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

BACKGROUND

Primary bladder neck obstruction (PBNO) in women is an underrecognized cause of lower urinary tract symptoms. This systematic review evaluates surgical outcomes following transurethral bladder neck incision (TUBNI) and resection (TURBN).

METHODS

A systematic search of PubMed, Embase, Scopus, and Cochrane databases identified studies from 2000 to 2025 evaluating surgical treatment of female PBNO. Primary outcomes included functional improvements and major complications. Quality assessment used the ROBINS-I tool.

RESULTS

A total of 16 studies encompassing 612 patients were included. The mean patient age was 52.4 ± 9.2 years, and the interval from symptom onset to diagnosis ranged between 19 weeks and 7.5 years. Alpha-blockers failed in 95% of patients who subsequently underwent surgery. TUBNI was performed in 87.5% of studies. Mean maximum flow rate improved by 11.0 ± 6.1 mL/s (p < 0.001), and postvoid residual decreased by 183.7 ± 140.6 mL. Major complications included vesicovaginal fistula (2.3%) and de novo stress incontinence (8.7%, predominantly mild). Younger patients (< 40 years) achieved superior outcomes.

CONCLUSIONS

TUBNI provides highly effective treatment for female PBNO with favorable safety profiles. In patients failing medical management, surgery should be strongly considered and can be justified promptly. These findings establish evidence-based treatment guidelines for this challenging condition.

TRIAL REGISTRATION: PROSPERO (CRD420251082520).