Feasibility of Bladder Neck Incision in Female Patients With Primary Bladder Neck Obstruction: Our Experience

Objectives To study the feasibility of bladder neck incision (BNI) in female patients with primary bladder neck obstruction in whom conservative measures have failed to show promising results. Materials and methods We included 48 female patients who had all the following features at presentation: maximum flow rate of urine <12 mL/second, inadequate funneling of the bladder neck on voiding cysto-urethrogram, post-void residual urine (PVRU) >100 mL, sustained detrusor contraction of >25 cmH2O at maximum urinary flow rate (Qmax), and a normal urethral caliber. Uroflowmetry, voiding cystometrogram, and cystourethroscopy were performed preoperatively in all patients. The surgical procedure involved endoscopic incisions at five and seven o'clock positions on the bladder neck with bipolar diathermy using the TURis system. All patients underwent a postoperative symptom score assessment and uroflowmetry at the one-year follow-up. Results The mean age of the patients in our study was 47 years (range: 23 to 66 years), with a median follow up of 33.4 months. Preoperatively Qmax, mean International Consultation on Incontinence Questionnaire - Female Lower Urinary Tract Symptoms Long Form (ICIQ-FLUTS LF) score, PVRU, and mean quality of life score were 7.14 mL/sec, 19.4, 139 mL, and 4.5, respectively. Postoperatively, the same variables were 19.37 mL/sec, 7.6, 32 ml, and 2.3, respectively. Mild-to-moderate stress urinary incontinence was observed in four patients (<2 points). Conclusion In female patients, BNI offers a safe, effective, and minimally invasive treatment option. Our technique, when done as described, is easy to perform and has a minimal complication rate.