Long-term therapeutic efficacy and quality of life improvement in women with detrusor underactivity after transurethral incision of the bladder neck
Chung-Hsin Peng (1), Professor Hann-Chorng Kuo (2)
(1) Department Of Urology, Cardinal Tien Hospital and School of Medicine, Fu-Jen Catholic University, New Taipei, Taiwan, (2) Department of Urology, Buddhist Tzu Chi General Hospital and Tzu Chi University, , Taiwan
We report the long-term therapeutic efficacy and quality of life improvement after transurethral incision of the bladder neck (TUI-BN) in women with detrusor underactivity (DU).
This retrospective study reviewed women with DU underwent TUI-BN. The voiding status and urodynamic parameters before TUI-BN and at long-term follow-up were compared. International Prostate Symptom Score quality of life index (IPSS-QoL) and global respond assessment index (GRA) were analyzed. A patient with increased voiding efficiency (VE) >50 % and voiding spontaneously is considered to have a satisfactory outcome. Adverse effects were recorded.
A total of 82 women were enrolled. The mean follow-up period was 56.7 months (range 12-145). Fifty-nine (72%) patients were diagnosed as neurogenic etiology and 23 (28%) as idiopathic. At baseline, 62 (75.6 %) patients presented with urinary retention or almost retention (VE <10 % or voided volume [VV] <50 ml). Twenty patients had voiding dysfunction (VE <50 %) with post-void residual (PVR) ≥200 mL in 12 and PVR <200 mL in 8. Nineteen patients had recurrent urinary tract infections (UTIs) and 3 had upper urinary tract deteriorations. At long-term follow-up, the maximum flow rate (Qmax), VV, VE, and bladder contractility index (BCI) were increased significantly. The PVR, BOO index (BOOI), and IPSS-QoL were decreased significantly (Table 1). Overall 40 (48.8 %) patients had satisfactory outcomes. Thirty of the 62 patients with urinary retention could void spontaneously by abdominal straining. Urinary catheterizations were needed in 32 (39 %) (Table 2). Twelve (14.6%) patients had stress urinary incontinence. Seven of them recovered within 6 months without surgical intervention, and 5 patients were corrected by suburethral sling procedures. Two patients developed vesicovaginal fistula and which were repaired without incontinence sequelae.
TUI-BN is an effective procedure to reduce bladder outlet resistance and increase voiding efficiency in women with DU. It leads to recovering spontaneous voiding and improvement in quality of life. The therapeutic efficacy is durable with acceptable complication occurrence.