Experience of transurethral incision of the bladder neck for female primary bladder neck obstruction

Abstract

Objective To analyse and discuss the outcomes of female primary bladder neck obstruction(PBNO) with transurethral incision of the bladder neck(TUIBN). Methods From January 2004 to December 2013, 38 female patients who underwent transurethral incision of the bladder neck were retrospectively reviewed. The mean age of patients was 57.7 years and the duration of symptoms before diagnosis was 3.5 years. All patients presented with varying degree of difficulty of urination. There were 10 cases with lower abdominal discomfort and 20 cases with history of urinary infection. Preoperative examinations included physical examination, urine routine, international prostate symptom score (IPSS), quality of life (QOL), ultrasonography, urodynamics and cystoscopy. The urodynamic diagnostic criteria for PBNO were a maximum uroflow rate(Qmax) 20 cmH2O. All patients failed with 3-6 month alpha-blockers treatment and then underwent TUIBN. Results Follow-up data of all patients were available for 12-60 months (average 29.6) after operation. Successful recovery after operation was achieved in 33 of 38 (86.84 %). At the first year follow-up, the IPSS decreased from 26.63±3.15 to 13.00±7.18 (P<0.01), the Qmax increased from (8.65±1.32) ml/s to (15.91±3.89) ml/s (P<0.01), the postvoid residual decreased from (122.92±58.36) ml to (56.55±36.57) ml (P<0.01), and the Pdet.Qmax decreased from (52.18±7.31) cmH2O to (36.12±4.74) cmH2O (P<0.01), respectively. Of the 5 cases in which the first operation was not successful, 3 cases (7.89%) underwent an additional TUIBN 1 to 2 years after the initial operation and 2 cases detected bilateral renal hydronephrosis by B-ultrasound before operation underwent life-long catheter cystostomy. The second operation of 3 cases was successful. Pathological examinations revealed fibrous tissue hyperplasia with chronic inflammation in 32 cases, glandular cystitis in 4 cases and chronic inflammation with squmaors metaplasia in 2 cases. Conclusions The diagnosis of primary bladder neck obstruction in women is based on typical symptoms, urodynamics and cystoscopy. TUIBN is a safe and effective therapy for PBNO. Key words: Bladder neck obstruction; Transurethral; Voiding dysfunction