Balloon dilation with a methylprednisolone-coated urethral catheter for the prevention of recurrent bladder neck contracture: results of a prospective observational study

Introduction. Bladder neck contracture (BNC) is a clinically significant late complication of transurethral surgical treatment for benign prostatic hyperplasia (BPH) and is often characterized by a recurrent course. Given the limited effectiveness of repeated endoscopic procedures, there remains a need to develop minimally invasive approaches aimed at preventing recurrent scarring and maintaining long-term bladder neck patency.
Objective. To evaluate the effectiveness of staged balloon dilation using a methylprednisolone drug-coated urethral catheter.
Materials & methods. This prospective observational study included 56 patients with recurrent BNC after transurethral interventions for BPH. As the first stage of treatment, all patients underwent transurethral incision of the scarred area, followed three weeks later by staged balloon dilation using a methylprednisolone drug-coated urethral catheter under transrectal ultrasound guidance. Treatment efficacy was assessed based on changes in IPSS, QoL, Qmax, post-void residual urine volume (PVR), recurrence rate, and recurrence-free survival.
Results. After the first treatment course, a marked improvement in functional parameters was observed: IPSS decreased from 17.4 to 8.4 points, QoL — from 3.6 to 1.9 points, and PVR — from 50.2 to 10.7 mL. Patients who required a second course of balloon dilation also demonstrated favorable dynamics: IPSS decreased from 16.0 to 4.5 points, QoL — from 3.0 to 1.6 points, Qmax increased from 10.5 to 20.9 mL/s, and PVR decreased from 23.8 to 7.4 mL. After the first course, a positive clinical effect was achieved in 44 patients (78.6%). A repeated course was required in 12 patients, of whom 7 achieved a stable clinical result. After two courses, the immediate effectiveness of the technique was 91.1%; however, at a median follow-up of 34.4 months, the final effectiveness was 78.6%, with recurrence recorded in 21.4% of patients. According to Kaplan—Meier analysis, recurrence-free survival was 91.1% at 12 months, 80.4% at 24 months, and 77.4% at 36 months. Most BNC recurrences occurred within the first 2 years after inclusion in the staged balloon dilation program.
Conclusion. Staged balloon dilation using a methylprednisolone drug-coated urethral catheter after transurethral incision is a promising minimally invasive treatment option for recurrent bladder neck contracture. The technique provides significant improvement in both subjective and objective voiding parameters in most patients; however, long-term follow-up is required, particularly during the first 2 years after treatment initiation.

1. Xu J., Han B., Xia S., Jing Y. Beyond size: A comprehensive overview of small-volume benign prostatic hyperplasia. Curr Urol. 2025;19(1):1-5. DOI: 10.1097/CU9.0000000000000261

2. Chuang S.H, Kor C.T, Tseng P.H, Chang C.P, Shih H.J, Pan Y., Huang S.H. Risk Factors for Bladder Neck Contracture following Transurethral Resection of the Prostate in Patients with Benign Prostatic Enlargement. Urol Int. 2024;108(5):442-448. DOI: 10.1159/000539296

3. Ren Y., Wu M., Jia L., Rui H. Bladder neck contracture: incidence, mechanisms, and therapeutic advances. Ann Med Surg (Lond). 2025;87(11):7378-7389. DOI: 10.1097/MS9.0000000000003930

4. Qian Y.X, Liu S.Y, Wang X.J, Xia S.J. [A new understanding of wound repair after surgery for benign prostatic hyperplasia]. Zhonghua Yi Xue Za Zhi. 2023;103(16):1163-1167. (In Chinese). DOI: 10.3760/cma.j.cn112137-20221213-02636

5. Abbosov S.A, Sorokin N.I, Shomarufov A.B, Kadrev A.V, Ugli Nuriddinov K.Z, Mukhtarov S.T, Akilov F.A, Kamalov1 A.A. Bladder Neck Contracture as a Complication of Prostate Surgery: Alternative Treatment Methods and Prospects (Literature Review). Urological Science. 2022;33(2):49-55. DOI: 10.4103/UROS.UROS_127_21

6. Nicholson H.L, Al-Hakeem Y., Maldonado J.J, Tse V. Management of bladder neck stenosis and urethral stricture and stenosis following treatment for prostate cancer. Transl Androl Urol. 2017;6(Suppl 2):S92-S102. DOI: 10.21037/tau.2017.04.33

7. Wu Y., Huang L., Liu C., Bai S., Chen Y., Bao Q., Luo X., Zhu J., Fu W., Zheng J., Jiang Z., Sun B. Analysis of risk factors for bladder neck contracture after transurethral endoscopic surgery for benign prostatic hyperplasia. Aging Male. 2024;27(1):2429456. DOI: 10.1080/13685538.2024.2429456

