Department of Urology, University of Sao Paulo School of Medicine, Sao Paulo, SP, Brazil.
Department of Urology, Medical University of South Carolina, Charleston, SC, United States of America.
PLoS One. 2021 Mar 19;16(3):e0248938. doi: 10.1371/journal.pone.0248938. eCollection 2021.
To present the clinical and radiological characteristics of women with severe structural deterioration of the bladder and upper urinary tract secondary to Primary Bladder Neck Obstruction (PBNO), and their outcomes after bladder neck incision (BNI).
Retrospective evaluation of adult women who underwent BNI for PBNO at one institution. Patients were assessed for symptoms, renal function, structural abnormalities of the urinary tract and video-urodynamics. PBNO diagnosis was confirmed with video-urodynamics in all patients. BNI was performed at the 4-5 and/or 7-8 o'clock positions. Postoperative symptoms, PVR, uroflowmetry and renal function were evaluated and compared to baseline.
Median patient age was 56.5 years (range 40-80). All presented with urinary retention-four were on clean intermittent Catheterization (CIC) and two with a Foley catheter. All patients had bladder wall thickening and diverticula. Four women had elevated creatinine levels, bilateral hydronephrosis was present in five (83.3%). After BNI, all patients resumed spontaneous voiding without the need for CIC. Median Qmax significantly improved from 2.0 [1.0-4.0] mL/s to 15 [10-22.7] mL/s (p = 0.031). Median PVR decreased from 150 to 46 [22-76] mL (p = 0.031). There were no postoperative complications. Creatinine levels returned to normal in 3/4 (75%) patients.
PBNO in women may result in severe damage to the bladder and upper urinary tract. Despite severe structural abnormalities of the bladder, BNI was effective in reducing symptoms and improving structural and functional abnormalities of the lower and upper urinary tract.
介绍继发于原发性膀胱颈梗阻（PBNO）的女性严重膀胱和上尿路结构恶化的临床和影像学特征，以及经膀胱颈切开术（BNI）治疗后的结果。
对一家机构中因 PBNO 而行 BNI 的成年女性进行回顾性评估。评估患者的症状、肾功能、尿路结构异常和视频尿动力学。所有患者均通过视频尿动力学确诊 PBNO。BNI 在 4-5 点和/或 7-8 点位置进行。术后评估症状、PVR、尿流率和肾功能，并与基线值进行比较。
患者中位年龄为 56.5 岁（范围 40-80 岁）。所有患者均存在尿潴留，4 例患者接受间歇性清洁导尿（CIC），2 例患者接受 Foley 导管。所有患者均存在膀胱壁增厚和憩室。4 例女性肌酐水平升高，5 例患者存在双侧肾积水（83.3%）。BNI 后，所有患者均恢复自发性排尿，无需 CIC。最大尿流率中位数从 2.0[1.0-4.0]mL/s 显著改善至 15[10-22.7]mL/s（p=0.031）。中位 PVR 从 150 降至 46[22-76]mL（p=0.031）。无术后并发症。3/4（75%）患者的肌酐水平恢复正常。
女性 PBNO 可能导致膀胱和上尿路严重受损。尽管膀胱存在严重的结构异常，BNI 仍可有效减轻症状，并改善下尿路和上尿路的结构和功能异常。
