Primary Bladder Neck Obstruction in a Young Woman: A Novel Technique of Bladder Neck Incision Using Holmium Laser

Management of primary bladder neck obstruction (PBNO) in women is difficult. Surgical treatment in the form of bladder neck incision (BNI) is indicated in many cases. There is no defined consensus on the best surgical technique of BNI in women. We present a novel technique of BNI in such cases using pediatric cystoscope and holmium laser, which is a promising alternative to the existing management techniques. A 28-year-old lady complained of obstructive lower urinary tract symptoms. Serum biochemistry revealed azotemia. Further investigation utilizing a micturating cystourethrogram showed a closed bladder neck, and urodynamic studies revealed a high bladder outlet obstruction index suggestive of PBNO. BNI was effectively performed using pediatric cystoscope and holmium laser at 3, 9, and 12 o'clock positions. Postoperatively the patient had improving renal function and clinical improvement. Use of pediatric cystoscope with holmium laser for BNI in females is a novel technique that offers the advantage of higher maneuverability in the female urethra, precise incision with protection of external sphincter from thermal damage, and avoidance of the complication of vesicovaginal fistula caused by posterior incisions.