Managing Primary Bladder Neck Obstruction in Females: Is Bladder Neck Incision the Best Way Forward?

Background Primary bladder neck obstruction (PBNO) in females is a rare condition with a tedious diagnostic process. The existing literature on bladder neck incision (BNI) to treat PBNO lacks a precise description of the surgical technique. Objective In this study, we provide a diagnostic protocol to streamline the evaluation of PBNO in females. We evaluate the outcomes of a precise surgical technique of BNI aimed at reducing the rates of known complications such as vesicovaginal fistula (VVF) and urinary incontinence. Methods This single-center prospective observational study, conducted over five years (2019-2024), included 20 patients diagnosed with PBNO who underwent BNI. Analyses included patient demographics, clinical presentation, treatment outcomes, and complications. Statistical analysis was performed using ANOVA, and univariate analysis was also conducted. Differences with P < 0.05 were considered statistically significant. Results At six months post-surgery, the mean maximum urinary flow rate (Qmax) increased from 6.49 ± 2.63 mL/sec to 12.41 ± 2.42 mL/sec (P = 0.0421). The mean post-void residual volume (PVR) decreased from 202.11 ± 70.20 mL to 53.11 ± 14.78 mL (P = 0.0152). The mean International Prostate Symptom Score (IPSS) decreased from 26.95 ± 2.84 to 14.74 ± 3.23 (P = 0.0325). The mean quality of life (QoL) score improved from 4.70 ± 0.80 to 1.60 ± 0.12 (P = 0.0067). None of the patients developed VVF or urinary incontinence in the post-operative period. One patient (5%) required re-surgery due to recurrence of bladder neck obstruction. Conclusion BNI for PBNO provides satisfactory results. A precise operative technique, with careful consideration of the depth and distal extent of the incision, helps avoid complications such as VVF and urinary incontinence.