Long-term follow up and predictive factors for successful outcome of transurethral incision of the bladder neck in women with detrusor underactivity

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• 作者：Jia-Fong Jhang ; Yuan-Hong Jiang ; Cheng-Ling Lee ; Hann-Chorng Kuo ; ^{alur1984@tzuchi.com.tw" class="auth_mail" title="E-mail the corresponding author} ; ^{hck@tzuchi.com.tw" class="auth_mail" title="E-mail the corresponding author}
• 关键词：intravesical pressure ; urinary retention ; video-urodynamic study ; voiding efficiency
• 刊名：Journal of the Formosan Medical Association
• 出版年：2016
• 出版时间：September 2016
• 年：2016
• 卷：115
• 期：9
• 页码：807-813
• 全文大小：615 K

文摘

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 of TUI-BN and identified the predictive factors of satisfactory outcomes.

Methods

A total 50 women with DU for whom medical treatment failed underwent TUI-BN. The urodynamic parameters at baseline and follow-up visits were analyzed. Patients with VEs >50% were considered to have satisfactory outcomes. Baseline urodynamic parameters were analyzed as factors predictive of outcomes.

Results

After a mean follow up of 61.8 months, 26 of 50 patients had satisfactory outcomes. The mean VE, maximum flow rate, voided volume, detrusor pressure, and postvoid residual volume significantly improved after TUI-BN. A higher intravesical pressure [P_ves, odds ratio (OR) = 1.023, p = 0.013] and smaller first sensation of bladder filling (OR = 0.990, p = 0.020) at baseline were predictive factors for satisfactory outcomes. The multivariate analysis revealed that only baseline P_ves was a significant predictor of satisfactory outcomes (OR = 1.024, p = 0.038). The receiver operating characteristic curve analysis of baseline P_ves showed that the area under the curve was 0.767 (95% confidence interval = 0.624–0.876). The optimal cutoff value of P_ves for a satisfactory outcome was 45 cmH₂O, which had a specificity of 78.26% and acceptable sensitivity of 73.08%.

Conclusion

TUI-BN improved VE in women with DU over the long term. A higher P_ves compared to a lower P_ves was predictive of satisfactory surgical outcomes.