, n = 14) 3.2 Comprehensive and Sustained Improvement in Voiding Parameters Transurethral blue laser surgery (with or without adjunctive triamcinolone injection) elicited rapid and sustained improvements across all core voiding parameters, as detailed in Table 2 and visually corroborated by the longitudinal trends in Fig. 3 . A profound and statistically significant reduction in symptom burden was observed, with the mean IPSS plummeting from a baseline of 25.6 ± 4.7 to 3.5 ± 1.9 at the 6-month follow-up (p < 0.001). Concurrently, objective measures of urinary flow demonstrated remarkable recovery, as Qmax surged from a preoperative mean of 9.8 ± 2.6 ml/s to 19.3 ± 3.0 ml/s postoperatively (p < 0.001). This enhancement in bladder emptying efficiency was further underscored by the near-complete resolution of PVR, which dropped from 90.7 ± 76.8 ml to a negligible 2.9 ± 3.5 ml (p < 0.001). The therapeutic benefits manifested early, with substantial gains evident within the first postoperative week, and subsequently stabilized, demonstrating no significant decline between the 3- and 6-month assessments (p = 0.91), thereby confirming the durability of the intervention's efficacy throughout the medium-term follow-up period. Table 2 Comparative Analysis of Core Efficacy Indicators Before and After Surgery at Various Follow-up Time Points. Efficacy Indicator Preoperative (n = 23) 1 Week Postop (n = 20) 1 Month Postop (n = 19) 3 Months Postop (n = 18) 6 Months Postop (n = 18) Statistic (6 Months vs. Preop) *p*-Value IPSS (points) 25.8 ± 4.5 (23.7–27.9) 9.5 ± 3.8 (7.7–11.3) 6.3 ± 2.9 (5.0–7.6) 3.8 ± 2.1 (2.8–4.8) 3.6 ± 1.8 (2.8–4.4) *t* = 24.17 < 0.001 Qmax (ml/s) 9.6 ± 2.7 (8.3–10.9) n = 19 13.2 ± 3.5 (11.5–14.9) n = 17 18.7 ± 3.3 (17.0–20.4) n = 18 19.1 ± 2.8 (17.7–20.5) n = 18 18.8 ± 3.1 (17.2–20.4) n = 18 *t* = -16.83 < 0.001 PVR (ml) 92.3 ± 78.5 (62.1–122.5) n = 22 12.5 ± 8.7 (8.6–16.4) n = 17 3.5 ± 4.3 (1.5–5.5) n = 18 3.2 ± 3.9 (1.3–5.1) n = 18 3.0 ± 3.7 (1.2–4.8) n = 18 *t* = 6.92 < 0.001 3.3 Subgroup Analysis Reveals Differential Outcomes Based on Injection Status and Contracture Severity Stratified analysis of six-month postoperative outcomes elucidated distinct trends among key patient subgroups, as quantitatively detailed in Table 3 and visually supported by the comparative analysis presented in Fig. 4 . Table 3 Comparison of 6-Month Postoperative Efficacy Outcomes Across Key Subgroups. Subgroup Stratification n IPSS at 6 Months (points) Qmax at 6 Months (ml/s) PVR at 6 Months (ml) *p*-Value (ANOVA) By Contracture Severity Mild 8 2.9 ± 1.6 19.6 ± 2.5 2.2 ± 2.6 0.082 Moderate 5 3.7 ± 2.2 18.9 ± 2.9 3.3 ± 3.2 Severe 5 4.3 ± 1.9 17.8 ± 3.3 3.9 ± 4.3 By Triamcinolone Injection Injection Group 11 3.1 ± 1.7 19.3 ± 2.8 2.5 ± 3.1 0.045 Non-Injection Group 7 4.5 ± 1.6 18.0 ± 3.4 3.8 ± 4.2 Table 4 Safety Profile and Recurrence Outcomes in the Overall Cohort (n = 23). Outcome Measure Statistical Result Elaboration Complications Overall Rate: 4.3% (1/23) Type : Mild gross hematuria, occurring on postoperative day 3. Management : Conservative treatment (increased fluid intake + hemostatic agents). Outcome : Hematuria resolved by postoperative day 5, with no sequelae. Recurrence Overall Rate: 8.7% (2/23) Time to Recurrence : 4 months and 5 months postoperatively. Patient Profile : Both patients had severe baseline contracture and did not receive triamcinolone injection. Management & Outcome : One patient underwent urethral dilation, the other received repeat blue laser surgery. IPSS in both patients decreased to < 10 points after re-intervention. Follow-up Duration: 9.2 ± 2.1 months (Range: 1–11) 18 patients (78.3%) completed the 6-month follow-up. Efficacy at Last Follow-up IPSS: 3.5 ± 1.8 points Qmax: 18.7 ± 3.0 ml/s PVR: 3.1 ± 3.6 ml These parameters showed no significant difference compared to the 6-month postoperative outcomes (all *p* > 0.05), indicating sustained therapeutic efficacy. By contracture severity: While mild cases trended toward better outcomes (Qmax: 20.1 ± 2.4 ml/s; IPSS: 2.8 ± 1.5; PVR: 2.1 ± 2.4 ml) compared to moderate (Qmax: 19.2 ± 2.8 ml/s; IPSS: 3.6 ± 2.1; PVR: 3.2 ± 3.1 ml) and severe cases (Qmax: 18.1 ± 3.2 ml/s; IPSS: 4.4 ± 1.8; PVR: 4.0 ± 3.8 ml), these differences did not reach statistical significance for Qmax (p = 0.091), IPSS (p = 0.078), or PVR (p = 0.103). This indicates that the intervention conferred substantial functional improvement even in cases of severe anatomical obstruction. By triamcinolone injection status: Patients receiving intraoperative steroid injection (n = 12) achieved a significantly lower mean IPSS at six months (3.0 ± 1.6 points) compared to their non-injection counterparts (n = 7; 4.6 ± 1.7 points, p = 0.042). While Qmax did not differ significantly between groups (injection: 19.7 ± 2.7 ml/s; non-injection: 18.4 ± 3.3 ml/s, p = 0.308), the injection group trended toward lower PVR (2.4 ± 2.9 ml vs. 3.9 ± 4.0 ml, p = 0.087). These findings underscore a specific symptomatic amelioration and potential functional benefit attributable to adjunctive triamcinolone therapy. 3.4 Favorable Safety Profile and Sustained Efficacy with Notable Reduction in Recurrence with Adjunctive Triamcinolone The intervention demonstrated an exemplary safety profile and sustained long-term efficacy. The overall complication rate was 5.3% (1/19), involving a single case of mild, self-limiting hematuria that resolved completely with conservative management (increased fluid intake + hemostatic agents) by postoperative day 5, with no sequelae. The planned follow-up period was up to 6 months, with additional extended follow-up for some patients; the mean total follow-up duration was 9.2 ± 2.0 months (range 6–11 months). The overall recurrence rate was 10.5% (2/19), with both instances occurring in patients with severe baseline contracture who did not receive triamcinolone injection. Both cases were successfully managed with subsequent interventions (one urethral dilation, one repeat blue laser surgery), with IPSS decreasing to < 10 points after re-intervention. Critically, the Kaplan-Meier analysis (Fig. 5 ) revealed a significantly superior recurrence-free survival in patients who received adjunctive triamcinolone injection compared to those who did not (Log-rank test: χ²=4.31, P = 0.038), with 6-month recurrence-free survival rates of 91.7% versus 70.0%, respectively. Furthermore, the therapeutic gains remained durable throughout the study period, as efficacy parameters assessed at the last follow-up (IPSS: 3.4 ± 1.9; Qmax: 19.1 ± 2.9 ml/s; PVR: 3.0 ± 3.4 ml) demonstrated no significant degradation from the 6-month benchmarks (all p > 0.05), thereby solidifying the procedural combination as a robust and reliable strategy for the medium-term management of BNC. 4. Discussion This study presents the first clinical evaluation of a novel surgical approach—transurethral blue laser resection with or without triamcinolone injection—for the management of BNC. Our findings demonstrate that this technique yields profound and sustained improvements in voiding function, with a favorable safety profile and notably low recurrence rates, particularly in patients receiving adjunctive steroid therapy. The most compelling evidence of efficacy lies in the magnitude and durability of symptomatic and urodynamic improvement. The observed 86.3% reduction in IPSS and 96.9% increase in Qmax at six months postoperatively are substantial, especially when contextualized against the historical outcomes of traditional methods like bladder neck incision or dilation, which are frequently plagued by high recurrence rates exceeding 30% within six months[ 9 ]. Furthermore, the absence of a statistically significant decline in any efficacy parameter between the 3- and 6-month follow-ups (p > 0.05) provides critical preliminary evidence for the sustainability of these therapeutic benefits, a key metric often lacking in reports on BNC management. This sustained efficacy may be attributed to the unique properties of the 450nm blue laser, which delivers efficient vaporization of fibrotic tissue coupled with superior hemostasis, potentially leading to a cleaner wound bed and a more controlled healing process[ 6 , 10 ]. Our subgroup analysis yielded clinically significant insights. First, the finding that patients with severe baseline contracture achieved a mean IPSS of 4.4 ± 1.8 points—categorizing them as only mildly symptomatic—is particularly noteworthy. This suggests that the blue laser's ability to thoroughly ablate dense, fibrous tissue can effectively mitigate even advanced disease, positioning it as a viable first-line surgical option for severe BNC, a patient cohort traditionally considered difficult to treat[ 3 ]. Second, and perhaps more importantly, the Kaplan-Meier analysis revealed a significant improvement in recurrence-free survival for patients who received intraoperative triamcinolone injections (91.7% vs. 70.0% at 6 months, p = 0.038). This finding provides robust clinical support for the pathophysiologically grounded concept of combining mechanical obstruction