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Year : 2019  |  Volume : 30  |  Issue : 6  |  Page : 266-271

Therapeutic Efficacy and Quality of Life Improvement in Women with Detrusor Underactivity Following Transurethral Incision of the Bladder Ne

Department of Urology, Hualien Tzu Chi General Hospital and Buddhist Tzu Chi Medical Foundation, and Tzu Chi University, Hualien, Taiwan

Correspondence Address:
Dr. Hann-Chorng Kuo
Department of Urology, Hualien Tzu Chi General Hospital and Buddhist Tzu Chi Medical Foundation, and Tzu Chi University, No. 707, Section 3, Chung Yang Road, Hualien
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/UROS.UROS_39_19

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Aims: To investigate the effects of transurethral incision of the bladder neck (TUI-BN) on long-term outcomes and quality of life (QoL) improvements in women with detrusor underactivity (DU) refractory to standard medical treatment. Materials and Methods: Data were retrieved for female patients with treatment-refractory DU who underwent TUI-BN between 2007 and 2018. Urodynamic parameters were measured at baseline and follow-up and were analyzed for surgical outcome. Patients who were capable of spontaneously voiding with a voiding efficiency (VE) of ≥50% with or without the aid of abdominal pressure were considered to have achieved satisfactory outcomes. Changes in self-reported QoL were measured based on the International Prostate Symptom Score QoL (IPSS-QoL), and treatment improvements were measured based on the global response assessment (GRA) index. Moreover, the voiding statuses of patients before and after TUI-BN were compared. Results: Overall, 82 women, with a mean age of 60.8 ± 17.9 years (range 12–102), were included. Most patients experienced chronic urinary retention or large postvoid residual (PVR) urine. Median follow-up period was 5 years (range 1–12). Following TUI-BN, 40 (48.8%) patients achieved satisfactory outcomes, with a mean GRA of 1.4 ± 0.93. Mean maximum flow rate, voided volume, PVR volume, VE, and IPSS-QoL were all significantly improved. Among all patients, 50 (61%) were subsequently able to spontaneously void with or without the aid of abdominal pressure without the need for catheterization. Indwelling catheters were required in 19 (23.2%) patients at baseline and in 5 (6.1%) following TUI-BN (P < 0.01). Moreover, 5 (6.1%) patients developed stress urinary incontinence and 2 (2.4%) experienced vesicovaginal fistulae following TUI-BN procedures, all of whom recovered satisfactorily after treatment. Conclusions: TUI-BN is an effective procedure for reducing the bladder outlet resistance and improving VE and QoL. Moreover, the procedure is durable with an acceptable incidence of complications.

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