Presentation Authors: Rachael Sussman, Ricardo Palmerola*, Benoit Peyronnet, Christina Escobar, Dominique Pape, Nirit Rosenblum, Benjamin Brucker, Victor Nitti, New York, NY
Introduction: Several diagnostic criteria for female bladder outlet obstruction have been described, but none link diagnosis to treatment outcomes. We sought to determine treatment outcomes of women diagnosed with primary bladder neck obstruction (PBNO) by videourodynamic (VUD) criteria to determine predictors of success.
Methods: A retrospective review was performed of all female patients undergoing bladder neck incision (BNI) at a single institution. All patients underwent VUD. PBNO was defined as radiographic evidence of obstruction at the bladder neck (BN) in the presence of sustained detrusor contraction of any magnitude. Cure was defined as improvement in symptoms, decreased post void residual (PVR) and for patients who were catheter dependent stopping clean intermittent catheterization (CIC); improvement as decreased frequency of CIC or improved but persistent symptoms; and failure as no significant change in symptoms or inability to void spontaneously. Detrusor underactivity (DU) was defined as maximum flow rate (Qmax) < 15 and detrusor pressure at Qmax (PdetQmax) < 20.
Results: Between Jan 2010 and Oct 2018, 18 women underwent BNI for PBNO. Mean age was 62.9 years (SD 17.2). All women failed treatment with an alpha-blocker. All met VUD criteria for obstruction at the BN. Mean preoperative Qmax on VUD was 2.5 mL/s (SD 3.4); PdetQmax was 46.2 cm H2O (SD 32.0). Of 9 women who were dependent on a catheter preop, 4 underwent unilateral BNI,1 bilateral BNI, and 4 had a staged bilateral BNI after unilateral BNI failed to relieve obstruction. Of the other 9 women, 7 had unilateral and 2 bilateral BNI (surgeon&[prime]s preference). Pre and postop data are summarized in Table 1. 14 patients (78%) were cured, 3 (17%) improved, and 1 (5%) failed. Only one patient had DU and she was cured of CIC. Although voiding pressures were higher in cured women, differences in mean PdetQmax of cured, improved, and failed women were not statistically significant (51, 29.7, and 27 cm H2O respectively, p = 0.507)
Conclusions: Using PBNO as a model, VUD criteria for diagnosing obstruction predicted success after BNI with 95% of women being cured or improved. This was independent of detrusor voiding pressures. Women should not be excluded from treatment of obstruction based on lower voiding pressures or DU alone.