Long-term therapeutic efficacy and quality of life improvement in women with detrusor underactivity after transurethral incision of the bladder neck

Lee Y1, Peng C2, Lee C1, Kuo H1

Research Type

Clinical

Abstract Category

Female Stress Urinary Incontinence (SUI)

Abstract 683
Urology - Best of the Rest
Scientific Podium Short Oral Session 32
Friday 6th September 2019
15:52 - 16:00
Hall H2
Surgery Questionnaire Voiding Dysfunction
1.Department of Urology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan, 2.Department of Urology, Cardinal Tien Hospital, An Kang, New Taipei, Taiwan
Presenter
Y

Yu Khun Lee

Links

Abstract

Hypothesis / aims of study
Detrusor underactivity (DU) is a common urologic problem. Our previous study revealed the transurethral incision of the bladder neck (TUI-BN) improves short-term voiding efficiency (VE) in female patients with DU. This study focused on the long-term outcomes and quality of life improvement of TUI-BN in women with DU refractory to medical treatment and demanded for spontaneous urination.
Study design, materials and methods
A total of 82 women with DU for whom medical treatment had failed underwent TUI-BN. The urodynamic parameters at baseline and follow-up were analysed. Surgical outcome was determined by comparing preoperative with postoperative urodynamic parameters and clinical presentation. We also analyzed subjective self-reported quality of life (QoL) changes by International Prostate Symptom Score quality of life (IPSS-QoL) and treatment improvement by global respond assessment index (GRA). Patients with VE of more than 50% and could void spontaneously with or without the aid of abdominal straining were considered to have satisfactory outcomes. The voiding status before and after TUI-BN were also compared.
Results
The mean age of the patients was 60.8 ± 17.9 years (range 12-102). The median follow-up period was 5 years (ranged 1 to 12 years). Fifty-nine (72%) patients were diagnosed as neurogenic etiology and 23 (28%) as idiopathic DU. Sixty-two patients initially presented with chronic urinary retention, who required catheterization by clean intermittent catheterization (CIC) or indwelling catheter to empty bladder. Thirty-eight patients had difficult micturition with large post-void residual (PVR) (>200 mL) in 30 and small PVR in 8. During a mean follow-up period of 56.7 months, 9 patients expired and 5 lost to follow up, but the postoperative status could be traced from chart review. Among the overall 82 patients 40 (48.8 %) had satisfactory outcomes. The mean maximum flow rate (Qmax), voided volume (VV), PVR, VE, BOO index (BOOI), bladder contractility index (BCI) and IPSS-QoL significantly improved (Table 1). Among the patients, 50 (61%) patients could void spontaneously by abdominal straining and without catheterization. Indwelling catheter or CIC was needed in 62 (75.6%) patients before TUI-BN and in 33 (40.2%) postoperatively (p<0.01) (Table 2). The incidence of urinary tract infection was not significantly different before and after TUI-BN. In the patients who failed the initial TUI-BN 32 (39%) patients received addition procedures, including repeat TUI-BN and urethral botulinum toxin A urethral sphincter injection after the first TUI-BN. Among these 32 patients who received addition procedures 19 (59.4%) had satisfactory outcomes during follow up. After these procedures, 59 (72%) of the 82 patients had satisfactory outcome. Five (6.1%) patients developed immediate stress urinary incontinence after TUI-BN which was subsequently corrected by a suburethral sling procedure. Two (2.4%) patients developed vesicovaginal fistula during the TUI-BN procedure, and the fistula was repaired immediately without any urinary incontinence sequelae. Both of the patients received multiple TUI-BN (twice and four times, respectively). Twelve (14.6%) patients had mild urinary incontinence during follow up period.
Interpretation of results
TUI-BN is effective in relieving voiding difficulty, improving VE, increasing Qmax and VV, decreasing PVR, and restoring spontaneous voiding in women with neurogenic or non-neurogenic DU. Patients could void with or without abdominal straining and free of catheterization. Most of the patients had satisfactory outcomes after the TUI-BN or additional procedure for the initial failed TUI-BN surgery over the long-term follow up. Among them, 39% of the patients might need addition procedure such as repeat TUI-BN or urethral botulinum toxin A urethral sphincter injections to achieve a satisfactory outcome. Nevertheless, multiple TUI-BN procedures might increase the risk of vesicovaginal fistula.
Concluding message
TUI-BN is an effective procedure to reduce bladder outlet resistance, improve voiding efficiency, and quality of life. In women who demands spontaneous urination without catheterization, TUI-BN is valuable. In patients who failed the initial TUI-BN, repeat procedure or urethral botulinum toxin A injection may increase the satisfactory rate. The procedure is also durable with acceptable complication occurrence.
Figure 1 Table 1. Urodynamic parameter changes before and after TUI-BN
Figure 2 Table 2. Voiding methods before and after TUI-BN
Disclosures
<span class="text-strong">Funding</span> NONE <span class="text-strong">Clinical Trial</span> Yes <span class="text-strong">Public Registry</span> No <span class="text-strong">RCT</span> No <span class="text-strong">Subjects</span> Human <span class="text-strong">Ethics Committee</span> Research Ethics Committee, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation <span class="text-strong">Helsinki</span> Yes <span class="text-strong">Informed Consent</span> Yes