Ong Hueih-Ling, Kuo Hann-Chorng
Department of Urology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chia-Yi 622, Taiwan.
Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Tzu Chi University, Hualien 970, Taiwan.
J Clin Med. 2023 Feb 14;12(4):1514. doi: 10.3390/jcm12041514.
This study evaluated the long-term effectiveness of transurethral incision of the bladder neck (TUI-BN) with or without an additional procedure for female voiding dysfunction.
Women with voiding difficulty who underwent TUI-BN in the last 12 years were included. All patients underwent a videourodynamics study (VUDS) at baseline and after TUI-BN. A successful outcome was defined as having a voiding efficiency (VE) increase by ≥50% after treatment. Patients with insufficient improvement were chosen for repeated TUI-BN, urethral onabotulinumtoxinA injection, or transurethral external sphincter incision (TUI-ES). The current voiding status, surgical complications, and additional surgeries were evaluated.
A total of 102 women with VUDS evidence of a narrow bladder neck during voiding were enrolled. The long-term success rate of the first TUI-BN was 29.4% (30/102) and increased to 66.7% (34/51) after combining TUI-BN and an additional procedure. The overall long-term success rates were 74.6% in women with detrusor underactivity (DU), 52.0% in detrusor overactivity and low contractility, 50.0% in bladder neck obstruction, 20.0% in hypersensitive bladder, and 75% in stable bladder ( = 0.022). Patients with a lower maximum flow rate (Qmax), ( = 0.002), lower voided volume ( < 0.001), lower corrected Qmax ( < 0.001), lower ladder contractility index ( = 0.003), lower voiding efficiency ( < 0.001), but larger post-void residual volume ( < 0.001) had a satisfactory surgical outcome. Spontaneous voiding was achieved in 66 (64.7%) patients, de novo urinary incontinence in 21 (20.6%), and vesicovaginal fistula in 4 (3.9%), all were repaired.
TUI-BN alone or in combination with an additional procedure was safe, effective, and durable in patients with DU to resume spontaneous voiding.
本研究评估了经尿道膀胱颈切开术（TUI-BN）单独或联合其他手术治疗女性排尿功能障碍的长期疗效。
纳入过去12年内接受TUI-BN治疗的排尿困难女性。所有患者在基线时和TUI-BN术后均接受了视频尿动力学检查（VUDS）。成功的结果定义为治疗后排尿效率（VE）提高≥50%。改善不足的患者被选择进行重复TUI-BN、尿道注射肉毒杆菌毒素A或经尿道外括约肌切开术（TUI-ES）。评估了当前的排尿状态、手术并发症和额外的手术情况。
共有102名在VUDS检查中有排尿时膀胱颈狭窄证据的女性入组。首次TUI-BN的长期成功率为29.4%（30/102），联合TUI-BN和其他手术治疗后成功率提高到66.7%（34/51）。逼尿肌活动低下（DU）女性的总体长期成功率为74.6%，逼尿肌活动亢进伴低收缩力女性为52.0%，膀胱颈梗阻女性为50.0%，膀胱过敏女性为20.0%，稳定膀胱女性为75%（P = 0.022）。最大尿流率（Qmax）较低（P = 0.002）、排尿量较低（P < 0.001）、校正后Qmax较低（P < 0.001）、阶梯收缩指数较低（P = 0.003）、排尿效率较低（P < 0.001）但残余尿量较大（P < 0.001）的患者手术效果良好。66例（64.7%）患者实现了自主排尿，21例（20.6%）出现了新发尿失禁，4例（3.9%）出现了膀胱阴道瘘，所有瘘口均得到修复。
TUI-BN单独或联合其他手术治疗对DU患者恢复自主排尿是安全、有效且持久的。
