Endoscopic incision for functional bladder neck obstruction in men: long-term outcome

Abstract

Objectives: To evaluate the long-term outcomes of endoscopic bladder neck incision (BNI) for functional bladder neck obstruction. Functional and/or mechanical obstruction of the bladder neck in men causes lower urinary tract symptoms. Although alpha-blockers are the initial treatment, they often fail to alleviate the symptoms.

Methods: The records of 45 men with obstructive voiding symptoms treated between 1988 and 1996 were reviewed. The symptom score, renal parameters, urine routine microscopy, urine culture and sensitivity, uroflowmetry, voiding cystourethrography, and videourodynamic results were reviewed. Patients with a peak flow rate of less than 10 mL/s, inadequate funneling of the bladder neck, more than 40 cm H2O opening pressure with a relaxed external sphincter, a postvoid residual urine volume greater than 100 mL, no neurologic defect, and a normal urethral caliber were included. They were treated with clean intermittent catheterization and alpha-blockers. Clean intermittent catheterization was stopped when the postvoid residual urine volume was less than 50 mL. BNI was performed in patients with a poor response, noncompliance, or side effects from the alpha-blockers. Postoperatively, patients were assessed by symptom score, uroflowmetry, and postvoid residual urine volume.

Results: Of the 45 men, 22 responded to alpha-blockers, 5 chose clean intermittent catheterization, and 18 underwent BNI. The mean patient age was 33.42 +/- 6.56 years. The mean follow-up was 96 months (range 46 to 140). After BNI, all patients showed improvement, with the symptom score improving from 26.9 to 3.6 (P < 0.001). The peak flow rate improved from 8.5 to 19.6 mL/s (P < 0.001). This improvement persisted in more than 80% of the 18 patients. Two required a second BNI and were also doing well at the last follow-up visit.

Conclusions: BNI is an effective treatment for functional bladder neck obstruction refractory to alpha-blockers and provides durable results.