Medical treatment does not usually achieve satisfactory results in resuming efficient voidingin patients with detrusor underactivity (DU). We report the long-term surgical outcomes and predictive factor of transurethral incision of the bladder neck (TUI-BN) in women with DU and bladder neck dysfunction (BND).

This retrospective study reviewed the medical records and videourodynamic studies of 182 women with voiding dysfunction owing to BND who underwent TUI-BN from 2003 to 2017. Patients diagnosed with DU participated in this study. The urodynamic parameters at baseline and follow-up visits were analyzed. Surgical outcome was determined by comparing preoperative with postoperative urodynamic parameters and clinical presentation. Symptoms assessments of Patient Global Impression of Improvement (PGI-I) and Bristol Female Lower Urinary Tract Symptoms (BFLUTS) questionnaire were also analyzed. Patients with voiding efficiency (VE) >50% were considered to have satisfactory outcomes, and factors predictive of outcomes were also determined.

A total of 77 woman, mean age of 61.0 ± 16.50 years (range 21-86), diagnosed with DU and BND with medical treatment failure received TUI-BN. Fifty two patients were considered as neurogenic etiology and 25 idiopathic. Forty eight patients presented with chronic urinary retention and 10 almost retention (VE <15%). Nineteen patients had difficult micturition with large postvoid residual (PVR) (>150 mL) in 15 and small PVR in 4 (Table 1). Eighteen patients had recurrent urinary tract infections and 9 had upper urinary tract deteriorations. After a mean follow-up of 71.9 months, 29 (37.7 %) patients had satisfactory outcomes. Full follow-up data were available for 54 patients. The mean VE, maximum flow rate (Qmax), voided volume (VV), and PVR significantly improved (Table 2). Ten patients resumed spontaneous voiding by abdominal straining. Indwelling catheter or intermittent catheterization was needed in 60 patients before surgery and in 20 postoperatively. In addition, 50% of the patients reported a decrease in the frequency of intermittent catheterization. PGI-I showed subjective improvements (2.58 ± 1.55) and BFLUTS showed mild symptom severity and impact on quality of life. Baseline Qmax, VV, and PVR were associated with satisfactory outcomes (Table 3); but not revealed as significant predictor in the multivariate analysis. Five patients developed urinary incontinence and one developed vesicovaginal fistula.

The majority of female patients with DU and BND presented with urinary retention or large PVR. Indwelling catheter or intermittent catheterization was needed in more than 60 % of patients. TUI-BN is effective in relieving voiding difficulty, improving VE, increasing Qmax and VV, decreasing PVR, and restoring spontaneous voiding. About 40 % of patients had satisfactory outcomes over the long term. Age, etiology and comorbidity did not impact surgical outcome.

TUI-BN is an effective procedure to reduce bladder outlet resistance, improve voiding efficiency, and lead to improvement in quality of life in women with DU and BND. The procedure is durable with acceptable complication occurrence.