The Clinical Effect Of Modified Transurethral Incision For Female Primary Bladder Neck Obstruction

OBJECTIVE Female primary neck obstruction (PBNO) may cause obstruction or irritation symptoms, which effect patients’lives a lot. At present, the standard surgical management for PBNO is transurethral incision. Some articles have reported that improper incision may cause complications such as recurrence, incontinence et al. This article describes a modified transurethral incision and observes its clinical effects in the management of female PBNO.METHODS In a retrospective study, between Feb2009and Feb2012, collected36patients that are diagnosed of PBNO. The mean age of the patients was56.5years (range,36～74years). Clarify the diagnose according to patients’history, symptoms, physical examination, urodynamic study, cystoscopy et al. Patients with neurogenic, surgery traumatic or other iatrogenic causes of obstruction were excluded. All patients have transurethral incision of the bladder neck at four sites that is the3-,6-,9-and12-o’clock position. The international prostate symptom score (IPSS), quality of life (QoL) score, postvoid residual urine volume and urodynamic parameters were assessed before surgery and1,3,12months after treatment.RESULTS Mean operation time is32min (range,22～45min), mean volume of bleeding was50ml (30～70ml) without severe bleeding or blood transfusion. Mean postoperative hospitalization time is7days (range,4-10d), and the mean time of indwelling catheter is4days (2-7d). Follow-up data were available for36(100%),35(97%), and32(89%) of the30patients at1,3and12months postoperatively, respectively. During the1-year follow-up, the mean International Prostate Symptom Score decreased from24.2to5.3. The mean quality of life scores decreased from4.6to1.0(P<0.01). The mean peak urinary flow rate increased from7.49to19.07ml/s (P<0.01). The mean voiding detrusor pressure decreased from61.7to19.8cmH2O (P<0.01). The mean post void residual urine volume decreased from176.41to28.74ml (P<0.01). All32patients had improvement in both objective and subjective voiding function. There is no severe complication during and after the modified treatment. Only1patient had mild stress incontinence postoperatively and cured by performing levator ani exercises.CONCLUSIONS Correct diagnosis is the key to success treatment. Diagnosing female PBNO should combine clinical symptoms with accessory examinations。The modified transurethral incision at four sites in the treatment of female PBNO is simple and can relieve voiding difficulties without severe complications.