Controlled transurethral resection and incision of the bladder neck to treat female primary bladder neck obstruction: Description of a novel surgical procedure

Abstract

The novel technique described here shortens the length of the urethra to 2.5 cm, which both released the obstruction and maintained continence. The results of the present preliminary study show that this method represents a safe and effective treatment for female primary bladder neck obstruction.

European Association of Urology Guidelines on the Management of Female Non-neurogenic Lower Urinary Tract Symptoms. Part 2: Underactive Bladder, Bladder Outlet Obstruction, and Nocturia

“…A review of case studies on bladder neck incision for the treatment of bladder neck obstruction in women reported success rates of 76-100% [45]. Several prospective case series consistently reported significant improvements in IPSS, QoL, Q max , P det Q max , and PVR after treatment, regardless of the site of the incision, type of energy used, or length of follow-up [74][75][76][77]. Complications reported included VVF (3.6%), SUI (4.7%), and urethral stricture (3.6%).…”

Clinical and videourodynamic study characteristics in female primary bladder neck obstruction and outcomes of bladder neck resection: A tertiary care center experience in India

“…enrolled 59 patients of female PBNO in their study for controlled transurethral resection and incision of the bladder neck after they failed medical management with alpha blockers for a period of 3 months. [ 9 ] In our study too, seven out of 10 patients (70%) underwent surgery because of failure of conservative strategy. Medical management may not be an effective option in the context of female PBNO because the smooth muscles of female bladder neck and urethra are usually poorer in alpha receptors than the males and hence a pronounced effect of alpha blockers in relieving the functional obstruction in women cannot be achieved.…”

“…They hypothesized that this procedure shortens the length of the urethra to 2.5 cm which both released the obstruction and maintained continence. [ 9 ]…”

Benefits and harms of conservative, pharmacological, and surgical management options for women with bladder outlet obstruction: A systematic review from the European Association of Urology non-neurogenic female LUTS guidelines panel

“…Six prospective non comparative studies evaluating transurethral bladder neck incision were found [17,21,24,26,30,33]. The rates of cure or reduction of obstruction ranged from 91% to 100% with significant improvement of PVR, Qmax, IPSS and IPSS-qol at 1 to 12 months in all of these five studies certainty of evidence: very low [17,21,24,26,33]. Two studies reported sustained efficacy with significant improvement of PVR, Qmax, IPSS and IPSS-qol after 1 to 5 years certainty of evidence: very low [24,26].…”

“…The only complication reported was de novo SUI with rates ranging from 3.3% to 9.1% certainty of evidence: very low [17,21,24,26,33].…”