8. Elsherif E., Salman B., Abozaid M., Badawy A. Evaluation of perioperative risk factors for bladder neck contracture after bipolar transurethral resection of the prostate. Int Urol Nephrol. 2024;56(12):3791-3796. DOI: 10.1007/s11255-024-04125-2

9. Wu M.H, Liu J.X, Zhang Y.F, Cao Z.B, Song H.C, Yang B.Y, Shi M.J, Du Y., Song J., Li X.H. Bladder neck contracture following transurethral surgery of prostate: a retrospective single-center study. World J Urol. 2024;42(1):14. DOI: 10.1007/s00345-023-04715-2

10. Rosenbaum C., Hook S., Becker B., Netsch C., Filmar S. Blasenhalskontraktur nach operativer Therapie der gutartigen Prostatahyperplasie [Bladder neck contracture after surgery for benigne prostate hyperplasia]. Aktuelle Urol. 2025;56(5):451-455. (In German). DOI: 10.1055/a-2645-6997

11. Katibov M.I., Bogdanov A.B., Alibekov M.M., Magomedov Z.M., Dovlatov Z.A. Thulium laser treatment of benign bladder neck stenosis. Urology Herald. 2023;11(4):44-51. (In Russian). DOI: 10.21886/2308-6424-2023-11-4-44-51

12. Rosenbaum C.M, Vetterlein M.W, Fisch M., Reiss P., Worst T.S, Kranz J., Steffens J., Kluth L.A, Pfalzgraf D. On Behalf Of The Trauma And Reconstructive Urology Working Party Of The European Association Of Urology Eau Young Academic Urologists Yau. Contemporary Outcomes after Transurethral Procedures for Bladder Neck Contracture Following Endoscopic Treatment of Benign Prostatic Hyperplasia. J Clin Med. 2021;10(13):2884. DOI: 10.3390/jcm10132884

13. Ramirez D., Zhao L.C, Bagrodia A., Scott J.F, Hudak S.J, Morey A.F. Deep lateral transurethral incisions for recurrent bladder neck contracture: promising 5-year experience using a standardized approach. Urology. 2013;82(6):1430-1435. DOI: 10.1016/j.urology.2013.08.018

14. Sun J., Xia S.Q, Tong Z., Xiao D.D, Chen B. Transurethral columnar balloon dilation of the prostate combined with holmium laser incision for bladder neck contracture in day-surgery mode. Lasers Med Sci. 2023;38(1):279. DOI: 10.1007/s10103-023-03942-8

15. Nadjimitdinov Y., Abbosov S., Giyasov S., Kamalov A., Akilov F., Mukhtarov S., Vitalevich M., Sorokin N., Alexsandrovich O., Fozilov A., Kadrev A., Shomarufov A. Assessment of the Balloon Dilation Efficiency in Bladder Neck Contracture after Transurethral Interventions on the Prostate. Urological Science. 2022;33(3):130-135. DOI: 10.4103/UROS.UROS_148_21

16. Patent RF na izobretenie RU2725549C1; 2020. Kamalov A.A., Sorokin N.I., Kadrev A.V., Dzitiev V.K., Kamalov D.M., Shaparov B.M., Tivtikyan A.S., Abbosov Sh.A., Pshikhachevi A.M. Method for prevention of bladder neck contracture after endoscopic removal of prostatic hyperplasia. (In Russian). Accessed February 07, 2026. URL: https://patents.google.com/patent/RU2725549C1/ru

17. Abbosov Sh.A., Sorokin N.I., Kadrev A.V., Shomarufov A.B., Nesterova O.Yu., Shaparov B.M., Giyasov Sh.I., Mukhtarov Sh.T., Akilov F.A., Kamalov A.A. The role of balloon dilation in the treatment and prevention of bladder neck contracture. Proceed-ings of the XVIII Congress “Men’s Health”. 2022:145-146. (In Russian). Accessed February 07, 2026. URL: https://kkkvd.ru/wp-content/uploads/COVER_XVIII_KMZ-2022.pdf

18. Abbosov Sh.A., Sorokin N.I., Kadrev A.V., Shomarufov A.B., Strigunov A.A., Kabanova O.O., Nesterova O.Yu., Shaparov B.M., Kamalov А.А. Bladder neck sclerosis: alternative methods of treatment and prospects for their development. Experimental and Clinical Urology. 2021;14(3):94- 99. (In Russian). DOI: 10.29188/2222-8543-2021-14-3-94-99

