Therapeutic efficacy and predictive factors for treatment outcomes of transurethral incision of the bladder neck in women with voiding dysfunction due to an underactive bladder.

INTRODUCTION: Transurethral incision of the bladder neck (TUI-BN) can effectively improve voiding efficiency in women with bladder neck obstruction. However, its role in women with low detrusor contractility remains unclear. This study retrospectively evaluated the clinical efficacy of TUI-BN and identified predictive factors for treatment failure in women with detrusor underactivity (DU). METHODS: Women with videourodynamic study (VUDS)-proven bladder neck dysfunction (BND) with DU, detrusor acontractility (DA), and neurogenic lower urinary tract dysfunction (NLUTD) who underwent TUI-BN were retrospectively analyzed. Treatment outcomes were graded according to the ability to void spontaneously and postvoid residual (PVR) volume. Successful treatment was defined as self-voiding with a PVR of <33% of bladder capacity. Treatment outcomes were assessed and compared among the different BND subgroups. RESULTS: A total of 212 women were analyzed, including 76 with DU, 75 with DA, and 61 with NLUTD. Among the three subgroups, patients with DA had the highest success rate (84.0%), followed by those with DU (77.6%), whereas those with NLUTD had the lowest success rate (67.2%) (p = 0.068). Logistic regression analysis of clinical and VUDS parameters showed that a large PVR, NLUTD, and chronic medical disease were predictors of treatment failure after TUI-BN. Patients with successful outcomes had significantly increased maximum flow rate, voiding efficiency, and bladder contractility index and significantly decreased PVR and bladder outlet obstruction index after TUI-BN CONCLUSION: TUI-BN is an effective surgical procedure for improving voiding efficiency in women with VUDS-proven BND and low detrusor contractility. A high PVR, had central nervous system-associated NLUTD, and chronic medical diseases may predict less favorable treatment outcomes.