Optilume Drug-Coated Balloon for Bladder Neck Contracture Following Pulsed Thulium:YAG Laser Enucleation of the Prostate: A Single-Institution Retrospective Case Series

Purpose: Bladder neck contracture (BNC) following anatomical endoscopic enucleation of the prostate (AEEP) occurs in approximately 3% of cases and carries high recurrence rates after standard endoscopic management. The Optilume drug-coated balloon (DCB) delivers paclitaxel at dilation but has not been reported for post-enucleation BNC. We describe the first such series following pulsed thulium laser enucleation of the prostate (p-ThuLEP). Patients and Methods: We retrospectively reviewed 10 consecutive patients with cystoscopically confirmed BNC after p-ThuLEP at a single high-volume center (IRB 2425566-1). All underwent laser enucleation of bladder neck scar followed by Optilume DCB dilation. Data were abstracted from the electronic health record. Results: Median age was 74 years (range 59–89). Median pre-p-ThuLEP prostate volume was 80 cc (range 36–100, n = 8). BNC presented at a median of 5.8 months after p-ThuLEP (range 2.7–12.0). A 36F balloon was used in nine patients and a 26F balloon in one, at 8 to 11 atm for 5 minutes. At a median follow-up of 5.2 months (range 0.9–15.1), no patient required reintervention (0% recurrence). Cystoscopy, performed in 5 of 10 on clinical indication, showed a patent bladder neck in all. Median post-procedure Qmax was 14.1 mL/s ( n = 7), and post-void residual was 23.5 mL ( n = 10). Thirty-day complications after Optilume occurred in two patients (20%), both Clavien–Dindo Grade II: gross hematuria with clot retention managed by continuous bladder irrigation and urinary tract infection. Conclusions: Optilume DCB following laser enucleation of post-p-ThuLEP BNC appears safe and feasible with encouraging short-term patency. Median follow-up (5.2 months) is shorter than the median interval to BNC presentation (5.8 months); thus, these short-term data do not establish durability. To the best of the authors’ knowledge, this is the first report of Optilume DCB outcomes for BNC specifically following AEEP. A prospective cohort trial with longer follow-up is warranted.