19. Sindeeva O.A, Abdurashitov A.S, Proshin P.I, Kadrev A.V, Kulikov O.A, Shaparov B.M, Sorokin N.I, Ageev V.P, Pyataev N.A, Kritskiy A., Tishin A., Kamalov A.A, Sukhorukov GB. Ultrasound-Triggerable Coatings for Foley Catheter Balloons for Local Release of Anti-Inflammatory Drugs during Bladder Neck Dilation. Pharmaceutics. 2022;14(10):2186. DOI: 10.3390/pharmaceutics14102186

20. Patent RF na izobretenie RU2826592C1; 2024. Kamalov A.A., Sorokin N.I., Kadrev A.V., Shaparov B.M. Method for the prevention of recurrent blad-der neck contracture after endoscopic removal of prostatic hyperplasia. (In Russian). Accessed February 07, 2026. URL: https://patents.google.com/patent/RU2826592C1/ru

21. Kamalov A.A., Sorokin N.I., Kadrev A.V., Shaparov B.M., Afanasevskaya E.V., Sindeeva O.A., Sukhorukov G.B., Kritsky A.A., Pyataev N.A., Abdurashitov A.S., Kulikov O.A., Proshin P.I. The use of a urethral catheter with an ultrasound-induced biopolymer drug coating for the prevention of recurrent bladder neck sclerosis in patients after endoscopic treatment of benign prostate hyperplasia. Urologiia. 2023;(6):145-150. (In Russian). DOI: 10.18565/urology.2023.6.145-150

22. Patent RF na izobretenie RU2803575C1; 2023. Kamalov A.A., Sorokin N.I., Kadrev A.V., Shaparov B.M., Afanas'evskaya E.V., Strigunov A.A., Kritskii A.A., Sukhorukov G.B., Pyataev N.A., Proshin P.I., Sindeeva O.A., Abdurashitov A.S. Method for the prevention of bladder neck con-tracture after endoscopic removal of prostatic hyperplasia. (In Russian). Accessed February 07, 2026. URL: https://patents.google.com/patent/RU2803575C1/ru

23. Abbosov Sh.A., Shomarufov A.B., Aminova D.R. Transurethral balloon dilation safety and efficacy in patients with recurrent bladder neck contracture after transurethral interventions. Urology Herald. 2024;12(4):5-13. (In Russian). DOI: 10.21886/2308-6424-2024-12-4-5-13

24. Abbosov Sh.A., Okhobotov D.A., Sorokin N.I., Shomarufov A.B., Shaparov B.M., Nadzhimitdinov Ya.S., Mukhtarov Sh.T., Akilov F.A., Kamalov A.A. Balloon dilatation of cicatricial bladder neck contracture: evaluation of the efficacy after transurethral prostate interventions (preliminary results). Urology Herald. 2021;9(1):5-13. (In Russian). DOI: 10.21886/2308-6424-2021-9-1-5-13

25. Abbosov Sh.A. The role of balloon dilation in the treatment and prevention of bladder neck contracture [dissertation]. Moscow; 2023. (In Russian). Accessed February 07, 2026. URL: https://www.dissercat.com/content/rol-ballonnoi-dilatatsii-vlechenii-i-profilaktike-rubtsovoi-deformatsii-sheiki-mochevogo

26. Berg E.K, Mehmedovic S., Askari D., Hermans J., Hoffmann M.A, Keller P., Marcon J., Weinhold P., Stief C.G, Eismann L., Bischoff R. Efficacy of Drug-coated Balloon Dilation Versus Endoscopic Standard Treatment in Posterior Urethral Stenosis: A Real-world Comparative Study. Urology. 2025;206:164-170. DOI: 10.1016/j.urology.2025.07.034

27. Fauconnier S., Waterloos M., Verla W; Trauma and Reconstructive Urology Working Party of the European Association of Urology Young Academic Urologists. Post-prostate-treatment stenosis and bladder neck contracture: reconstructive options and continence trade-offs. Curr Opin Urol. 2026;36(4):349-353. DOI: 10.1097/MOU.0000000000001402

28. Castellani D., Stramucci S., Enganti B., Lane J., Kumar S., Tanidir Y., Farré A., Soebhali B., Malkhasyan V., Gadzhiev N., Zawadzki M.A, Maheshwari P.N, Fong K.Y, Pirola G.M, Naselli A., Anand A., Bhadranavar S.K, Somani B.K, Galosi A.B, Gauhar V. One-Year Outcomes of Transurethral Treatment of Bladder Neck Stenosis Following Transurethral Resection of the Prostate. Results from a Large, Multicenter Series. Int J Gen Med. 2024;17:1967-1974. DOI: 10.2147/IJGM.S459441

29. Nealon S.W, Bhanvadia R.R, Badkhshan S., Sanders S.C, Hudak S.J,

30. Morey AF. Transurethral Incisions for Bladder Neck Contracture: Comparable Results without Intralesional Injections. J Clin Med. 2022;11(15):4355. DOI: 10.3390/jcm11154355