Transurethral Incision of the Bladder Neck Using KTP in the Treatment of Bladder Neck Obstruction in Women

Abstract

Objectives: To study the results and complications of the potassium-titanyl-phosphate (KTP, green) laser during transurethral incision of the bladder neck in the treatment of female voiding dysfunction due to bladder neck obstruction. Methods: A total of 40 women (43–79 years of age) with obstruction were identified. Patients with neurogenic, traumatic, or iatrogenic causes of obstruction were excluded. Preoperative investigations included a full urodynamic examination and urethrocystoscopy. Transurethral bladder neck incision with KTP was performed in all patients. Urodynamic results, clinical improvements in voiding symptoms, and volume of bleeding were assessed. Results: Of the 40 patients, 12 had chronic urinary retention and 28 had difficult micturition. The most common findings on urodynamic study were a high voiding pressure plus low flow rate and high urethral pressure. After treatment, the lower urinary tract symptoms were resolved or improved in all patients. Urodynamic study revealed decreased voiding pressure, post-void residual urine volume, and increased maximal flow rate. Conclusions: Transurethral incision of the bladder neck is effective in relieving voiding difficulties owing to anatomic or functional bladder neck obstruction in women. KTP has great efficacy in the treatment of female voiding dysfunction due to bladder neck obstruction.

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

“…Reported incision sites for TUIBNinclude 12 o'clock, 5 and 7 o'clock, and 3, 6, 9 and 12 o'clock . In fact, most urological surgeries begin with incisions or resections of the proximal third of the urethra at or between the 5 and 7 o'clock positions, using a Collings knife electrode or other equipment . In the present study, 22.0% (13/59) of the patients had previously undergone TUIBN or TURBN at other hospitals without significant relief from the obstruction.…”

“…The present study is the first to develop a method for controlled urethral‐length resection and incision of the bladder neck for the treatment of FPBNO. The transurethral resection or incision of the bladder neck usually provides definitive treatment for FPBNO patients . Reported incision sites for TUIBNinclude 12 o'clock, 5 and 7 o'clock, and 3, 6, 9 and 12 o'clock .…”

“…It is distinguished from other kinds of FBOO by a silent sphincter on electromyography, and a non‐funneling appearance of the bladder neck during voiding on fluoroscopy. The transurethral resection or incision of the bladder neck usually provides a definitive treatment for patients with this condition …”

“…The transurethral resection or incision of the bladder neck usually provides a definitive treatment for patients with this condition. [14][15][16][17][18][19][20] The area of the bladder neck between 5 and 7 o'clock is accepted as the appropriate site for incision or resection. 19,20 However, determining the length of bladder neck that should be incised or resected remains problematic: excising a urethral section that is too long can cause urinary incontinence, but excising a section that is too short can be ineffective.…”

Female functional bladder outlet obstruction: treatment with α-blockers

“…Surgical treatments include urethral calibration and transurethral incision or resection of the bladder neck [27][28][29][30][31]. Pharmacotherapy includes a-blockers and anticholinergics in cases of bothersome storage symptoms.…”