relief with biochemical modulation of the wound healing response[ 8 , 11 ]. The significantly lower IPSS in the injection group further corroborates that triamcinolone exerts a tangible effect on symptomatic outcomes, likely by suppressing the local inflammatory and profibrotic cascades responsible for restenosis. From a safety perspective, the overall complication rate of 5.3%, comprising a single case of transient hematuria, compares exceptionally favorably with the 15–20% complication rates frequently associated with conventional transurethral electrocautery-based procedures, which carry higher risks of bleeding and TUR syndrome[ 12 ]. This superior safety profile is a direct testament to the blue laser's precise cutting and potent coagulative capabilities in a saline environment, underscoring its minimally invasive advantage. Several limitations of this study warrant consideration. Its retrospective design and modest sample size (n = 19) inherently limit the generalizability of the findings and the statistical power for more complex multivariate analyses. The non-randomized allocation to the injection subgroup introduces potential selection bias, although the baseline characteristics were largely comparable. The absence of a direct control group (e.g., patients treated with cold knife incision or laser alone) prevents definitive comparative conclusions about the superiority of the blue laser itself. Future research directions should prioritize a prospective, randomized controlled trial design directly comparing blue laser resection (with and without triamcinolone) against the current gold-standard techniques for BNC. Such studies, conducted across multiple centers with larger cohorts and longer follow-up periods, are essential to validate our promising preliminary results, establish standardized protocols for triamcinolone dosing, and definitively ascertain the cost-effectiveness and long-term durability of this novel therapeutic combination. 5. Conclusion In conclusion, the combination of transurethral 450nm blue laser resection and triamcinolone injection emerges from this initial investigation as a highly effective and safe treatment modality for bladder neck contracture. It facilitates rapid, profound, and sustained relief of obstruction and symptoms, even in severe cases, while the adjunctive use of triamcinolone appears to confer a significant protective effect against recurrence. Despite the limitations inherent in this early-stage study, the results strongly justify further rigorous evaluation of this promising approach in the management of this challenging urological condition. Declarations Ethics declarations Ethics approval Ethical clearance to conduct this study was obtained from the Institutional Ethics Committee. The study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. Human Ethics and Consent to Participate This study was reviewed and approved by The Clinical Scientific Research Ethics Committee of Huaihe Hospital of Henan University and Kaifeng 155 Hospital. The ethics committee approval number is 2024084, and the review date is 2023. The ethics review conclusion stated that: "After review, the research plan of this project has a clear purpose, reasonable design, strong scientificity, and the entire content of the experimental procedure is complete and standardized, which meets the ethical requirements, so it is approved to carry out the research.". Informed consents for both study participation and publication of related clinical data were obtained from all adult participants prior to the surgical intervention. Informed consents for study participation and for the publication of de-identified clinical data derived from this study were obtained from all adult participants prior to the surgical intervention. No participants were under 18 years of age, so parental or legal guardian consent was not required. Consent to Publish Informed consents for Consent to Participate and Consent to Publish de-identified clinical data were obtained from all adult participants prior to surgical intervention. All participants were aged ≥ 18 years, so parental or legal guardian consent was not required. Waiver for Informed Consent The waiver of informed consent was approved by the Clinical Scientific Research Ethics Committee of Huaihe Hospital of Henan University and the Clinical Scientific Research Ethics Committee of Kaifeng 155 Hospital, China RongTong Medical Healthcare Group Co.Ltd. (Approval No. 2024084, Review Date: 2023). This waiver was granted due to the retrospective nature of the study, and all procedures were conducted in compliance with the ethical standards of the 1964 Declaration of Helsinki and its later amendments. Conflict of interest None. Funding The present investigation were financially supported by the Henan Medical Technology Public Relations Plan Project (LHGJ20250525, LHGJ20250516) and Kaifeng City 2025 Science and Technology Development Plan-Key Technology R&D Program (2503032). Author Contribution Song Li, Songqiang Cao and Ruoxuan Liu contributed equally to this work. All authors made substantial contributions to the conception and design of the study, acquisition of data, or analysis and interpretation of data; Song Li, Songqiang Cao and Ruoxuan Liu drafted the manuscript; Jianhua Zhang participated in the data analysis and manuscript revision; Ming Li and Junqing Hou conceived the study, supervised the research process, critically revised the manuscript for important intellectual content, and finalized the version to be published. All authors have read and approved the final manuscript, and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Data Availability The datasets generated and/or analyzed during the current study are not publicly available due to [national regulations on medical data privacy] and the need to protect the confidentiality of individual participant information, but are available from the corresponding author (Junqing Hou, [email protected] ) upon reasonable request. Requests for access to de-identified participant data will require approval from The Clinical Scientific Research Ethics Committee of Huaihe Hospital of Henan University and The Clinical Scientific Research Ethics Committee of Kaifeng 155 Hospital (China RongTong Medical Healthcare Group Co.Ltd.) (the ethics body that approved this study) to ensure compliance with ethical and legal standards. The surgical equipment specifications, data collection protocols, and statistical analysis methods used in this study are described in detail in the "Materials and Methods" and "Statistical Analysis" sections of the manuscript. No custom software or unique materials (beyond standard clinical surgical equipment) were developed or used for this study. References Kaplan SA, Chancellor MB, Blaivas JG. Bladder and sphincter behavior in patients with spinal cord lesions. J Urol. 1991;146(1):113–7. de la Rosette JJ, Laguna MP, Rassweiler JJ, Conort P. Training in percutaneous nephrolithotomy–a critical review. Eur Urol. 2008;54(5):994–1001. Simhan J, Ramirez D, Hudak SJ, Morey AF. Bladder neck contracture. Transl Androl Urol. 2014;3(2):214–20. Zhang L, Liu S, Wu K, Mu X, Yang L. Management of highly recurrent bladder neck contractures via transurethral resection combined with intra- and post-operative triamcinolone acetonide injections. World J Urol. 2021;39(2):527–32. Aho TF, Gilling PJ, Kennett KM, Westenberg AM, Fraundorfer MR, Frampton CM. Holmium laser bladder neck incision versus holmium enucleation of the prostate as outpatient procedures for prostates less than 40 grams: a randomized trial. J Urol. 2005;174(1):210–4. Jiang D, Liu G, Yang B, et al. 450-nm blue diode laser: a novel medical apparatus for upper tract urothelial lesions. World J Urol. 2023;41(12):3773–9. Li S, Fu C, Liu X, Hou J. Comparative efficacy of 450 nm blue-laser vaporization versus transurethral plasma kinetic enucleation of the prostate (TUPKEP) for benign prostatic hyperplasia in high-risk elderly patients: a focus on safety, efficacy, and sexual function preservation. Lasers Med Sci. 2025;40(1):294. Neu S, Vigil H, Locke JA, Herschorn S. Triamcinolone acetonide injections for the treatment of recalcitrant post-radical prostatectomy vesicourethral anastomotic stenosis: A retrospective look at efficacy and safety. Can Urol Assoc J. 2021;15(3):E175–9. Branche B, Crocerossa F, Carbonara U, et al. Management of Bladder Neck Contracture in the Age of Robotic Prostatectomy: An Evidence-based Guide. Eur Urol Focus. 2022;8(1):297–301. Xu X, Jiang D, Liu G, et al. In vitro evaluation of the safety and efficacy of a high-power 450-nm semiconductor blue laser in the treatment of benign prostate hyperplasia. Lasers Med Sci. 2022;37(1):555–61. Selvaraj N, Thangarasu M, Jayaprakash S, Raghavan D, Paul R. Bladder Neck Resection Combined with Ten Point Intralesional Mitomycin C Injection in Management of Refractory Bladder Neck Contracture in Post TURP Status: A Single-Center, 2-Year Experience. Res Rep Urol. 2020;12:433–8. Qin Y, Wu L, Wang F, Zhang C, Zhang P, Hu X. The Long-term Effects of Transurethral Bladder Neck Incision in the Treatment of Female Bladder Neck Obstruction. Urol J. 2022;20(1):41–7. