Surgical Outcomes of Transurethral Bladder Neck Incision and Resection in Female Primary Bladder Neck Obstruction: A...

Area of Science:

• Urology
• Gynecology
• Surgical Outcomes

Background:

• Primary bladder neck obstruction (PBNO) in women is an underrecognized cause of lower urinary tract symptoms.
• Surgical interventions like transurethral bladder neck incision (TUBNI) and resection (TURBN) are evaluated for PBNO treatment.
• Many patients with PBNO do not respond to conservative medical management, necessitating surgical consideration.

Purpose of the Study:

• To systematically review and evaluate surgical outcomes for female primary bladder neck obstruction.
• To compare the efficacy and safety of transurethral bladder neck incision (TUBNI) and resection (TURBN) for PBNO.
• To establish evidence-based treatment guidelines for female PBNO.

Main Methods:

• Systematic literature search of PubMed, Embase, Scopus, and Cochrane databases (2000-2025).
• Inclusion of 16 studies with 612 female patients diagnosed with PBNO.
• Assessment of primary outcomes including functional improvements and major complications using the ROBINS-I tool.

Main Results:

• Transurethral bladder neck incision (TUBNI) was performed in 87.5% of studies, with alpha-blocker failure in 95% of surgical patients.
• Significant improvements observed: mean maximum flow rate increased by 11.0 mL/s (p<0.001), and postvoid residual decreased by 183.7 mL.
• Major complications included vesicovaginal fistula (2.3%) and de novo stress incontinence (8.7%, predominantly mild); younger patients (<40 years) showed superior outcomes.

Conclusions:

• Transurethral bladder neck incision (TUBNI) offers a highly effective and safe treatment for female primary bladder neck obstruction (PBNO).
• Prompt surgical consideration is justified for patients with PBNO who fail medical management.
• The findings support the development of evidence-based guidelines for managing this condition.