A double-blind trial on the effect of alpha-adrenergic blocker (bunazosin hydrochloride) in the symptomatic treatment of prostatism

A double-blind placebo-controlled study of bunazosin for the treatment of symptomatic prostatism is reported, incorporating urologic departments of 25 hospitals. Four different doses of bunazosin hydrochloride was administrated orally to 174 patients having benign prostatic hyperplasia and 31 with bladder neck contracture for a period of four weeks; high dose group (45 patients, 3 mg/day for the first week followed by 4.5 mg/day for the next three weeks), middle dose group (45 patients, from 1.5 mg/day for the first week to 3.0 mg/day for the next three), low dose group (39 patient, 0.15 mg/day for the first to 1.5 mg/day for the next three) and a control group (40 patients, 0.125 mg/day for the entire four weeks). Subjective symptoms (urinary frequency, retarded urination, prolonged urination, condition of urinary stream and abdominal pressure at voiding) and objective signs (residual ratio, maximum and mean flow rate, voiding time) were observed and analyzed statistically. No bias in the background features was confirmed between any of the four groups. The subjective improvement rates evaluated by the attending doctors demonstrated a significant dose-dependent efficacy of bunazosin by H-test (p less than 0.01), although the objective improvement rates revealed no significant difference between any of the four groups. The global improvement rate evaluated by the same means demonstrated that the middle dose group was significantly superior to the control group (p less than 0.05 by U-test). According to each subjective symptom evaluated by the criteria of the drug efficacy, a dose-dependent significant (p less than 0.01) was noticed between the four groups in the improvement of the voiding condition. Although there was no significant difference by use of the H-test, the middle dose group had a significant superiority to the control group in the improvement rate of retarded voiding by use of the U-test (p less than 0.05). Only in the symptomatic cases of prolonged voiding, were dose-dependent significant differences observed between all four groups by use of the H-test (p less than 0.05). On the other hand, there was no significant difference between the four groups in the subjective or global improvement rates. Judging from the real data and the graded classification of objective signs, the high and middle dose groups were significantly superior to the control in terms of voiding time, and the high and low dose groups were the same as the control for residual urine ratio.(ABSTRACT TRUNCATED AT 400 WORDS)     

Clinical study of bunazosin hydrochloride, an alpha 1-adrenergic blocker, in benign prostatic obstruction and neurogenic bladder dysfunction

A newly developed alpha 1-adrenergic blocker, bunazosin hydrochloride (Detantol, Eisai) was clinically investigated in 17 patients with benign prostatic obstruction and 18 patients with neurogenic bladder dysfunction. Subjective symptoms improved in 11 of the 17 cases (64.7%) with prostatic obstruction and in 4 of the 10 cases (40%) with neurogenic bladder dysfunction. Dose-dependent subjective improvement was observed with dosages of 3 to 9 mg/day. A dosage of 12 mg/day did not improve subjective symptoms more than did the 9 mg/day dose. In prostatic obstruction, 7 of the 10 objective parameters improved significantly. However, for neurogenic bladder dysfunction, only two parameters improved significantly. Improvements in objective findings were generally dose-dependent in cases of prostatic obstruction, but not in neurogenic bladder dysfunction. Mild side effects, none of them serious, were reported in 9 of the total 35 cases (26%). They generally consisted of dizziness, nasal obstruction and headache. Comprehensive improvement, i.e., improvement of both subjective symptoms and objective parameters, occurred in 11 of the 17 cases (64.7%) of prostatic obstruction and 6 of the 18 cases (33.3%) of neurogenic bladder dysfunction.     

A double-blind trial on the effect of bunazosin hydrochloride for the symptoms of benign prostatic hypertrophy]