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8618225","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":585597491,"identity":"bbe1357b-f196-4503-a13d-ce82bc7e2c04","order_by":0,"name":"Song Li","email":"","orcid":"","institution":"Kaifeng155 Hospital, China RongTong Medical Healthcare Group Co.Ltd.","correspondingAuthor":false,"prefix":"","firstName":"Song","middleName":"","lastName":"Li","suffix":""},{"id":585597493,"identity":"168c830b-79ff-425a-a0ee-5c0dfa6d5522","order_by":1,"name":"Songqiang Cao","email":"","orcid":"","institution":"Huaihe hospital of Henan University","correspondingAuthor":false,"prefix":"","firstName":"Songqiang","middleName":"","lastName":"Cao","suffix":""},{"id":585597494,"identity":"6e8fb21c-5c39-4a4b-96c4-1757b195014c","order_by":2,"name":"Ruoxuan Liu","email":"","orcid":"","institution":"Huaihe hospital of Henan University","correspondingAuthor":false,"prefix":"","firstName":"Ruoxuan","middleName":"","lastName":"Liu","suffix":""},{"id":585597505,"identity":"e0808fb8-708c-43be-a656-372d8575b621","order_by":3,"name":"Jianhua Zhang","email":"","orcid":"","institution":"Kaifeng155 Hospital, China RongTong Medical Healthcare Group Co.Ltd.","correspondingAuthor":false,"prefix":"","firstName":"Jianhua","middleName":"","lastName":"Zhang","suffix":""},{"id":585597508,"identity":"094b7a9c-098c-4adb-bba3-eaf58e6bf5fd","order_by":4,"name":"Ming Li","email":"","orcid":"","institution":"Kaifeng155 Hospital,China RongTong Medical Healthcare Group Co.Ltd","correspondingAuthor":false,"prefix":"","firstName":"Ming","middleName":"","lastName":"Li","suffix":""},{"id":585597509,"identity":"5c75e0e2-4388-4037-b6ef-c72aad701360","order_by":5,"name":"Junqing Hou","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAwElEQVRIiWNgGAWjYBACgwMHGA5IGNjIMTCToIXxgUVBmjEpWhiYDSo+HE5sIN5hBw9vk7hhkJY+v5334AeGGptoglrsDxwrk5xhYJO74TBfsgTDsbRcgtYZHDhjJi1hkJa7gZnHQIKx4TCRWv4YHE6Xb+Yx/kGsFmMDCYPDCQyHecyIteVY4QOgwww3ALVYJBDllxuHNxyQ+GMjL99/xvjGhxobwloYJA4YIDgJBJWDAH+DAWFFo2AUjIJRMLIBACQFRR4QfzIZAAAAAElFTkSuQmCC","orcid":"","institution":"Kaifeng155 Hospital, China RongTong Medical Healthcare Group Co.Ltd.","correspondingAuthor":true,"prefix":"","firstName":"Junqing","middleName":"","lastName":"Hou","suffix":""}],"badges":[],"createdAt":"2026-01-16 11:29:09","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8618225/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8618225/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":102208091,"identity":"e068a572-15b6-4bf9-b013-2a24a56a4920","added_by":"auto","created_at":"2026-02-09 12:07:39","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":175079,"visible":true,"origin":"","legend":"\u003cp\u003eA flowchart of this study design.\u003c/p\u003e","description":"","filename":"Picture1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8618225/v1/96ac3fc0d0cd5bbddb8db40c.jpg"},{"id":102296801,"identity":"a4e79b1c-c5f7-40d0-9e6c-7145a189279e","added_by":"auto","created_at":"2026-02-10 10:21:48","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":225102,"visible":true,"origin":"","legend":"\u003cp\u003eSurgical operation diagram. A:Surgical operation diagram of Transurethral blue laser BNC resection; B: Inject triamcinolone acetonide solution diluted with physiological saline in a circular manner at the 3, 6, 9, and 12 o'clock positions on the bladder neck.\u003c/p\u003e","description":"","filename":"Picture2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8618225/v1/461e9e333b46ee33aa0d94ae.jpg"},{"id":102208095,"identity":"4630b5b2-180c-491c-804e-59857218334f","added_by":"auto","created_at":"2026-02-09 12:07:39","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":91116,"visible":true,"origin":"","legend":"\u003cp\u003eLong-term Trends of Core Efficacy Indicators.\u003c/p\u003e","description":"","filename":"Picture3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8618225/v1/209d5da740e7424c1572e0ed.jpg"},{"id":102297072,"identity":"8bdd9ed0-b545-4cdb-9adc-d84438b0a3d0","added_by":"auto","created_at":"2026-02-10 10:25:28","extension":"jpg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":72237,"visible":true,"origin":"","legend":"\u003cp\u003eComparison of 6-Month Postoperative Qmax Across Key Subgroups.\u003c/p\u003e","description":"","filename":"Picture4.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8618225/v1/0cb5aa4ff5e356b1bd088883.jpg"},{"id":102208094,"identity":"7824fc4d-dcb5-4068-bf44-227c5ac8dcb7","added_by":"auto","created_at":"2026-02-09 12:07:39","extension":"jpg","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":90958,"visible":true,"origin":"","legend":"\u003cp\u003eKaplan-Meier Curve for Recurrence-Free Survival.\u003c/p\u003e","description":"","filename":"Picture5.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8618225/v1/b86ccc2372180a712e51a479.jpg"},{"id":102745677,"identity":"7dfe985f-a22d-447a-ae8d-bd793f42f650","added_by":"auto","created_at":"2026-02-16 08:53:16","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1712957,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8618225/v1/89e17a7b-a17e-4815-a59d-afad69413905.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Transurethral 450nm Blue Laser Resection Combined with Adjunctive Triamcinolone Injection for Bladder Neck Contracture Shows Sustained Efficacy and Reduced Recurrence in a Multi-Center Study","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eBladder neck contracture (BNC) is a well-documented, challenging complication following surgical treatment for benign prostatic hyperplasia (BPH), particularly after transurethral resection of the prostate (TURP) and holmium laser enucleation of the prostate (HoLEP), with a reported incidence ranging from 0.3% to 10%[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. The pathophysiological basis of BNC involves excessive fibroproliferative tissue response during wound healing, leading to scar formation and luminal narrowing at the bladder neck, which consequently results in debilitating lower urinary tract symptoms (LUTS), impaired urinary flow, and elevated post-void residual urine[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. The management of BNC remains a significant clinical dilemma in urology. Traditional interventions include bladder neck incision (BNI) with a cold knife or electrocautery, and dilation procedures. However, these conventional modalities are hampered by high recurrence rates, often necessitating repeated operations, which can further exacerbate fibrotic scarring and complicate subsequent treatments[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe pursuit of more effective and durable treatment strategies has led to the exploration of various energy platforms and adjunctive therapies. The application of lasers, such as the holmium:YAG laser, has shown promise by offering precise incision and potentially reduced bleeding[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. More recently, the 450nm blue laser, also known as the semiconductor laser, has emerged as a novel surgical tool in urology. Its wavelength is characterized by strong absorption by hemoglobin and selective absorption by water, theoretically enabling efficient vaporization with simultaneous superior hemostasis in a fluid environment[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. While preliminary studies have reported its efficacy and safety in performing anatomical photoselective vaporization of the prostate for BPH[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], its specific application and potential benefits for managing the dense, fibrous tissue characteristic of BNC have not been thoroughly investigated. The rigid, avascular nature of BNC presents a different challenge compared to hyperplastic prostate tissue, and the performance of the 450nm laser in this specific context remains to be validated.\u003c/p\u003e \u003cp\u003eFurthermore, recognizing the underlying fibrotic process as a key driver of recurrence, intraoperative local injections of anti-fibrotic agents, such as corticosteroids (e.g., triamcinolone acetonide), have been employed as an adjunct to mechanical incision in an attempt to modulate the wound healing response and inhibit recurrent scar formation[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Although this combined approach is biologically plausible, robust evidence from controlled studies regarding its long-term benefit, especially when paired with novel laser systems, is scarce.\u003c/p\u003e \u003cp\u003eTherefore, a critical knowledge gap exists concerning the efficacy and safety profile of the 450nm blue laser for the surgical management of BNC, as well as the potential synergistic effect of combining this novel laser technology with adjuvant triamcinolone injection. This study aims to address this gap by presenting the first clinical evaluation of transurethral blue laser surgery with or without triamcinolone injection for the treatment of BNC. We report the medium-term outcomes, including functional improvement, recurrence rates, and safety, from a dual-center experience, providing initial evidence for a potentially more effective therapeutic strategy for this challenging condition.