Managing Primary Bladder Neck Obstruction in Females: Is Bladder Neck Incision the Best Way Forward?

TL;DR

This study examines bladder neck incision as a treatment for female bladder neck obstruction, showing improved urinary flow and quality of life with minimal complications.

Contribution

The study introduces a precise surgical technique for bladder neck incision to treat female PBNO, reducing complications like vesicovaginal fistula and urinary incontinence.

Findings

Bladder neck incision improved urinary flow rates and reduced post-void residual volume in patients with PBNO.

The procedure significantly enhanced quality of life and symptom scores without causing major complications.

Only 5% of patients required re-surgery due to recurrence of obstruction.

Abstract

Background

Primary bladder neck obstruction (PBNO) in females is a rare condition with a tedious diagnostic process. The existing literature on bladder neck incision (BNI) to treat PBNO lacks a precise description of the surgical technique.

Objective

In this study, we provide a diagnostic protocol to streamline the evaluation of PBNO in females. We evaluate the outcomes of a precise surgical technique of BNI aimed at reducing the rates of known complications such as vesicovaginal fistula (VVF) and urinary incontinence.

Methods

This single-center prospective observational study, conducted over five years (2019-2024), included 20 patients diagnosed with PBNO who underwent BNI. Analyses included patient demographics, clinical presentation, treatment outcomes, and complications. Statistical analysis was performed using ANOVA, and univariate analysis was also conducted. Differences with P < 0.05 were considered statistically significant.

Results

At six months post-surgery, the mean maximum urinary flow rate (Qmax) increased from 6.49 ± 2.63 mL/sec to 12.41 ± 2.42 mL/sec (P = 0.0421). The mean post-void residual volume (PVR) decreased from 202.11 ± 70.20 mL to 53.11 ± 14.78 mL (P = 0.0152). The mean International Prostate Symptom Score (IPSS) decreased from 26.95 ± 2.84 to 14.74 ± 3.23 (P = 0.0325). The mean quality of life (QoL) score improved from 4.70 ± 0.80 to 1.60 ± 0.12 (P = 0.0067). None of the patients developed VVF or urinary incontinence in the post-operative period. One patient (5%) required re-surgery due to recurrence of bladder neck obstruction.

Conclusion

BNI for PBNO provides satisfactory results. A precise operative technique, with careful consideration of the depth and distal extent of the incision, helps avoid complications such as VVF and urinary incontinence.

Figures