A multicenter clinical trial was carried out on 372 patients in double-blind conditions in order to determine the clinical effects of Ea-0643 (bunazosin hydrochloride) on voiding disorders in benign prostatic hypertrophy, compared with paraprost and placebo. Of the 372 patients, 129 were assigned to bunazosin hydrochloride, 118 to paraprost and 125 to placebo. The improvement rating for all five subjective symptoms improved with passage of time in all the bunazosin hydrochloride, paraprost and placebo groups. A higher improvement rating was obtained in the bunazosin hydrochloride group for retarded urination, urinary stream condition and abdominal pressure at voiding, while the improvement rating was higher for prolonged urination in the placebo group and for residual urine in the paraprost group, but there was no significant difference in improvement ratings between the groups. The daily frequency of voiding decreased to a significant extent in the bunazosin hydrochloride and placebo group at week 1, and there was a significant difference between the bunazosin hydrochloride and the paraprost groups and between the placebo and the paraprost groups. The improvement rating for conditions of voiding was higher with the bunazosin hydrochloride group, when "slightly or better improved" cases were taken into account, but there was no difference between the groups. As for objective symptoms, maximum and average flow rate, useful measures for clinical evaluation of drug effects on voiding disorders, were significantly increased, with a decrease to match in residual urine ratio in the bunazosin hydrochloride group. In terms of maximum and average flow rate bunazosin hydrochloride was significantly superior to paraprost at weeks 1 and 2 and superior to placebo at weeks 2 and 4 and at the final evaluation as well. In terms of residual urine ratio bunazosin hydrochloride was superior to both paraprost and placebo. The global improvement rating, as assessed by the U- and chi 2-tests, was significantly higher in the bunazosin hydrochloride group than in the paraprost group, and there was a significant difference in global improvement ratings, as assessed by the chi 2-test, between the placebo and the paraprost groups, when "moderately or better improved" cases were taken into account. The stratified analysis of the prostate glands, subjective symptoms, maximum flow rate and residual urine ratio revealed that in patients with more advanced conditions the bunazosin hydrochloride group showed significantly superior improvement rates than the paraprost and placebo groups.(ABSTRACT TRUNCATED AT 400 WORDS)     

Transrectal longitudinal ultrasonography of the prostate by electronic linear scanning (1)

Transrectal longitudinal ultrasonography of the prostate was done for 20 patients with prostatic diseases, 12 with benign prostatic hypertrophy, 6 with bladder neck contracture, and 2 with chronic prostatitis. The intravesical protrusion of the prostate and the opening of the bladder neck, which can be easily recognized by this method, were discussed in relation to dysuria, using subjective symptoms, residual urine, and uroflowmetry (peak flow rate) as parameters. The former was slightly correlated to dysuria, and the latter was definitely correlated to dysuria.     

The evaluation of the effects of bunazosin hydrochloride in the treatment of prostatic hyperplasia]

Thirty-five patients with prostatic hyperplasia were entered into a randomized controlled study using bunazosin hydrochloride(alpha 1-adrenergic blocker). Eighteen patients were allocated to be treated with an initial dose of 1.5 mg/day (group 1) and 17 patients received an initial dose of 3.0 mg/day (group 2). Subjective symptoms and parameters of urodynamic studies were evaluated after 4 weeks and 12 weeks. There were 5 withdrawals or exclusions within 4 weeks and 6 within 12 weeks. Therefore, 15 patients in group 1 and 15 patients in group 2 were eligible for evaluation at 4 weeks, 12 patients in group 1 and 11 patients in group 2 were eligible for evaluation at 12 weeks. The rates of the improvement in subjective symptoms such as retarded urination, protracted urination, weakened urinary stream, abdominal straining on voiding, and sense of residual urine were 40%, 25% in group 1 and 46.7%, 36.4% in group 2, at 4 weeks and at 12 weeks, respectively. The rate of improvement in objective parameters of the urodynamic study such as voiding volume, residual volume, maximum flow rate and average flow rate were 26.7%, 16.7% in group 1 and 26.7%, 20.0% in group 2, at 4 weeks and at 12 weeks, respectively. Thus, these improvements were not correlated with the dosage of drug. Adverse effects such as diarrhea, mild headache, palpitation and gastric disturbance were observed in 2 patients in group 1, and 3 patients in group 2. In the 24 patients treated with the drug over 12 weeks, there were no specific adverse effects due to prolonged administration. These findings showed that bunazosin hydrochloride is beneficial for the treatment of prostatic hyperplasia, and could be safety administered for a prolonged period of time up to 12 weeks.     