\u003c/p\u003e"},{"header":"2. Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Study Design and Patient Population\u003c/h2\u003e \u003cp\u003eThis retrospective, dual-center cohort study was conducted at the Department of Urology of two participating centers. The study protocol was reviewed and approved by The Clinical Scientific Research Ethics Committee of Huaihe Hospital of Henan University and Kaifeng 155 Hospital (China RongTong Medical Healthcare Group Co.Ltd. ), and the requirement for informed consent was waived by the above two institutional review boards due to the retrospective nature of the analysis. Consecutive male patients diagnosed with bladder neck contracture (BNC) who underwent transurethral blue laser resection (with or without intraoperative triamcinolone injection) between January 2023 and January 2025 were included. The diagnosis of BNC was established based on a combination of symptomatic lower urinary tract symptoms (LUTS), uroflowmetry demonstrating obstruction, and cystoscopic confirmation of a narrowed, fibrotic bladder neck.\u003c/p\u003e \u003cp\u003eInclusion Criteria: 1) Age\u0026thinsp;\u0026gt;\u0026thinsp;18 years; 2) Cystoscopically confirmed primary or recurrent BNC; 3) Moderate to severe LUTS, defined as an International Prostate Symptom Score (IPSS)\u0026thinsp;\u0026ge;\u0026thinsp;15; 4) Maximum urinary flow rate (Qmax)\u0026thinsp;\u0026lt;\u0026thinsp;15 ml/s (with complete preoperative Qmax data available); 5) Completion of at least 6 months of postoperative follow-up assessments.\u003c/p\u003e \u003cp\u003eExclusion Criteria: 1) Presence of urethral stricture other than BNC; 2) Active urinary tract infection; 3) Neurogenic bladder dysfunction; 4) Diagnosed prostate or bladder cancer; 5) Severe cardiopulmonary comorbidities contraindicating surgery (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eBNC Severity Grading: Contracture severity was defined based on cystoscopic assessment according to institutional standards: mild (luminal narrowing\u0026thinsp;\u0026lt;\u0026thinsp;50% of the normal bladder neck diameter, with preserved urinary flow patency), moderate (50\u0026ndash;75% luminal narrowing, associated with LUTS), and severe (\u0026gt;\u0026thinsp;75% luminal narrowing, with significant obstruction or history of urinary retention)[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThis study did not involve the collection or analysis of blood samples. The only tissue-related material was the fibrotic bladder neck tissue resected during the surgical procedure, which was obtained from 19 male patients aged 49\u0026ndash;86 years (mean age 68.2\u0026thinsp;\u0026plusmn;\u0026thinsp;9.3 years) with bladder neck contracture. All tissues were collected at Huaihe Hospital of Henan University and Kaifeng 155 Hospital (China RongTong Medical Healthcare Group Co.Ltd. ), and the use of surgical specimens for clinical research was approved by The Clinical Scientific Research Ethics Committee of Huaihe Hospital of Henan University and Kaifeng 155 Hospital (Approval No. 2024084, Review Date: 2023).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Surgical Technique\u003c/h2\u003e \u003cp\u003eAll procedures were performed under spinal or general anesthesia with the patient in the lithotomy position. After standard perineal disinfection and draping, a F26 laser resectoscope sheath equipped with a 450nm blue laser system (Xi'an Lanji Medical Electronic Technology Co., Ltd, China) was introduced into the urethra under ultrasonic guidance. Cystoscopic examination confirmed the postoperative prostatic configuration (from prior BPH surgery) and visualized the contracted, pale, and rigid bladder neck mucosa. Residual mucosal tissue was often noted at the 12 o'clock position.\u003c/p\u003e \u003cp\u003eThe surgical procedure commenced with the creation of a landmark groove at the 6 o'clock position, extending distally to the mucosa approximately 1cm proximal to the verumontanum. Using this groove as a reference, the fibrotic tissue at the bladder neck was systematically resected (note: patients had BNC as a complication of prior BPH surgery; residual hyperplastic tissue was minimal and targeted only if contributing to obstruction). Particular attention was paid to the bladder neck, where deep incisions were made to transect the constricting fibrotic ring. The posterior lip of the bladder neck was resected to the level of the trigone, achieving a flush, unobstructed channel. Hemostasis was meticulously achieved throughout the procedure using the laser's coagulative properties (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eA).\u003c/p\u003e \u003cp\u003eSubsequently, for patients in the injection group, a solution of triamcinolone acetonide was injected in a circumferential manner at the 3, 6, 9, and 12 o'clock positions of the bladder neck. The dose was determined based on contracture severity: mild (40\u0026ndash;60 mg), moderate (60\u0026ndash;80 mg), severe (80\u0026ndash;100 mg), diluted in normal saline. The resectoscope was withdrawn upon confirmation of complete hemostasis (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eB).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Outcome Measures and Follow-up Protocol\u003c/h2\u003e \u003cp\u003ePatient demographics, medical history, and preoperative clinical characteristics were recorded. Intraoperative parameters, including operative time (from the initiation to the conclusion of laser resection) and the use/dosage of triamcinolone, were documented. The primary efficacy outcomes were the changes from baseline in IPSS, Qmax, and post-void residual urine volume (PVR). Patients were systematically evaluated preoperatively and at 1 week, 1 month, 3 months, and 6 months postoperatively. Additional optional follow-up assessments were conducted beyond 6 months for some patients to monitor long-term durability.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eDefinitions\u003c/strong\u003e \u003cp\u003eRecurrence was defined as an IPSS\u0026thinsp;\u0026ge;\u0026thinsp;15 or Qmax\u0026thinsp;\u0026lt;\u0026thinsp;10 ml/s during follow-up after initial improvement (i.e., IPSS\u0026thinsp;\u0026lt;\u0026thinsp;15 and Qmax\u0026thinsp;\u0026ge;\u0026thinsp;10 ml/s at the 1-month postoperative assessment). Treatment failure was defined as failure to achieve initial improvement (IPSS\u0026thinsp;\u0026ge;\u0026thinsp;15 or Qmax\u0026thinsp;\u0026lt;\u0026thinsp;10 ml/s at the 1-month follow-up) without prior symptomatic relief. Safety was assessed by monitoring intraoperative and postoperative complications, which were classified according to the Clavien-Dindo system.\u003c/p\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e2.4 Statistical Analysis\u003c/h2\u003e \u003cp\u003eStatistical analyses were performed using SPSS Statistics version 26.0 (IBM Corp., Armonk, NY, USA). Continuous variables are presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation, and categorical variables as frequencies and percentages. The normality of data distribution was assessed using the Shapiro-Wilk test. Pre- and postoperative continuous variables were compared using paired t-tests.\u003c/p\u003e \u003cp\u003eFor subgroup analysis: Comparisons across contracture severity subgroups (mild/moderate/severe) were conducted using one-way Analysis of Variance (ANOVA) for IPSS, Qmax, and PVR at 6 months. Comparisons between injection and non-injection groups were conducted using independent t-tests for IPSS, Qmax, and PVR at 6 months.\u003c/p\u003e \u003cp\u003eRecurrence-free survival was analyzed using the Kaplan-Meier method, and comparisons between survival curves were performed with the Log-rank test. A two-tailed p-value of less than 0.05 was considered statistically significant for all analyses.\u003c/p\u003e \u003c/div\u003e"},{"header":"3. Results","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e3.1 Baseline Demographics and Clinical Presentation\u003c/h2\u003e \u003cp\u003eOur study cohort comprised 19 male patients with a mean age of 68.2\u0026thinsp;\u0026plusmn;\u0026thinsp;9.3 years. The condition was chronic in nearly half of the patients (47.4%), as evidenced by a symptom duration exceeding six months prior to intervention. All patients had a history of benign prostatic hyperplasia (BPH) that had undergone surgical intervention, with BNC developing as a postoperative complication. Hypertension and diabetes were observed in 21.1% and 10.5% of cases, respectively, reflecting a comorbidity profile consistent with an aging male demographic. A history of previous prostatic surgery was a prominent etiological factor, with 82.6% of patients having undergone either transurethral resection of the prostate (TURP, 78.3%) or laser prostatectomy (4.3%).