Long-Term Outcomes of Surgical Management of Primary Bladder Neck Obstruction in Females: Clinical Insights into Bladder Neck Resection Techniques – A Single-Centre Experience

Kalra S1, Bolar S1, Pal A1, Dorairajan L1, K.S. S1, R. B1, Narkhede V1

Research Type

Clinical

Abstract Category

Female Lower Urinary Tract Symptoms (LUTS) / Voiding Dysfunction

Abstract 427
Open Discussion ePosters
Scientific Open Discussion Session 102
Thursday 18th September 2025
13:05 - 13:10 (ePoster Station 4)
Exhibition
Female Retrospective Study Surgery Voiding Dysfunction
1. Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, 605006, India
Presenter
Links

Abstract

Hypothesis / aims of study
Bladder neck incision (BNI) and bladder neck resection (BNR) have been the primary surgical approaches for Primary Bladder Neck Obstruction (PBNO) but is not commonly practiced for  fear of complications and limited literature available. (1)  Long-term success of BNI and BNR and its potential complications, such as bladder neck contracture, incontinence, vesico-vaginal fistula and recurrences, remain under investigation. (2)Data on durability of symptom relief and frequency of post-operative issues are limited, underlining the importance of extended follow-up studies. Additionally, there is no consensus on the optimal BNI technique, as incision depth, location, and tools (e.g., laser vs. electrocautery) vary. Standardizing these approaches through comparative research could improve patient care. This study assesses the trifecta outcomes - long-term effectiveness of surgical intervention, reoperation rates and postoperative complications and also evaluates the impact of technique modifications on surgical outcomes.
Study design, materials and methods
This retrospective analysis includes 41 patients diagnosed with PBNO between 2018 and 2024, all of whom underwent BNI and BNR. Their clinical features, renal function tests (RFT) , ultrasonography (USG) findings, uroflowmetry results, and video-urodynamic study (VUDS) data were analyzed. Initially, 10 patients had BNI at 5 and 7 o’clock positions. Later, the technique was modified :  BNI at 3 and 9 o’clock with resection (BNR) of interposing tissue was used for next 31 patients (Figure 1). Different perioperative parameters along with complications if any, were evaluated during follow-up.
Results
Out of 41 patients, 9, 11, and 14 patients presented with Lower Urinary Tract Symptoms (LUTS)  with chronic retention, acute retention, and hydroureteronephrosis with deranged RFT, respectively. The mean serum creatinine and IPSS were 2.8±1.9 mg/dl and 21.8±10.7, respectively. On VUDS, the mean Qmax, pdet@Qmax, and PVR were 6.7±3.08 ml/s, 58.2±14.2 cm H2O, and 280±80 ml, respectively. The mean operating time and blood loss were 20.7±6.4 minutes and 28.6±10.5 ml, respectively. The mean follow-up was 41.6±13.2 months.
In assessing trifecta outcomes, the mean IPSS, Qmax, and PVR were 6.2±1.5, 22.6±6.8 ml/s, and 29.5±12.7 ml, respectively after a minimum one year follow up. Of the 10 patients operated in first two years, 4 had no immediate symptom relief probably due to inadequate resection and underwent re-resection within a week after which they were symptom-free. Subsequently, after the modification of the surgical technique, only one patient experienced symptom recurrence at 2 years and required re-do surgery. Two patients developed urinary incontinence, one of which resolved spontaneously within 3 months. No bladder neck contracture or urethrovaginal fistula were noted. Two patients underwent BNR after a failed wrongly done female urethroplasty elsewhere. Both the patients improved with no incontinence.
Interpretation of results
It is believed that unique arrangement of muscle fibers around bladder neck tends to shift toward the bladder as it fills. The incision site gradually migrates towards the urethra, which increase risk of SUI, and fistulas. It is necessary to regularly empty the bladder in order to reassess the incision and make adjustments as needed. As the surgeon gains experience and progresses through the learning curve, a more detailed understanding of depth perception develops. BNI at 3 and 9 o’clock with controlled BNR improves outcomes by creating a wider channel, lowering outlet resistance.
Concluding message
Absence of immediate symptom relief should not be construed as failure but rather an indication to reassess the adequacy of resection and if warranted, redo resection should be done. Although there were initial concerns that BNR could be an overly aggressive approach, with theoretical increased risk of bladder neck contractures, our extended follow-up of patients over a span of 5 to 6 years has not shown any instances of bladder neck contracture. BNR for PBNO demonstrates safety, effectiveness and ensures the achievement of trifecta outcomes.
Figure 1 (a) Preoperative image of bladder neck in case of PBNO (b) Post bladder neck resection; (c) Adequate resection (BNI at 3 and 9 o’clock positions); (d) Inadequate resection (BNI at 5 and 7 o’clock positions)
Figure 2 (a) VUDS of PBNO patient who underwent BNR. (b) Patient had symptom recurrence after 2 years, repeat VUDS showing PBNO. (c) Preoperative VUDS of patient with post-op incontinence, Pdet@endfill 22 cmH2O, impaired compliance 20 ml/H2O, leak at 400 ml
References
  1. Blaivas JG, Flisser A, Tash JA. Treatment of primary bladder neck obstruction in women with transurethral resection of the bladder neck. J Urol 2004;171:1172 5
  2. Zhang P, Wu Z- J, Xu L, et al. Bladder neck incision for female bladder neck obstruction: long- term outcomes. Urology 2014;83:762–7
Disclosures
Funding None Clinical Trial No Subjects Human Ethics Committee JIPMER Institutional Ethics Committee Helsinki Yes Informed Consent Yes
12/07/2025 13:11:08