Clinical effect of oxybutynin hydrochloride (1 mg/tablet)

The clinical efficacy of oxybutynin hydrochloride was studied on 21 patients with neurogenic bladder or unstable bladder complaining of urinary frequency, urgency and urgent incontinence. Oxybutynin hydrochloride (1 mg/tablet) was administered orally for 26.7 days, on average, 3 mg per day in 3 and 6 mg per day in 18 patients and the usefulness of this drug was assessed subjectively and objectively. Of 21 patients treated, 9 had neurogenic bladder and 10 had unstable bladder. Urinary frequency was normalized in 6 out of 16 (37.5%), urgency ceased in 6 out of 17 (35.7%) and urgent incontinence disappeared in 9 out of 14 (50%) patients. The mean volume at the first desire to void and the maximum cystometric capacity increased significantly on the cystometrogram after the administration of oxybutynin hydrochloride (p less than 0.01). Furthermore, the maximum vesical pressure decreased significantly (p less than 0.05). The maximum urinary flow rate increased slightly (p less than 0.1) and the residual urine volume significantly increased (p less than 0.05) after medication, although no changes were observed in tidal voiding volume or mean urinary flow rate. Of 20 patients, 9 showed improvement globally (45%), although no subjective or objective improvement was observed in 4 (20%) patients. Marked side effects were observed in 5 cases (two of acute urinary retention, each of increased urgency, residual urine and liver dysfunction), and side effects were seen in 10 of the 21 (47.6%) patients.(ABSTRACT TRUNCATED AT 250 WORDS)     

Clinical evaluation of bunazosin hydrochloride for the treatment of voiding disturbances due to neurogenic bladder--a double-blind study

The therapeutic utility of bunazosin hydrochloride was evaluated by a multi-center (67 hospitals) double-blind controlled study in patients who complained of voiding disturbances due to neurogenic bladder. For means of comparison, bethanechol chloride and placebo were used as reference drugs. Bunazosin hydrochloride was orally administered 1.5 mg per day for the first week and 3.0 mg per day for two weeks thereafter (Group E). Bethanechol chloride 15 mg (Group B) and placebo (Group P) were orally administered three times daily for three weeks. Three hundred and twenty-three cases were subjected to this study. The global improvement rating was analyzed for 244 cases (83 in Group E, 78 in Group B and 83 in Group P). The global utility rating (GUR) was analyzed for 252 cases (84 in Group E, 81 in Group B and 87 in Group P). Three hundred and twenty cases (107 in Group E, 104 in Group B and 109 in Group P) were analyzed with respect to overall safety rating (OSR). The global improvement ratings (excellent and good) were 32.5% in Group E, 28.2% in Group B and 21.2% in Group P. In the evaluation of GUR, Group E was superior to Group P. In addition, the incidence judged to be useless in Group E was significantly lower than that in Group B. There were no differences in OSR among these three groups. In the total evaluation of the subjective symptoms, the rates of improvement were not different among these three groups. In the total evaluation of the objective findings, the improvement rate in Group E was significantly higher than that in Group P. In addition, the deterioration rate in Group E was significantly lower than that in Group B. In objective findings before and after administration of bunazosin hydrochloride (Group E), the volume of residual urine, the rate of residual urine and the average flow rate improved significantly However, the bladder capacity, the maximum resting bladder pressure and the maximum urethral pressure did not change significantly. Bunazosin hydrochloride improved the objective findings regardless of the bladder capacity and the maximum resting bladder pressure. These significant improvements were marked in the neurogenic bladder patients who were able to urinate and in the patients whose urethral pressure was high. There were no differences in the incidence of side effects or in the appearance of abnormal values of laboratory findings in these three groups. Neither specific signs nor serious clinical side effects except those reported previously were observed.(ABSTRACT TRUNCATED AT 400 WORDS)     

A multicenter, fixed-flexible dose study of terazosin hydrochloride in the treatment of symptomatic benign prostatic hypertrophy]

In this study the multicenter, fixed-flexible dose regimen was taken to evaluate the effective dose range of Terazosin for the treatment of micturition disturbance in benign prostatic hypertrophy (BPH) and to clarify the characteristics of patients who are more responsive to Terazosin therapy. After a 1-week washout (placebo) the first two weeks 1 mg/day of Terazosin was administered, then depending on efficacy of subjective symptoms, Terazosin doses were increased up to 2 mg/day and 4 mg/day at intervals of two weeks. After six weeks the final efficacy and safety were assessed. The subjective symptom improvement rate was 18.5% by 1 mg/day, 55.6% by 2 mg/day and 65.4% by 4 mg/day cumulatively. The objective symptom improvement rate were 13.2% by 1 mg/day, 42.1% by 2 mg/day and 50.0% by 4 mg/day cumulatively. The global improvement rate was 14.5% by 1 mg/day, 50.0% by 2 mg/day and 61.8% by 4 mg/day cumulatively. The patients who had a higher subjective symptom score in the lead-in period were more improved rather than those who had a lower score. In objective symptoms, voided volume, maximum flow rate (MFR), MFR nomogram score and average flow rate improved and the ratio of residual urine volume decreased. There was no relationship between clinical improvement on either subjective or objective symptoms and prostatic weight. Adverse reactions, such as dizziness, vertigo, tinnitus, nausea and blurred vision; were seen in 10 cases. In conclusion Terazosin was effective and well tolerated for the treatment of patients who had micturition disturbance with BPH in the dose range of 2 to 4 mg/day.     

