Transurethral Incision of the Bladder Neck with Additional Procedure Resumes Spontaneous Voiding in Female Voiding Dysfunction – A Long-term Follow-up

Introductions: To evaluate the long-term effectiveness of transurethral incision of the bladder neck (TUI-BN) with or without additional procedure for female voiding dysfunction.Methods: Women with voiding difficulty and underwent TUI-BN in recent 12 years were included. All patients underwent videourodynamics study (VUDS) at baseline and after TUI-BN. Successful outcome was defined as having a voiding efficiency (VE) by ≥50% after treatment. Patients with insufficient improvement were opt for repeated TUI-BN, urethral onabotulinumtoxinA injection or transurethral external sphincter incision (TUI-ES). The current voiding status, surgical complications were evaluated.Results: A total of 102 women with VUDS evidence of a narrow bladder neck during voiding were enrolled. The long-term success rate of the first TUI-BN was 29.4% (30/102) and increased to 66.7% (34/51) after combining TUI-BN and additional procedure. The overall long-term success rates were 74.6% in detrusor underactivity (DU), 52.0% in detrusor overactivity and low contractility, 50.0% in bladder neck obstruction (p=0.022). Spontaneous voiding was achieved in 66 (64.7%) patients, de novo urinary incontinence in 21 (20.6%), and vesicovaginal fistula in 4 (3.9%), all were repaired.Conclusions: TUI-BN alone or in combination with additional procedure was safe, effective and durable. Patients with DU benefit most in resuming spontaneous voiding.

Medical evaluation and management of male and female voiding dysfunction: a review

A significant workforce shortage of urologists available to serve the US population has been projected to occur over the next decade. Accordingly, much of the management of urologic patients will need to be assumed by other specialties and practitioners. Since primary care physicians are often first evaluate common urologic complaints, it makes sense that these physicians are in an excellent position to intervene in the management of these patients when appropriate. One of the most common complaints in urology is voiding dysfunction. The incidence of voiding dysfunction increases with age, with conservative estimates showing that over 50% of elderly patients suffer. Despite this high prevalence and its negative impact on quality of life, however, few seek or receive treatment, as many do not readily disclose these impactful yet personal symptoms. We sought to summarize the typical presentation, evaluation, assessment and therapeutic options for both male and female patients presenting with voiding dysfunction.