Internal Urethrotomy in Treatment of Female with Anatomical Bladder Outlet Obstruction

Abstract

Background: Bladder outlet obstruction (BOO) is a relatively infrequent urologic condition in women, but can cause bothersome symptoms. In this article, transurethral incisions of the bladder neck (TUIBN) and urethra in the treatment of anatomical BOO were assessed. Materials and Methods: A total of 23 women who referred with chronic lower urinary tract symptoms, urinary retention, and difficulty in micturition were assessed. Diagnose was made on the basis of urethrocystoscopy, voiding cystourethrography, and urodynamic studies. All patients underwent transurethral incisions of bladder neck contracture or site of observed urethral stenosis at 3- and 9-o'clock positions. Clinical improvements and complications were assessed by follow-up examination and International Prostate Symptom Score (IPSS) and quality of life (QOL) scoring before and after intervention. Results: All patients were followed for at least 6 months after intervention. Follow-up data were available for 19 (90.5%), 13 (61.9%), and 7 (33.3%) of patients at 12, 24, and 48 months' follow-up, respectively. During the follow-up period, the mean IPSS and QOL significantly changed from 26.84 to 10.74 and 4.76 to 2.32, respectively ( P < 0.001). Approximately 66.7% had satisfactory outcomes, 47.7% patients after first, and 19.1% after second TUI. About9.5% patients developed new onset of stress urinary incontinence, one of them had indications of surgical intervention, and thus, symptoms were relieved by mid-urethral sling. Conclusion: Transurethral incision of bladder neck and urethra seems to be effective in relieving urinary symptoms of anatomical BOO in women. Complications may rarely occur and can be fully managed.

Treatment of Urethral Stricture Disease in Women: Nonsystematic Review of Surgical Techniques and Intraoperative Considerations

“… 17 , 18 One contemporary retrospective analysis in 2019 by Sharifian et al reviewed 23 patients who had an internal urethrotomy with a 66% success rate and a rate of new onset stress urinary incontinence (SUI) of 9.5%. 19 …”

“…17,18 One contemporary retrospective analysis in 2019 by Sharifian et al reviewed 23 patients who had an internal urethrotomy with a 66% success rate and a rate of new onset stress urinary incontinence (SUI) of 9.5%. 19 In cases of completely occluded, yet short urethral strictures, a "cut to the light" procedure can be performed, which requires antegrade placement of a flexible cystoscope to aid in identifying the obliterated urethra. 2,20 Meanwhile for urethral dilation, there is no specific recommendation for dilation calibration size as studies report on dilation from 24F to 41F with similar results.…”