经尿道前列腺电切术后膀胱颈挛缩17例诊治分析

目的探讨经尿道前列腺电切术(TURP)后膀胱颈挛缩的手术方法和预防措施。方法对17例膀胱颈挛缩患者临床资料进行回顾性分析。结果经尿道行残留前列腺组织电切术或先用冷刀切开颈部后换用电切刀切除瘢痕组织,术后3个月随访,17例患者症状均改善或消失。结论经尿道腔内治疗TURP术后膀胱颈挛缩是一种安全有效的方法。     

维汉族BPH患者前列腺形态与尿流动力学的相关性

目的 探讨维汉民族前列腺增生患前列腺的体积、症状积分和膀胱排尿症状的相关性。方法 对71例住院手术的维汉不同民族前列腺增生症(BPH)患进行国际前列腺症状评分(BPSS)，生活质量评分(L)，前列腺体积(V)，重量(M)，患年龄(age)，尿流动力学指标的直线相关分析。结果 40例汉族及31例维族BPH患的前列腺体积与膀胱颈压，膀胱颈压与膀胱顺应性，最大尿流率与膀胱顺应性均呈正相关。结论 最大尿流率、前列腺体积、膀胱顺应性、膀胱颈压四个参数不但能了解膀胱排尿功能和形态改变，也可做为临床上手术切除增生前列腺组织，解除梗阻，缓解症状，评价治疗效果的指标。     

Surgery (TUR-P) as a recommended initial treatment modality for the presented case

The pathophysiology of lower urinary tract dysfunction in the presented case comprised voiding dysfunction and overactive bladder. Two etiologies for voiding dysfunction in this case could be considered, bladder outlet obstruction due to benign prostatic hyperplasia (BPH) or detrusor underactivity. Prospected efficacies of pharmacological and surgical treatment (transurethral resection of prostate: TUR-P) for this case were compared based on a literature review. Alpha-1 blockers improve both voiding and storage symptoms in patients with BPH. However, improvement of maximum flow rate (Qmax) on uroflowmetry is limited within a small range and there is no evidence of significant reduction in residual urine volume. Alpha-1 blockers have no significant efficacy in improvement of objective measures in patients with detrusor underactivity. Although anticholinergics improve overactive bladder symptoms, they are contraindicated for patients with severe voiding dysfunction with residual urine. There is a lack of study on efficacy of apha-1 blocker administration combined with anticholinergics available in our hands for patients with BPH and overactive bladder. On the other hand, TUR-P brings remarkable improvement in voiding and storage symptoms, increase of flow rate and reduction of residual urine as a gold-standard surgical treatment for BPH. Urge incontinence and uninhibited detrusor contraction on cystometry reportedly disappeared in 60% of patients following TUR-P. TUR-P also improves subjective symptom and objective measures in patients with BPH and detrusor underactivity. Based on the literature review, surgery is recommended as a standard initial therapy for the presented patient with significant voiding dysfunction (Qmax 9.4 ml/sac and residual urine 72 ml).     