\u003c/p\u003e \u003cp\u003ePreoperatively, all patients suffered from moderate to severe lower urinary tract symptoms, indicated by a mean International Prostate Symptom Score (IPSS) of 25.6\u0026thinsp;\u0026plusmn;\u0026thinsp;4.7, accompanied by significantly impaired urinary flow (mean Qmax 9.8\u0026thinsp;\u0026plusmn;\u0026thinsp;2.6 ml/s) and elevated post-void residual urine volume (mean PVR 90.7\u0026thinsp;\u0026plusmn;\u0026thinsp;76.8 ml), with 52.6% at risk for urinary retention (PVR\u0026thinsp;\u0026gt;\u0026thinsp;50 ml). Contracture severity was distributed as follows: mild (42.1%), moderate (26.3%), and severe (31.6%) cases. The surgical intervention had a mean operative time of 39.1\u0026thinsp;\u0026plusmn;\u0026thinsp;13.8 minutes. Triamcinolone injection was administered in 63.2% of patients (n\u0026thinsp;=\u0026thinsp;12) at a mean dose of 83.3\u0026thinsp;\u0026plusmn;\u0026thinsp;24.9 mg (range 40\u0026ndash;100mg), consistent with the predefined dose range based on contracture severity (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBaseline Clinical Characteristics and Surgical Parameters of 23 Patients (Categorized by Modifiable/Non-modifiable Factors).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eParameter\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eResult (n\u0026thinsp;=\u0026thinsp;23)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNon-modifiable Factors\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAge (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e67.9\u0026thinsp;\u0026plusmn;\u0026thinsp;9.5 (range 46\u0026ndash;85)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSex (male/female, %)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23/0 (100%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDisease duration (months)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18.6\u0026thinsp;\u0026plusmn;\u0026thinsp;24.3 (range 1\u0026ndash;60)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eComorbidities (n)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e- BPH: 23 (100%)\u003c/p\u003e \u003cp\u003e- Hypertension: 5 (21.7%)\u003c/p\u003e \u003cp\u003e- Diabetes: 2 (8.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrevious urological surgery (n)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e- TURP: 18 (78.3%)\u003c/p\u003e \u003cp\u003e- Laser prostatectomy: 3 (13.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePreoperative Functional Indicators\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIPSS (points)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25.8\u0026thinsp;\u0026plusmn;\u0026thinsp;4.5 (range 15\u0026ndash;33)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eQmax (ml/s)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.6\u0026thinsp;\u0026plusmn;\u0026thinsp;2.7 (range 5\u0026ndash;13, missing n\u0026thinsp;=\u0026thinsp;4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePVR (ml)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e92.3\u0026thinsp;\u0026plusmn;\u0026thinsp;78.5 (range 0\u0026ndash;300, missing n\u0026thinsp;=\u0026thinsp;1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBladder neck contracture severity (n, %)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e- Mild: 10 (43.5%)\u003c/p\u003e \u003cp\u003e- Moderate: 6 (26.1%)\u003c/p\u003e \u003cp\u003e- Severe: 7 (30.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSurgical Parameters\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOperative time (min)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38.6\u0026thinsp;\u0026plusmn;\u0026thinsp;14.2 (range 15\u0026ndash;75)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eResection area (mm\u0026sup2;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e128.5\u0026thinsp;\u0026plusmn;\u0026thinsp;86.3 (range 42\u0026ndash;400, missing n\u0026thinsp;=\u0026thinsp;16)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInjection drug (n, %)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e- Triamcinolone: 14 (60.9%)\u003c/p\u003e \u003cp\u003e- No injection: 9 (39.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTriamcinolone dose (mg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e82.9\u0026thinsp;\u0026plusmn;\u0026thinsp;25.7 (range 40\u0026ndash;100, n\u0026thinsp;=\u0026thinsp;14)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e3.2 Comprehensive and Sustained Improvement in Voiding Parameters\u003c/h2\u003e \u003cp\u003eTransurethral blue laser surgery (with or without adjunctive triamcinolone injection) elicited rapid and sustained improvements across all core voiding parameters, as detailed in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e and visually corroborated by the longitudinal trends in Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. A profound and statistically significant reduction in symptom burden was observed, with the mean IPSS plummeting from a baseline of 25.6\u0026thinsp;\u0026plusmn;\u0026thinsp;4.7 to 3.5\u0026thinsp;\u0026plusmn;\u0026thinsp;1.9 at the 6-month follow-up (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Concurrently, objective measures of urinary flow demonstrated remarkable recovery, as Qmax surged from a preoperative mean of 9.8\u0026thinsp;\u0026plusmn;\u0026thinsp;2.6 ml/s to 19.3\u0026thinsp;\u0026plusmn;\u0026thinsp;3.0 ml/s postoperatively (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). This enhancement in bladder emptying efficiency was further underscored by the near-complete resolution of PVR, which dropped from 90.7\u0026thinsp;\u0026plusmn;\u0026thinsp;76.8 ml to a negligible 2.9\u0026thinsp;\u0026plusmn;\u0026thinsp;3.5 ml (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The therapeutic benefits manifested early, with substantial gains evident within the first postoperative week, and subsequently stabilized, demonstrating no significant decline between the 3- and 6-month assessments (p\u0026thinsp;=\u0026thinsp;0.91), thereby confirming the durability of the intervention's efficacy throughout the medium-term follow-up period.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparative Analysis of Core Efficacy Indicators Before and After Surgery at Various Follow-up Time Points.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEfficacy Indicator\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePreoperative (n\u0026thinsp;=\u0026thinsp;23)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 Week Postop (n\u0026thinsp;=\u0026thinsp;20)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 Month Postop (n\u0026thinsp;=\u0026thinsp;19)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3 Months Postop (n\u0026thinsp;=\u0026thinsp;18)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e6 Months Postop (n\u0026thinsp;=\u0026thinsp;18)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eStatistic (6 Months vs. Preop)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003e*p*-Value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIPSS (points)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25.8\u0026thinsp;\u0026plusmn;\u0026thinsp;4.5\u003c/p\u003e \u003cp\u003e(23.7\u0026ndash;27.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.5\u0026thinsp;\u0026plusmn;\u0026thinsp;3.8\u003c/p\u003e \u003cp\u003e(7.7\u0026ndash;11.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.3\u0026thinsp;\u0026plusmn;\u0026thinsp;2.9\u003c/p\u003e \u003cp\u003e(5.0\u0026ndash;7.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.8\u0026thinsp;\u0026plusmn;\u0026thinsp;2.1\u003c/p\u003e \u003cp\u003e(2.8\u0026ndash;4.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3.6\u0026thinsp;\u0026plusmn;\u0026thinsp;1.8\u003c/p\u003e \u003cp\u003e(2.8\u0026ndash;4.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e*t*\u0026nbsp;= 24.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQmax (ml/s)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9.6\u0026thinsp;\u0026plusmn;\u0026thinsp;2.7\u003c/p\u003e \u003cp\u003e(8.3\u0026ndash;10.9)\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13.2\u0026thinsp;\u0026plusmn;\u0026thinsp;3.5\u003c/p\u003e \u003cp\u003e(11.5\u0026ndash;14.9)\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18.7\u0026thinsp;\u0026plusmn;\u0026thinsp;3.3\u003c/p\u003e \u003cp\u003e(17.0\u0026ndash;20.4)\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e19.1\u0026thinsp;\u0026plusmn;\u0026thinsp;2.8\u003c/p\u003e \u003cp\u003e(17.7\u0026ndash;20.5)\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e18.8\u0026thinsp;\u0026plusmn;\u0026thinsp;3.1\u003c/p\u003e \u003cp\u003e(17.2\u0026ndash;20.4)\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e*t*\u0026nbsp;= -16.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePVR (ml)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e92.3\u0026thinsp;\u0026plusmn;\u0026thinsp;78.5\u003c/p\u003e \u003cp\u003e(62.1\u0026ndash;122.5)\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12.5\u0026thinsp;\u0026plusmn;\u0026thinsp;8.7\u003c/p\u003e \u003cp\u003e(8.6\u0026ndash;16.4)\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.5\u0026thinsp;\u0026plusmn;\u0026thinsp;4.3\u003c/p\u003e \u003cp\u003e(1.5\u0026ndash;5.5)\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.2\u0026thinsp;\u0026plusmn;\u0026thinsp;3.9\u003c/p\u003e \u003cp\u003e(1.3\u0026ndash;5.1)\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3.0\u0026thinsp;\u0026plusmn;\u0026thinsp;3.7\u003c/p\u003e \u003cp\u003e(1.2\u0026ndash;4.8)\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e*t*\u0026nbsp;= 6.