CU 64. The treatment of primary bladder neck obstruction with Transurethral Resection of Bladder Neck (TURBN) (report of 22 cases)

Purpose: We reported the outcomes of transurethral resection of bladder neck (TURBN) in 22 women who were diagnosed as primary bladder neck obstruction (PBNO).

Materials and Methods: As many as 22 women, who presented with difficulty of urination and failed in medical therapy were recruited between 2001 and 2007. All the patients were excluded the neurogenic, traumatic, anatomical or iatrogenic causes of obstruction by urodynamics and cystoscopy. All the patients were then diagnosed with PBNO according to the Blaivas- Groutz nomogram, and underwent TURBN. The parameters before and after operation were analyzed.

Results: 22 patients were diagnosed with PBNO. Age was 35-78 (54.2±12.4) years. All of the patients presented with symptoms of obstruction, including a weak or intermittent stream and urinary hesitancy. All patients had overt urethral obstruction on urodynamic study and the following cystoscopy ruled out the possibility of urethral disease. All of the obstruction of patients was clearly at the bladder neck. These patients were treated or had previously been treated pharmacologically with α-blockers. All patients then underwent TURBN at the bladder neck and the 1/3 proximal urethra. Surgical specimens showed urethral fragments, fibromuscular tissue or hypertrophy of the paraurethral gland. Follow-up was 12 months and it included physical examination, uroflowmetry, post-void residual urine measurement and urodynamic study. 16 patients considered themselves cured of lower urinary tract symptoms, and the satisfaction rate reached 72.7%. The average change in AUA score was 27.0±3.5 vs. 12.0±5.2 (P<0.001). The average change in flow was 10.9±5.8 mL/s vs. 16.2±3.3 mL per second (P<0.001). The average change in voided volume was 360.2±124.9 mL vs. 385.0±115.2 mL (P<0.01). The average change in post-void residual urine was 178.9±166.8 mL vs. 68.2±43.9 mL (P<0.01). The average change in detrusor pressure was 58.9±20.3 vs. 46.1±11.7 cmH₂O (P<0.001).

Conclusions: TURBN is a useful and safe method for the relief of the primary bladder neck obstruction.