Functional and anatomical effects of hormonally induced experimental prostate growth: a urodynamic model of benign prostatic hyperplasia (BPH) in the beagle

BACKGROUND: Benign prostatic hypertrophy (BPH) produces a variety of changes in the urodynamic pattern of micturition and is usually associated with high detrusor voiding pressure and poor urine flow-rate. In most previous experimental models, designed to simulate this condition, some degree of obstruction is immediately imposed by the technique employed to produce urethral occlusion. Consequently these models cannot reproduce the gradual onset of obstruction. In the present study a canine prostatic enlargement model, using 5alpha-dihydrotestosterone (DHT) + 17beta-estradiol (E) was adapted in order to produce a more gradual onset of partial obstruction and impaired voiding. MATERIALS AND METHODS: Hormonally induced prostatic enlargement was produced using seven beagles, given DHT 75 mg/day together with E 0.75 mg/day for 28 days via an implantable pump. The functional effects of DHT + E treatment on micturition pressure/flow were measured in the conscious animal. Identical measurements were also made using a separate older group of five beagles with symptoms of BPH. In addition seven beagles similarly instrumented were used as controls. RESULTS: Pressure/flow studies show that DHT + E produced obstructive micturition, characterized by a significantly increased micturition detrusor pressure, from 33.3 +/- 10.5 to 50.8 +/- 10.7 cmH(2)O and significantly decreased low urine flow-rate from 8.6 +/- 2.1 to 6.9 +/- 0.9 ml/sec. Associated with the obstructive micturition, this treatment increased wet prostate weight from 11.9 +/- 2.5 to 31.6 +/- 10.0 g. Prostate volume of the BPH beagles was 29.3 +/- 8.9 g. Morphologic studies show that DHT + E produced epithelial hyperplasia extending focally into the lumen. CONCLUSIONS: Hormonally induced prostate growth produced bladder obstruction, in terms of pressure/flow characteristics, that are analogous to BPH. It is suggested that this type of hormonal treatment can be used to create a model for the study of the effects of controlled increased in prostate growth and the development of BPH on micturition.     

Long-term therapy with Robaveron tablet (KN-7) for urinary disturbance

Sixteen patients with benign prostatic hypertrophy (BPH, 5 cases) and neurogenic bladder (NB, 11 cases) were treated with Robaveron tablets (KN-7) containing an extract of swine prostate gland 20 mg/T. at the dose of 2 tablets t.i.d. for a long term of 6-33 months. Evaluation of drug efficacy and safety were based on decrease of residual urine, improvement of subjective symptoms, complaints of side effects and clinical laboratory tests recorded every three months. Significant decrease of residual urine rate and good improvement of various subjective symptoms such as difficulty in urination, pollakisuria, urinary incontinence, etc. were obtained and maintained. The overall effectiveness, rated as slightly improved or better on the final evaluation of these cases was 68.8%. No cases of side effects or abnormal changes in the laboratory tests directly due to the test drug were observed. Robaveron tablet is both safe and effective for the long-term therapy of urinary disturbance.     

Uroflowmetry of males over 50 years old--analysis of the mass examination of the prostate

The uroflowmetry of a total of 533 males over 50 years old, who had undergone a mass examination of the prostate in Tanno Town, Hokkaido Prefecture in 1982, and 1985, was studied. These subjects were divided into 4 groups, i.e., those 50 to 69 years old and those over 70 years old and those with and without prostatic hypertrophy by rectal palpation, the relationship between voided volume and flow rate was examined. Subjects without prostatic hypertrophy by rectal palpation in the older group showed markedly lower flow rate rate than the younger group and subjects with prostatic hypertrophy in the younger group had a lower flow rate than the older group. Thus, urinary disturbance in elderly men was supposed to occur due to aging changes such as benign prostatic hypertrophy and bladder neck contracture.     

Clinical effects of oxybutynin hydrochloride on neurogenic bladder

Clinical effects of oxybutynin hydrochloride on lower urinary tract function at a dosage of 2 mg given orally three times daily (6 mg/day), were studied on 10 patients with neurogenic bladder by cystometry and measurement of residual urine. There was a significant increase, of about 34% in FDV, but no significant changes in MBV, or maximum voiding pressure of residual urine after administration. Urinary frequency, incontinence and urgency in subjective symptoms were decreased in patients given this drug. The effective rate (excellent and good) was 50% in global evaluation. Side effects were observed in 4 out of 10 patients; 3 had dry mouth and 1 had diarrhea. There were no serious side effects. These findings suggested that oxybutynin hydrochloride may be a useful drug for neurogenic bladder.     