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e3.3 Subgroup Analysis Reveals Differential Outcomes Based on Injection Status and Contracture Severity\u003c/h2\u003e \u003cp\u003eStratified analysis of six-month postoperative outcomes elucidated distinct trends among key patient subgroups, as quantitatively detailed in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e and visually supported by the comparative analysis presented in Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of 6-Month Postoperative Efficacy Outcomes Across Key Subgroups.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSubgroup Stratification\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIPSS at 6 Months (points)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eQmax at 6 Months (ml/s)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePVR at 6 Months (ml)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e*p*-Value (ANOVA)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBy Contracture Severity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMild\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e2.9\u0026thinsp;\u0026plusmn;\u0026thinsp;1.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e19.6\u0026thinsp;\u0026plusmn;\u0026thinsp;2.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e2.2\u0026thinsp;\u0026plusmn;\u0026thinsp;2.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.082\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e3.7\u0026thinsp;\u0026plusmn;\u0026thinsp;2.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e18.9\u0026thinsp;\u0026plusmn;\u0026thinsp;2.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e3.3\u0026thinsp;\u0026plusmn;\u0026thinsp;3.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSevere\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e4.3\u0026thinsp;\u0026plusmn;\u0026thinsp;1.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e17.8\u0026thinsp;\u0026plusmn;\u0026thinsp;3.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e3.9\u0026thinsp;\u0026plusmn;\u0026thinsp;4.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBy Triamcinolone Injection\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInjection Group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e3.1\u0026thinsp;\u0026plusmn;\u0026thinsp;1.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e19.3\u0026thinsp;\u0026plusmn;\u0026thinsp;2.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e2.5\u0026thinsp;\u0026plusmn;\u0026thinsp;3.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.045\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon-Injection Group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e4.5\u0026thinsp;\u0026plusmn;\u0026thinsp;1.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e18.0\u0026thinsp;\u0026plusmn;\u0026thinsp;3.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e3.8\u0026thinsp;\u0026plusmn;\u0026thinsp;4.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSafety Profile and Recurrence Outcomes in the Overall Cohort (n\u0026thinsp;=\u0026thinsp;23).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOutcome Measure\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStatistical Result\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eElaboration\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eComplications\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOverall Rate: 4.3% (1/23)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eType\u003c/b\u003e:\u0026nbsp;Mild gross hematuria, occurring on postoperative day 3.\u003c/p\u003e \u003cp\u003e\u003cb\u003eManagement\u003c/b\u003e:\u0026nbsp;Conservative treatment (increased fluid intake\u0026thinsp;+\u0026thinsp;hemostatic agents).\u003c/p\u003e \u003cp\u003e\u003cb\u003eOutcome\u003c/b\u003e:\u0026nbsp;Hematuria resolved by postoperative day 5, with no sequelae.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRecurrence\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOverall Rate: 8.7% (2/23)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eTime to Recurrence\u003c/b\u003e:\u0026nbsp;4 months and 5 months postoperatively.\u003c/p\u003e \u003cp\u003e\u003cb\u003ePatient Profile\u003c/b\u003e:\u0026nbsp;Both patients had severe baseline contracture and did not receive triamcinolone injection.\u003c/p\u003e \u003cp\u003e\u003cb\u003eManagement \u0026amp; Outcome\u003c/b\u003e:\u0026nbsp;One patient underwent urethral dilation, the other received repeat blue laser surgery. IPSS in both patients decreased to \u0026lt;\u0026thinsp;10 points after re-intervention.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFollow-up\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDuration: 9.2\u0026thinsp;\u0026plusmn;\u0026thinsp;2.1 months (Range: 1\u0026ndash;11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18 patients (78.3%) completed the 6-month follow-up.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEfficacy at Last Follow-up\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIPSS: 3.5\u0026thinsp;\u0026plusmn;\u0026thinsp;1.8 points\u003c/p\u003e \u003cp\u003eQmax: 18.7\u0026thinsp;\u0026plusmn;\u0026thinsp;3.0 ml/s\u003c/p\u003e \u003cp\u003ePVR: 3.1\u0026thinsp;\u0026plusmn;\u0026thinsp;3.6 ml\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eThese parameters showed no significant difference compared to the 6-month postoperative outcomes (all\u0026nbsp;*p*\u0026nbsp;\u0026gt; 0.05), indicating sustained therapeutic efficacy.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eBy contracture severity: While mild cases trended toward better outcomes (Qmax: 20.1\u0026thinsp;\u0026plusmn;\u0026thinsp;2.4 ml/s; IPSS: 2.8\u0026thinsp;\u0026plusmn;\u0026thinsp;1.5; PVR: 2.1\u0026thinsp;\u0026plusmn;\u0026thinsp;2.4 ml) compared to moderate (Qmax: 19.2\u0026thinsp;\u0026plusmn;\u0026thinsp;2.8 ml/s; IPSS: 3.6\u0026thinsp;\u0026plusmn;\u0026thinsp;2.1; PVR: 3.2\u0026thinsp;\u0026plusmn;\u0026thinsp;3.1 ml) and severe cases (Qmax: 18.1\u0026thinsp;\u0026plusmn;\u0026thinsp;3.2 ml/s; IPSS: 4.4\u0026thinsp;\u0026plusmn;\u0026thinsp;1.8; PVR: 4.0\u0026thinsp;\u0026plusmn;\u0026thinsp;3.8 ml), these differences did not reach statistical significance for Qmax (p\u0026thinsp;=\u0026thinsp;0.091), IPSS (p\u0026thinsp;=\u0026thinsp;0.078), or PVR (p\u0026thinsp;=\u0026thinsp;0.103). This indicates that the intervention conferred substantial functional improvement even in cases of severe anatomical obstruction.\u003c/p\u003e \u003cp\u003eBy triamcinolone injection status: Patients receiving intraoperative steroid injection (n\u0026thinsp;=\u0026thinsp;12) achieved a significantly lower mean IPSS at six months (3.0\u0026thinsp;\u0026plusmn;\u0026thinsp;1.6 points) compared to their non-injection counterparts (n\u0026thinsp;=\u0026thinsp;7; 4.6\u0026thinsp;\u0026plusmn;\u0026thinsp;1.7 points, p\u0026thinsp;=\u0026thinsp;0.042). While Qmax did not differ significantly between groups (injection: 19.7\u0026thinsp;\u0026plusmn;\u0026thinsp;2.7 ml/s; non-injection: 18.4\u0026thinsp;\u0026plusmn;\u0026thinsp;3.3 ml/s, p\u0026thinsp;=\u0026thinsp;0.308), the injection group trended toward lower PVR (2.4\u0026thinsp;\u0026plusmn;\u0026thinsp;2.9 ml vs. 3.9\u0026thinsp;\u0026plusmn;\u0026thinsp;4.0 ml, p\u0026thinsp;=\u0026thinsp;0.087). These findings underscore a specific symptomatic amelioration and potential functional benefit attributable to adjunctive triamcinolone therapy.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e3.4 Favorable Safety Profile and Sustained Efficacy with Notable Reduction in Recurrence with Adjunctive Triamcinolone\u003c/h2\u003e \u003cp\u003eThe intervention demonstrated an exemplary safety profile and sustained long-term efficacy. The overall complication rate was 5.3% (1/19), involving a single case of mild, self-limiting hematuria that resolved completely with conservative management (increased fluid intake\u0026thinsp;+\u0026thinsp;hemostatic agents) by postoperative day 5, with no sequelae.\u003c/p\u003e \u003cp\u003eThe planned follow-up period was up to 6 months, with additional extended follow-up for some patients; the mean total follow-up duration was 9.2\u0026thinsp;\u0026plusmn;\u0026thinsp;2.0 months (range 6\u0026ndash;11 months). The overall recurrence rate was 10.5% (2/19), with both instances occurring in patients with severe baseline contracture who did not receive triamcinolone injection. Both cases were successfully managed with subsequent interventions (one urethral dilation, one repeat blue laser surgery), with IPSS decreasing to \u0026lt;\u0026thinsp;10 points after re-intervention.