Long Term Follow-up and Predictive Factors for Successful Outcome of Transurethral Incision of the Bladder Neck in Women with Detrusor Underactivity
Jia-Fong Jhang*, Yuan-Hong Jiang, Cheng-Ling Lee, Hann-Chorng Kuo
Department of Urology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan
conflicts of interest: none
*Correspondence to: Dr. Hann-Chorng Kuo, Department of Urology, Buddhist Tzu Chi General Hospital, 707, Chung-Yang Road, Section 3, Hualien, Taiwan, 970
Background/Purpose
Detrusor underactivity (DU) is a common urologic problem. Our previous study revealed the transurethral incision of the bladder neck (TUI-BN) improves short-term voiding efficiency in female patients with DU. This study focused on long-term outcomes of TUI-BN and identified predictive factors of satisfactory outcomes
Methods
A total 50 woman with DU for whom medical treatment failed underwent TUI-BN. The urodynamic parameters at baseline and follow-up visits were analyzed. Patients with voiding efficiencies (VE) > 50% were considered to have satisfactory outcomes. Baseline urodynamic parameters were analyzed as factors predictive of outcomes.
Results
After a mean follow-up of 61.8 months, 26 of 50 patients had satisfactory outcomes. The mean VE, maximum flow rate, voided volume, detrusor pressure, and post-void residual volume significantly improved after TUI-BN. A higher intravesical pressure (Pves, odds ratio [OR] = 1.023, p = 0.013) and smaller first sensation of bladder filling (OR = 0.990, p = 0.020) at baseline were predictive factors for satisfactory outcomes. Multivariate analysis revealed that only baseline Pves was a significant predictor of satisfactory outcomes (OR = 1.024, p = 0.038). ROC curve analysis of baseline Pves showed that the area under the curve (AUC) was 0.767 (95% CI = 0.624–0.876). The optimal cutoff value of Pves for a satisfactory outcome was 45 cmH2O, which had a specificity of 78.26% and acceptable sensitivity of 73.08%.
Conclusion
TUI-BN improved VE for women with DU over the long term. A higher Pves compared to a lower Pves was predictive of satisfactory surgical outcomes.