Endoscopic incision for functional bladder neck obstruction in men: long-term outcome

Efficacy of single and repeated transurethral bladder neck incisions for female voiding dysfunction

OBJECTIVE

This study aimed to assess the efficacy of single and repeat transurethral bladder neck incision (TUI-BN) for female voiding dysfunction caused by bladder outlet obstruction (BNO). Further, the predictive factors associated with better treatment outcomes were identified.

METHODS

Women with voiding difficulty due to BNO who underwent TUI-BN were included in this research. All patients underwent videourodynamics study at baseline and after TUI-BN. Successful outcome was defined as a voiding efficiency of ≥ 66.7% and a global response assessment score of ≥ 2 after treatment. Repeat TUI-BN was considered for patients with insufficient improvement. The outcomes of repeat surgery, surgical complications, and predictive factors of successful outcomes were evaluated.

RESULTS

In total 158 cases, the success rates were 61.4% and 45.2% after the first and second TUI-BN, respectively, with an overall cumulative rate of 70.3%. The success rates were comparable between patients with detrusor underactivity (DU) and those without (54.9% vs. 68.4%). The absence of a previous history of suburethral sling and a high baseline corrected maximum flow rate were a significant predictor of favorable outcomes. The cumulative rate of regaining self-voiding function was 95.1%. The incidence rates of vesico-vaginal fistula and de novo stress urinary incontinence requiring surgery were 1.2% and 2.5%, respectively.

CONCLUSIONS

Regardless of the presence of DU, TUI-BN is effective against female voiding dysfunction caused by BNO. Repeat procedures are beneficial and can improve self-voiding function. A high corrected maximum flow rate and the absence of a previous history of suburethral sling can contribute to greater success rates.

Transurethral incision of the bladder neck improves voiding efficiency in female patients with detrusor underactivity

INTRODUCTION AND HYPOTHESIS

Detrusor underactivity (DU) is a common urologic problem and usually presents with urine retention or large postvoid residual (PVR). Medical treatment of DU does not always achieve satisfactory results. We report the surgical outcomes of transurethral incision of the bladder neck (TUI-BN) in women with DU and urine retention.

METHODS

A total 31 woman with DU in whom medical treatment failed underwent TUI-BN and were retrospectively studied. Surgical outcome was determined by postoperative urodynamic studies and clinical presentation. Patients with postoperative voiding efficiency of >67% had excellent outcomes, those with 33-66% had moderate results, and those with <33% had poor surgical outcomes.

RESULT

PVR, voiding efficiency, and maximum urinary flow rate (Qmax) significantly improved after TUI-BN. PVR decreased by 56.3% overall. Intermittent catheterization was needed in 27 patients before surgery and in only seven after TUI-BN. There were 14 (45.2%), 11 (35.5%), and six (19.3%) patients with excellent, moderate, and poor surgical outcomes, respectively. Baseline urodynamic parameters, age, and etiologies did not impact surgical outcome. Three patients developed transient urinary incontinence, and one developed vesicovaginal fistula after TUI-BN.

CONCLUSION

TUI-BN is an effective procedure to improve PVR, Qmax, and voiding efficiency in women with DU and urine retention. The procedure is safe and effective, even in patients with medical treatment failure, those with large PVR at baseline, and those with different etiologies.

Efficacy of bladder neck incision on urodynamic abnormalities in patients with posterior urethral valves

PURPOSE

This study aims to study the efficacy of simultaneous endoscopic bladder neck incision (BNI) and primary endoscopic valve incision (PEVI) in patients with posterior urethral valves (PUV).

MATERIALS AND METHODS

Nine PUV patients underwent PEVI and BNI over a year. They were compared to nine comparable historical controls that had undergone only PEVI. Trends in renal function tests, urodynamics and changes in the upper urinary tracts were evaluated after 3 months during which no pharmacotherapy was given.

RESULTS

The incidence of bladder dysfunction in the two groups was similar-55.5 % in case group and 66.6 % in control group. Hypocompliant, high-pressure bladder was the predominant cystometric finding in both groups. Three patients in the case group and two patients in the control group had high end infusion pressure (EIP) with poor compliance. Detrusor overactivity (DOA) was seen in 23.1 % patients in the case group as compared to 55.5 % patients in the control group (P = 0.3348). Five patients in both groups were later started on anticholinergics due to raised EIP, small capacity bladder and/or DOA.

CONCLUSION

Although BNI should theoretically improve the outcome of PUV patients, the current pilot study failed to demonstrate any significant difference. A larger sample size and longer follow-up are required to prove or disprove its efficacy.