Primary bladder neck obstruction in females: Case series from the Indonesian population

Primary bladder neck obstruction (PBNO) is a rare but significant cause of BOO and LUTS in females, with unclear etiology involving theories of fibrotic narrowing, tissue hyperplasia, or muscle abnormalities. Due to nonspecific symptoms, PBNO diagnosis remains challenging, and optimal surgical treatment needs to be better defined.

We report two cases of females in their 50s with recurrent urinary retention managed by indwelling catheters. The first, aged 58, experienced worsening LUTS over five months, requiring catheter use for two months. The second, aged 50, had persistent voiding difficulty and failed previous catheter trials. Both lacked a history of trauma, pelvic surgery, or significant comorbidities. Cystoscopy revealed bladder neck obstruction with moderate trabeculation of the detrusor muscle. Transurethral resection of the bladder neck (TURBN) was performed circumferentially. Postoperatively, both patients showed marked improvement, with uroflowmetry demonstrating maximum flow rates of 10.7 mL/s and 9.4 mL/s and minimal residual volumes. No incontinence or other complications were observed.

PBNO in females is underdiagnosed due to nonspecific presentations. Structural abnormalities and potential neurogenic factors are implicated in its pathophysiology. In our cases, TURBN effectively improved voiding function, underscoring its role for patients unresponsive to conservative therapy. However, data on long-term outcomes and risks, such as stress urinary incontinence, remain limited.

TURBN is a promising treatment for female PBNO, offering symptom relief and improved voiding function. Continued research is needed to refine techniques and develop evidence-based guidelines.