Clinical effects of distigmine bromide (Ubretid), a cholinesterase inhibitor, on micturition disturbance by benign prostatic hypertrophy--comparative study of distigmine bromide and the combination of distigmine bromide and adrenergic blocker]

We report the results of a comparative study on the clinical efficacy of the single use of distigmine bromide and its combined use with prazosin hydrochloride in the treatment of benign prostatic hypertrophy. The single use and combined use groups were administered 10 mg/day of distigmine bromide and the same with 1 mg/day of prazosin hydrochloride for a period of 8 weeks respectively. In the single administration group, marked improvement was found in one patient (9%), moderate improvement in 4 patients (36.3%), slight improvement in 3 patients (27.2%) and aggravation in 3 patients. In the combined use group, marked improvement was found in one patient (11.0%), moderate improvement in 5 patients (55.5%), and slight improvement in 3 patients (33.3%). No significant differences were found in the improvement rate between the two groups. However, significant improvements were found in both groups for the subjective symptoms of urinary disturbance, diurnal and nocturnal frequency. As a result of the examination of objective findings, a significant decrease in residual urine ratio was also shown in both groups, while significant improvement for average flow and maximum flow rates were found in only the combined use group. In conclusion, distigmine bromide and distigmine bromide+prazosin hydrochloride are considered very useful for the treatment of miturition disturbance due to benign prostatic hypertrophy.     

Effect of terazosin on urine storage and voiding in the aging male with prostatism

Patients in a private practice. evaluated for prostatism due to benign prostatic hypertrophy were offered the options of medical treatment with the alpha blocker terazosin, surgical treatment, or continued observation. Nineteen men accepted terazosin treatment and are the subjects of the present series. They were treated over a mean period of 8 months, the longest treatment lasting over 22 months. Dosage was started at 1 mg/d and increased as tolerated to 2.5, and 10 mg/d over the test period. Extensive testing including invasive urodynamics, multiple voiding diaries, and symptoms scores at each dosage level was carried out. We found that flow rales increased moderately from baseline in a dose dependent fashion. At the 10 mg/d dosage some patients achieved flow rates in the low normal range. Patients on treatment documented a decrease in the number of voidings per day, a decrease in nocturia, an increase in bladder capacity and the volume of each voiding. On the other hand, patients frequently did not appreciate changes in their voiding patterns, as reflected in their responses to the symptom questionnaires. We could not demonstrate significant changes in bladder pressures on cystometry either during filling or voiding. Our data suggested that terazosin may well have a direct effect on the fundus of the aging bladder to increase capacity, and, through the well-known relationship between voided volume and flow rate, increase urinary flow rate. © 1994 Wiley-Liss, Inc.     

A double-blind trial of the effects of candicidin on patients with benign prostatic hypertrophy.

62 patients with benign prostatic hypertrophy, leading to bladder outflow obstruction, took part in a randomised double-blind trial. Those patients in the treatment group took 6 capsules of a polyene macrolide, candicidin, each day (300 mg daily dose). Subjective improvement was noted in both the treated and the control group. This improvement was not confirmed by pressure flow analysis of micturition. The results of this trial do not support the view that candicidin is a useful drug in the treatment of benign prostatic hypertrophy.     

Clinical experience with oxendolone for treatment of benign prostatic hyperplasia. Clinical efficacy and effects on serum lipid and lipoprotein fraction levels

Forty-three patients with benign prostatic hyperplasia were treated with weekly i.m. injections of 400 mg oxendolone for 12 weeks. The subjective symptoms were improved in 83% of these patients. Residual urine was decreased significantly and Qmax was increased by this treatment. Serum VLDL level was suppressed significantly, whereas the levels of LDL, total cholesterol, HDL-cholesterol and triglycerides were changed little. Atherosclerotic index and the ratio of (total cholesterol--HDL-cholesterol) to (HDL-cholesterol), was not influenced by the treatment. No severe side-effect was found. These findings suggest that oxendolone is the drug of choice for non-surgical treatment of benign prostatic hyperplasia.     

Neodymium:YAG laser treatment of bladder neck contracture following prostatectomy.

A total of 21 patients with postprostatectomy bladder neck contracture underwent treatment with Nd:YAG laser irradiation. A new 800-microns hemispherical optical quarz fiber was used in contact technique to produce linear incisions in the scarred tissue. Within 11.2 months, median of follow-up, there was improvement in the obstructive voiding symptoms in all the patients. Two patients who had still mild contracture in the first follow-up cystoscopy were managed successfully with a second treatment. Endoscopic application of laser energy in the contact mode enables the immediate vaporization and disintegration of the fibrous area and secondary reepithelization of the bladder neck without scarring.