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

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 < 0.001). Efficacy remained stable between 3 and 6 months (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.