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.

Effectiveness of endoscopic treatment of duplex system ureteroceles in children

Objective. The aim of this study is to evaluate the efficiency of transurethral incision of ureteroceles and incidence of vesicoureteral reflux in pediatric patients with duplex system ureterocele. Materials and methods. This is a retrospective study of 155 pediatric patients with duplex system ureterocele. The age of patients at the time of surgery ranged from 5 days to 17 years (median 8.0 months). Intravesical ureterocele had 108 patients (69.8%), extravesical 47 (30.2%). Results. Complications occurred in 2 patients (1.3%), recurrence obstruction was in 1 case (0.6%). Ipsilateral vesicoureteral reflux after surgery had 112 patients (72.3%): in the upper pole 51 cases (32.9%), in the lower pole 32 (20.6%), in both ureters 29 (18.7%). In the long-term period after transurethral incision of ureteroceles 97 patients (62.5%) needed reoperation due to infection and voiding dysfunction. Statistically significant risk factors associated with the need for reoperation were the presence of vesicoureteral reflux on the ureteroceles side and non-functioning upper pole of the kidney. Conclusion. Transurethral incision of ureteroceles for duplex system ureterocele is a safe and effective minimally invasive method of primary resolving of the obstruction. Vesicoureteral reflux on the ureterocele side after surgery had 72.3% of patients; reoperation in the long term was necessary in 62.5% cases. The main risk factor reoperation is vesicoureteral reflux on the ureterocele side.