Voiding dysfunction in men has been extensively studied, however, female voiding dysfunction is often overlooked and under-treated. This study aimed to evaluate the long-term effectiveness of transurethral incision of bladder neck (TUI-BN) with or without additional procedure in female voiding dysfunction with a period of 12-year follow-up.

We retrospectively reviewed women who had voiding symptom and underwent TUI-BN at least once in recent 12 years. All patients underwent videourodynamics study (VUDS) at baseline and after TUI-BN. We defined the improvement of voiding efficiency of ≥ 50% as success. Patients with insufficient improvement will opt for consecutive TUI-BN or additional procedure such as urethral Botox injection or transurethral external sphincter incision (TUI-ES). The current voiding status, surgical complications, additional surgeries were evaluated.

A total of 102 female patients with the VUDS diagnosis of voiding dysfunction with a narrow bladder neck were enrolled. Detrusor underactivity (DU, n=59, 59.6%); detrusor overactivity (DO, n=23, 23.2%); hypersensitive bladder (HSB, n=9, 9.1%); bladder neck obstruction (BNO, n=4, 4.0%); and stable bladder (n=4, 4.0%) were identified. Patients with baseline VUDS parameters of lower maximum flow rate (Qmax, p=0.002), voided volume (p<0.001), corrected Qmax (<0.001), bladder contractility index (p=0.003), voiding efficiency (p<0.001), but larger post-void residual volume (PVR, p<0.001) had higher success rate (Table 1). Patients with stable bladder (75.0%) had the highest success rate followed by DU (74.6%), DO (52.2%), BNO (50.0%) and HSB (22.2%) (p=0.022). Among 102 female patients, the overall success rate was 62.7%, The success rate of the first TUI-BN was 29.4% (30 out of 102, p<0.001), with additional procedure was 66.7% (34 out of 51) (p=0.413). The types of additional procedures and surgeries due to complication (slings implantation, urethral plasma rich platelet urethral injection) showed no significant differences in consequence to success. Post-operative spontaneous voiding was in 63.7%, clean intermittent catheterization (CIC) in 11.8%, self-voiding with CIC in 20.6% and indwelling catheter in 2.9% of patients. The multivariate analysis showed that the likelihood of success are lower voided volume (cut off value <35 mL) and higher PVR (cut off value > 355 mL) (Fig. 1).

TUI-BN is effective in treatment of women with voiding dysfunction due to bladder neck dysfunction or obstruction. Lower voided volume and larger PVR were the predictor factors for better surgical outcome especially among DU patients.

TUI-BN alone or with additional procedure was safe and effective. Patients with DU have benefit in resuming spontaneous voiding after treatment. The lower voided volume and higher PVR showed significant association for likelihood for treatment success.