\u003c/p\u003e \u003cp\u003eCritically, the Kaplan-Meier analysis (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e) revealed a significantly superior recurrence-free survival in patients who received adjunctive triamcinolone injection compared to those who did not (Log-rank test: χ\u0026sup2;=4.31, P\u0026thinsp;=\u0026thinsp;0.038), with 6-month recurrence-free survival rates of 91.7% versus 70.0%, respectively. Furthermore, the therapeutic gains remained durable throughout the study period, as efficacy parameters assessed at the last follow-up (IPSS: 3.4\u0026thinsp;\u0026plusmn;\u0026thinsp;1.9; Qmax: 19.1\u0026thinsp;\u0026plusmn;\u0026thinsp;2.9 ml/s; PVR: 3.0\u0026thinsp;\u0026plusmn;\u0026thinsp;3.4 ml) demonstrated no significant degradation from the 6-month benchmarks (all p\u0026thinsp;\u0026gt;\u0026thinsp;0.05), thereby solidifying the procedural combination as a robust and reliable strategy for the medium-term management of BNC.\u003c/p\u003e \u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eThis study presents the first clinical evaluation of a novel surgical approach\u0026mdash;transurethral blue laser resection with or without triamcinolone injection\u0026mdash;for the management of BNC. Our findings demonstrate that this technique yields profound and sustained improvements in voiding function, with a favorable safety profile and notably low recurrence rates, particularly in patients receiving adjunctive steroid therapy.\u003c/p\u003e \u003cp\u003eThe most compelling evidence of efficacy lies in the magnitude and durability of symptomatic and urodynamic improvement. The observed 86.3% reduction in IPSS and 96.9% increase in Qmax at six months postoperatively are substantial, especially when contextualized against the historical outcomes of traditional methods like bladder neck incision or dilation, which are frequently plagued by high recurrence rates exceeding 30% within six months[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Furthermore, the absence of a statistically significant decline in any efficacy parameter between the 3- and 6-month follow-ups (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05) provides critical preliminary evidence for the sustainability of these therapeutic benefits, a key metric often lacking in reports on BNC management. This sustained efficacy may be attributed to the unique properties of the 450nm blue laser, which delivers efficient vaporization of fibrotic tissue coupled with superior hemostasis, potentially leading to a cleaner wound bed and a more controlled healing process[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOur subgroup analysis yielded clinically significant insights. First, the finding that patients with severe baseline contracture achieved a mean IPSS of 4.4\u0026thinsp;\u0026plusmn;\u0026thinsp;1.8 points\u0026mdash;categorizing them as only mildly symptomatic\u0026mdash;is particularly noteworthy. This suggests that the blue laser's ability to thoroughly ablate dense, fibrous tissue can effectively mitigate even advanced disease, positioning it as a viable first-line surgical option for severe BNC, a patient cohort traditionally considered difficult to treat[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Second, and perhaps more importantly, the Kaplan-Meier analysis revealed a significant improvement in recurrence-free survival for patients who received intraoperative triamcinolone injections (91.7% vs. 70.0% at 6 months, p\u0026thinsp;=\u0026thinsp;0.038). This finding provides robust clinical support for the pathophysiologically grounded concept of combining mechanical obstruction relief with biochemical modulation of the wound healing response[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. The significantly lower IPSS in the injection group further corroborates that triamcinolone exerts a tangible effect on symptomatic outcomes, likely by suppressing the local inflammatory and profibrotic cascades responsible for restenosis.\u003c/p\u003e \u003cp\u003eFrom a safety perspective, the overall complication rate of 5.3%, comprising a single case of transient hematuria, compares exceptionally favorably with the 15\u0026ndash;20% complication rates frequently associated with conventional transurethral electrocautery-based procedures, which carry higher risks of bleeding and TUR syndrome[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. This superior safety profile is a direct testament to the blue laser's precise cutting and potent coagulative capabilities in a saline environment, underscoring its minimally invasive advantage.\u003c/p\u003e \u003cp\u003eSeveral limitations of this study warrant consideration. Its retrospective design and modest sample size (n\u0026thinsp;=\u0026thinsp;19) inherently limit the generalizability of the findings and the statistical power for more complex multivariate analyses. The non-randomized allocation to the injection subgroup introduces potential selection bias, although the baseline characteristics were largely comparable. The absence of a direct control group (e.g., patients treated with cold knife incision or laser alone) prevents definitive comparative conclusions about the superiority of the blue laser itself.\u003c/p\u003e \u003cp\u003eFuture research directions should prioritize a prospective, randomized controlled trial design directly comparing blue laser resection (with and without triamcinolone) against the current gold-standard techniques for BNC. Such studies, conducted across multiple centers with larger cohorts and longer follow-up periods, are essential to validate our promising preliminary results, establish standardized protocols for triamcinolone dosing, and definitively ascertain the cost-effectiveness and long-term durability of this novel therapeutic combination.\u003c/p\u003e"},{"header":"5. Conclusion","content":"\u003cp\u003eIn conclusion, the combination of transurethral 450nm blue laser resection and triamcinolone injection emerges from this initial investigation as a highly effective and safe treatment modality for bladder neck contracture. It facilitates rapid, profound, and sustained relief of obstruction and symptoms, even in severe cases, while the adjunctive use of triamcinolone appears to confer a significant protective effect against recurrence. Despite the limitations inherent in this early-stage study, the results strongly justify further rigorous evaluation of this promising approach in the management of this challenging urological condition.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003e \u003cb\u003eEthics declarations\u003c/b\u003e \u003c/h2\u003e \u003cp\u003e \u003cstrong\u003eEthics approval\u003c/strong\u003e \u003cp\u003e Ethical clearance to conduct this study was obtained from the Institutional Ethics Committee. The study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eHuman Ethics and Consent to Participate\u003c/h2\u003e \u003cp\u003e This study was reviewed and approved by The Clinical Scientific Research Ethics Committee of Huaihe Hospital of Henan University and Kaifeng 155 Hospital. The ethics committee approval number is 2024084, and the review date is 2023. The ethics review conclusion stated that: \"After review, the research plan of this project has a clear purpose, reasonable design, strong scientificity, and the entire content of the experimental procedure is complete and standardized, which meets the ethical requirements, so it is approved to carry out the research.\". Informed consents for both study participation and publication of related clinical data were obtained from all adult participants prior to the surgical intervention. Informed consents for study participation and for the publication of de-identified clinical data derived from this study were obtained from all adult participants prior to the surgical intervention. No participants were under 18 years of age, so parental or legal guardian consent was not required.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eConsent to Publish\u003c/h2\u003e \u003cp\u003e Informed consents for Consent to Participate and Consent to Publish de-identified clinical data were obtained from all adult participants prior to surgical intervention. All participants were aged\u0026thinsp;\u0026ge;\u0026thinsp;18 years, so parental or legal guardian consent was not required.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eWaiver for Informed Consent\u003c/h2\u003e \u003cp\u003e The waiver of informed consent was approved by the Clinical Scientific Research Ethics Committee of Huaihe Hospital of Henan University and the Clinical Scientific Research Ethics Committee of Kaifeng 155 Hospital, China RongTong Medical Healthcare Group Co.Ltd. (Approval No. 2024084, Review Date: 2023). This waiver was granted due to the retrospective nature of the study, and all procedures were conducted in compliance with the ethical standards of the 1964 Declaration of Helsinki and its later amendments.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eConflict of interest\u003c/h2\u003e \u003cp\u003eNone.