Bladder neck incision for female bladder neck obstruction: long-term outcomes.

OBJECTIVE: To evaluate the long-term outcomes of bladder neck incision (BNI) for primary bladder neck obstruction in women.

METHODS: Eighty-four women were diagnosed on the basis of videourodynamic study. BNI was performed for each patient, with incisions made at 2 different sites on the bladder neck.

RESULTS: Follow-up data were available for 6-78 months (average, 27.4), postoperatively. Successful recovery after BNI without serious complications was achieved in 71 of 84 (84.5%) patients. During follow-up, the mean International Prostate Symptom Score decreased from 22.9 to 7.9 (P <.01). Quality of life decreased from 4.1 to 2.4 (P <.01). The maximum uroflow rate increased from 9.75 to 18.79 mL/s (P <.01). The postvoid residual decreased from 115.11 to 23.29 mL (P <.01). The maximal detrusor pressure at the maximum uroflow rate decreased from 69.61 to 20.48 cm H2O (P <.01). Several complications were identified after surgery, including hemorrhage, re-BNI, vesicovaginal fistula (VVF), stress urinary incontinence (SUI), and urethral stricture. All these complications were grade IIIa in the Clavien Classification of Surgical Complications. Three patients (3.6%) developed a VVF after BNI; these VVFs were repaired successfully. Four (4.7%) patients experienced SUI and recovered after transvaginal tension-free vaginal tape-obturator. Postoperative bleeding was identified in 3 patients (3.6%), and 1 received a blood transfusion. Three (3.6%) patients experienced urethral stricture after BNI and recovered after receiving intermittent urethral dilation.

CONCLUSION: Primary bladder neck obstruction is uncommon and easily treatable when properly diagnosed by videourodynamic study, and BNI has a high success rate. Careful, sufficiently deep incisions at the 2- and 10-o'clock positions can ensure its success. Complications such as postoperative VVF or SUI can occur and must be actively managed.