經尿道切開合併 PRP 注射治療骨盆腔化放療後複雜性膀胱出口阻塞：

病例報告

黃建翔、余家政、王大齊

高雄榮民總醫院 外科部 泌尿外科

Refractory Urinary Retention after Pelvic Chemoradiotherapy: A Case of Bladder Outlet Obstruction Treated by Transurethral Incision and PRP Injection

Chien-Hsiang Huang, Chia-Cheng Yu, Ta-Chyi Wang

Divisions of Urology, Department of Surgery, Kaohsiung Veterans General Hospital

Introduction

Pelvic CCRT can lead to chronic lower urinary tract dysfunction (LUTD) through obliterative endarteritis, causing tissue hypoxia and progressive fibrosis. These changes often manifest as urethral stricture or bladder neck contracture (BNC). Management is challenging when detrusor function is preserved but the outlet is non-compliant, leading to a "devastated bladder outlet" scenario

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Case Presentation

A 73-year-old female with a history of mucinous adenocarcinoma of the anal canal (ypT4bN0M0, stage IIIB) underwent APR and adjuvant CCRT. She subsequently suffered from refractory urinary retention for 4 years. Videourodynamic study (VUDS) performed in May 2025 showed a bladder capacity of 230 mL and residual urine of 220 mL, with no effective voiding despite normal detrusor reflexia. Cystoscopy confirmed severe urethral stricture and BNC. In December 2025, she underwent TUIBN and PRP injection. Postoperatively, her voiding function improved significantly, and symptoms of nocturia were managed with desmopressin.

Discussion

Precision Diagnosis via VUDS: VUDS is essential to differentiate between detrusor underactivity and BOO. In this case, VUDS successfully identified that the retention was due to outlet obstruction rather than bladder failure, guiding the decision for surgical intervention.Regenerative Therapy (PRP): PRP contains high concentrations of growth factors (TGF-β, VEGF) that promote angiogenesis and wound healing. It may serve as an adjunctive therapy to reduce the recurrence of strictures and combat radiation-induced fibrosis.

Management Algorithm: Current guidelines suggest conservative management first, followed by endoscopic or reconstructive surgery for refractory cases of radiation-induced cystopathy and urethritis.

Conclusion

In patients presenting with refractory urinary retention following pelvic CCRT, a thorough evaluation using VUDS is critical to accurately pinpoint the site of obstruction. This case demonstrates that the combination of TUIBN and PRP injection is a feasible multimodal strategy. By simultaneously relieving mechanical obstruction and addressing radiation-induced tissue damage through regenerative therapy, clinicians can restore voiding function and significantly enhance the quality of life for this challenging patient population.