女性神經性與非神經性排尿功能障礙接受膀胱頸經尿道切開術之療效與成功預測因子

楊家誠、劉民慶、郭漢崇、江元宏、張嘉峰、游婉茹、黃子修、李雨霜

花蓮慈濟醫院 泌尿部

Treatment Outcome and Predictive Factor for Successful Results of Transurethral Incision of the Bladder Neck in Women with Neurogenic or Non-neurogenic Voiding Dysfunction

Chia-Cheng Yang, Min-Ching Liu, Hann-Chorng Kuo, Yuan-Hong Jiang, Jia-Fong Jhang,

 Wan-Ru Yu, Tsu-Hsiu Huang, Yu-Shuang Lee

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

Purpose: Voiding dysfunction in women may result from detrusor underactivity (DU), bladder neck dysfunction (BND), or urethral sphincter dysfunction. Videourodynamic study (VUDS) can demonstrate a non-opening or non-funneling bladder neck. Transurethral incision of the bladder neck (TUI-BN) is performed to reduce outlet resistance and facilitate voiding. This study aimed to evaluate treatment outcomes and identify predictors of success in women undergoing TUI-BN.

Materials and Methods: A total of 141 women who underwent TUI-BN were retrospectively analyzed. VUDS was performed to confirm bladder neck dysfunction with or without detrusor contraction. TUI-BN was performed at the 5 and 7 o’clock positions. Treatment success was defined as voiding efficiency (VE) >67% (GRA ≥2). Patients with persistent voiding dysfunction underwent repeat VUDS, and urethral sphincter botulinum toxin A (BoNT-A) injection was administered when indicated. Clinical characteristics and VUDS parameters were analyzed to identify predictors of success.

Results: A successful outcome was achieved in 86 patients (61.0%). Patients with DU had a lower success rate (54.2%) compared with other subgroups. No significant differences were observed with respect to neurological status or prior pelvic or spinal surgery. Maximum flow rate, detrusor pressure, voiding efficiency, and bladder outlet obstruction index significantly improved in the successful group. Among patients with failed TUI-BN, BoNT-A injection achieved success in 29.0%. Nine patients developed stress urinary incontinence requiring further treatment, of whom 77.8% regained continence. DU was identified as a marginal predictor of treatment failure (p = 0.074).

Conclusions: TUI-BN is an effective treatment for women with voiding dysfunction, with a success rate of 61.0%. Patients with DU may have lower success rates but can still benefit from the procedure. Additional urethral sphincter BoNT-A injection may further improve outcomes, suggesting a contributory role of concomitant sphincter dysfunction.