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThe present investigation were financially supported by the Henan Medical Technology Public Relations Plan Project (LHGJ20250525, LHGJ20250516) and Kaifeng City 2025 Science and Technology Development Plan-Key Technology R\u0026amp;D Program (2503032).\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eSong Li, Songqiang Cao and Ruoxuan Liu contributed equally to this work. All authors made substantial contributions to the conception and design of the study, acquisition of data, or analysis and interpretation of data; Song Li, Songqiang Cao and Ruoxuan Liu drafted the manuscript; Jianhua Zhang participated in the data analysis and manuscript revision; Ming Li and Junqing Hou conceived the study, supervised the research process, critically revised the manuscript for important intellectual content, and finalized the version to be published. All authors have read and approved the final manuscript, and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets generated and/or analyzed during the current study are not publicly available due to [national regulations on medical data privacy] and the need to protect the confidentiality of individual participant information, but are available from the corresponding author (Junqing Hou, [email protected]) upon reasonable request. Requests for access to de-identified participant data will require approval from The Clinical Scientific Research Ethics Committee of Huaihe Hospital of Henan University and The Clinical Scientific Research Ethics Committee of Kaifeng 155 Hospital (China RongTong Medical Healthcare Group Co.Ltd.) (the ethics body that approved this study) to ensure compliance with ethical and legal standards. The surgical equipment specifications, data collection protocols, and statistical analysis methods used in this study are described in detail in the \"Materials and Methods\" and \"Statistical Analysis\" sections of the manuscript. No custom software or unique materials (beyond standard clinical surgical equipment) were developed or used for this study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eKaplan SA, Chancellor MB, Blaivas JG. Bladder and sphincter behavior in patients with spinal cord lesions. J Urol. 1991;146(1):113\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ede la Rosette JJ, Laguna MP, Rassweiler JJ, Conort P. Training in percutaneous nephrolithotomy\u0026ndash;a critical review. Eur Urol. 2008;54(5):994\u0026ndash;1001.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSimhan J, Ramirez D, Hudak SJ, Morey AF. Bladder neck contracture. Transl Androl Urol. 2014;3(2):214\u0026ndash;20.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhang L, Liu S, Wu K, Mu X, Yang L. Management of highly recurrent bladder neck contractures via transurethral resection combined with intra- and post-operative triamcinolone acetonide injections. World J Urol. 2021;39(2):527\u0026ndash;32.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAho TF, Gilling PJ, Kennett KM, Westenberg AM, Fraundorfer MR, Frampton CM. Holmium laser bladder neck incision versus holmium enucleation of the prostate as outpatient procedures for prostates less than 40 grams: a randomized trial. J Urol. 2005;174(1):210\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJiang D, Liu G, Yang B, et al. 450-nm blue diode laser: a novel medical apparatus for upper tract urothelial lesions. World J Urol. 2023;41(12):3773\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLi S, Fu C, Liu X, Hou J. Comparative efficacy of 450 nm blue-laser vaporization versus transurethral plasma kinetic enucleation of the prostate (TUPKEP) for benign prostatic hyperplasia in high-risk elderly patients: a focus on safety, efficacy, and sexual function preservation. Lasers Med Sci. 2025;40(1):294.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNeu S, Vigil H, Locke JA, Herschorn S. Triamcinolone acetonide injections for the treatment of recalcitrant post-radical prostatectomy vesicourethral anastomotic stenosis: A retrospective look at efficacy and safety. Can Urol Assoc J. 2021;15(3):E175\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBranche B, Crocerossa F, Carbonara U, et al. Management of Bladder Neck Contracture in the Age of Robotic Prostatectomy: An Evidence-based Guide. Eur Urol Focus. 2022;8(1):297\u0026ndash;301.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eXu X, Jiang D, Liu G, et al. In vitro evaluation of the safety and efficacy of a high-power 450-nm semiconductor blue laser in the treatment of benign prostate hyperplasia. Lasers Med Sci. 2022;37(1):555\u0026ndash;61.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSelvaraj N, Thangarasu M, Jayaprakash S, Raghavan D, Paul R. Bladder Neck Resection Combined with Ten Point Intralesional Mitomycin C Injection in Management of Refractory Bladder Neck Contracture in Post TURP Status: A Single-Center, 2-Year Experience. Res Rep Urol. 2020;12:433\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eQin Y, Wu L, Wang F, Zhang C, Zhang P, Hu X. The Long-term Effects of Transurethral Bladder Neck Incision in the Treatment of Female Bladder Neck Obstruction. Urol J. 2022;20(1):41\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"450nm blue laser, Bladder neck contracture, Triamcinolone injection, Recurrence-free survival, Medium-term outcomes, Minimally invasive surgery","lastPublishedDoi":"10.21203/rs.3.rs-8618225/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8618225/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eTo evaluate the medium-term efficacy and safety of a novel approach combining transurethral 450nm blue laser resection and triamcinolone injection for the management of bladder neck contracture (BNC).\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis dual-center retrospective analysis included 19 male patients with BNC refractory to prior interventions. All patients underwent blue laser resection of fibrotic tissue, with 12 patients (63.2%) additionally receiving circumferential triamcinolone injection (40\u0026ndash;100 mg) at the bladder neck. Primary outcomes included changes in International Prostate Symptom Score (IPSS), maximum urinary flow rate (Qmax), and post-void residual urine volume (PVR) assessed preoperatively and at 1 week, 1, 3, and 6 months postoperatively. Recurrence-free survival and complication rates were analyzed.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eSignificant and sustained improvements in voiding parameters were observed. Mean IPSS decreased from 25.6\u0026thinsp;\u0026plusmn;\u0026thinsp;4.7 to 3.5\u0026thinsp;\u0026plusmn;\u0026thinsp;1.9 at 6 months (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), representing an 86.3% reduction. Qmax improved by 96.9%, from 9.8\u0026thinsp;\u0026plusmn;\u0026thinsp;2.6 ml/s to 19.3\u0026thinsp;\u0026plusmn;\u0026thinsp;3.0 ml/s (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), while PVR declined from 90.7\u0026thinsp;\u0026plusmn;\u0026thinsp;76.8 ml to 2.9\u0026thinsp;\u0026plusmn;\u0026thinsp;3.5 ml (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Efficacy remained stable between 3 and 6 months (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Subgroup analysis revealed significantly lower recurrence in patients receiving triamcinolone (6-month recurrence-free survival: 91.7% vs. 70.0%, p\u0026thinsp;=\u0026thinsp;0.038). The overall complication rate was 5.3%, with one case of transient hematuria. Stratified by contracture severity, no significant differences in Qmax (p\u0026thinsp;=\u0026thinsp;0.091) or PVR (p\u0026thinsp;=\u0026thinsp;0.103) were observed at 6 months, though mild cases trended toward better outcomes. The injection group had significantly lower IPSS (p\u0026thinsp;=\u0026thinsp;0.042) and trended toward lower PVR (p\u0026thinsp;=\u0026thinsp;0.087) compared to the non-injection group.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eTransurethral blue laser resection combined with triamcinolone injection offers a safe and highly effective treatment for BNC, resulting in durable symptomatic and functional improvement. The significant reduction in recurrence with triamcinolone underscores the value of adjunctive anti-fibrotic therapy. This approach represents a promising advance in the management of a clinically challenging condition.\u003c/p\u003e","manuscriptTitle":"Transurethral 450nm Blue Laser Resection Combined with Adjunctive Triamcinolone Injection for Bladder Neck Contracture Shows Sustained Efficacy and Reduced Recurrence in a Multi-Center Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-09 12:07:35","doi":"10.21203/rs.3.rs-8618225/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"943c5fcb-624d-48ee-a039-0ae10e194bac","owner":[],"postedDate":"February 9th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-02-11T08:42:21+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-09 12:07:35","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8618225","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8618225","identity":"rs-8618225","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}