經尿道膀胱頸切開手術治療女性排尿障礙：分析手術成效、預測因子、以及重複進行手術的好處

江景翔、郭漢崇

佛教花蓮慈濟醫院 泌尿部

Transurethral Bladder Neck Incision for Female Voiding Dysfunction: Analyzing Outcomes, Success Factors, and Repeat Procedure Benefits

Ching-Hsiang Chiang, Hann-Chorng Kuo

Department of Urology, Buddhist TzuChi Hospital, Hualien, Taiwan

Purpose: This study aims to assess the efficacy of single and repeated transurethral Bladder Neck Incision (TUI-BN) for female voiding dysfunction due to bladder outlet obstruction (BNO), and identify predictive factors associated with improved treatment outcomes.

Methods:

Women experiencing voiding difficulty due to BNO who underwent TUI-BN between March 2012 and September 2022 were included. All patients received a videourodynamics study at baseline and after TUI-BN. A successful outcome was defined as achieving both subjective and objective goals, with a voiding efficiency ≥66.7% and a global response assessment score of ≥2 following treatment. Patients with insufficient improvement were considered for repeated TUI-BN if necessary. The outcomes of repeat surgery, surgical complications, and predictive factors for successful outcomes were evaluated.

Results: In this study of 158 women, the success rate for the first TUI-BN was 61.4% (97/158) and 45.2% (14/31) for the second, with an overall cumulative rate of 70.3%(111/158). Comparable success rates were observed for Detrusor underactivity (DU) and non-DU patients (54.9% vs 68.4%, p=0.08). Absence of a suburethral sling history and high baseline cQmax significantly predicted favorable outcomes (OR = 0.28, p = 0.049; OR = 5.96, p = 0.031, respectively). The cumulative rate of regaining self-voiding was 95.1%(77/81). Vesico-vaginal fistula and de novo stress urinary incontinence requiring surgery had rates of (2/158) and 2.5% (4/158), respectively.

Conclusions: TUI-BN efficiently treats female voiding dysfunction from BNO, regardless of DU presence. Repeated procedures remain beneficial, yielding comparable outcomes for both patient groups and improved self-voiding. Higher cQmax and the absence of a suburethral sling procedure histrory contribute to greater success rates.