Modified Transurethral Incision of the Bladder Neck Treating Primary Bladder Neck Obstruction in Young Men: A Method to Improve Voiding Function and to Preserve Antegrade Ejaculation

Abstract

Objectives: To evaluate the voiding function, ejaculation status and sexual function after the novel modification of transurethral incision of the bladder neck (TIBN) treating young men with primary bladder neck obstruction (PBNO). Methods: Using a videourodynamic study, PBNO was diagnosed in 33 young men 27–50 years of age who presented with chronic lower urinary tract symptoms and low urinary flow. TIBN was performed in all patients, with the modification of preserving a portion of the supramontanal tissue during the procedure. International Prostate Symptom Score (I-PSS), quality of life, uroflowmetry, postvoid residual urine, the status of ejaculation and sexual function using the 5-item version of the International Index of Erectile Function (IIEF-5) were assessed before, 3 and 24 months after treatment. Results: Follow-up data were available in 32 (97%) and 26 (79%) patients at 3 and 24 months postoperatively, respectively. During the 2-year follow-up, mean I-PSS decreased from 20.7 to 5.9 (p < 0.01). Mean quality of life decreased from 4.2 to 2.3 (p < 0.01). Mean maximum flow increased from 10.7 to 19.2 ml/s (p < 0.01). Mean postvoiding residual urine decreased from 107 to 48 ml (p < 0.01). All patients had antegrade ejaculation postoperatively. Mean IIEF scores did not change significantly (22.6 ± 2.6 vs. 20.7 ± 4.3, p = 0.08). Successful overall outcome was achieved in 22 (84.6%) of 26 patients. Conclusions: Applying thismodified TIBN to treat the sexually active young men with PBNO had the advantage of improving voiding function and preserving both antegrade ejaculation and sexual function.

OnabotulinumtoxinA injection therapy in men with LUTS due to primary bladder‐neck dysfunction: Objective and patient‐reported outcomes

“…The TUIBN has the advantage of sustained long‐term benefit without the need of re‐do procedures. However, the main concern with this invasive treatment is the development of retrograde ejaculation in 11–27% of patients, although modifications of the technique have been reported to allow avoiding this troublesome dysfunction . Significant risk of reduced sperm counts has been reported also after modified, unilateral TUIBN …”

Role of Bladder Dysfunction in Men with Lower Urinary Tract Symptoms Refractory to Alpha‐blocker Therapy: A Video‐urodynamic Analysis

“…In younger patients with LUTS and a small TPV, BND or PRES could be responsible for the LUTS. Surgical intervention should be carefully considered in patients with PRES while transurethral incision of the prostate may be adequate to preserve ejaculatory function in these young men . On the other hand, in older patients with a small TPV, diagnosis of DO, DU or DHIC should be considered.…”

“…Surgical intervention should be carefully considered in patients with PRES while transurethral incision of the prostate may be adequate to preserve ejaculatory function in these young men. 19 On the other hand, in older patients with a small TPV, diagnosis of DO, DU or DHIC should be considered. Surgical intervention such as TURP should be carefully evaluated when treatment with alpha-blockers has failed.…”

“…This retrospective study included male patients (aged ≥40 years) with LUTS and an IPSS of 8 or more who were treated for LUTS from January 2000 to December 2014. Only patients with a moderate IPSS (scoring [8][9][10][11][12][13][14][15][16][17][18][19][20] and a quality of life index greater than 3 were included in this study. 5 All patients underwent transrectal sonography of the prostate to measure the total prostate volume (TPV) and calculate the transition zone index.…”

Effects of posterior urethral valves on long-term bladder and sexual function

“…82 In a study of men who had undergone BNI for outflow obstruction rather than PUV, 47 of 61 men retained normal antegrade ejaculation, although reduced semen volume was noted in 11 men and retrograde ejaculation in three. 83 Yang et al 84 reported antegrade ejaculation in all 32 patients who underwent the modi fied BNI procedure (ending 0.5-1.0 cm proximal to the verumontanum). Consistently, no difference in sexual function or paternity rates were found in our study of men with PUV who had or had not undergone BNI.…”