Understanding lower urinary tract function in women soon after bladder neck surgery

The aim of this work was to correlate anatomic and urodynamic measures with function following bladder neck surgery. Eighty-seven women who underwent bladder neck surgery at two tertiary academic medical centers in the southe astern U.S. were studied in this prospective outcomes analysis. Preoperativ e and 6-week and 6-month postoperative status was assessed with urodynamic testing, physical examination, and condition-specific quality of life instr uments. Correlations of dynamic urethral obstruction (quantified by pressur e transmission ratio, PTR, determinations) and urethral support (quantified by urethral axis measurements) with functional status were determined. At 6 weeks, 50% of the subjects with inadequate dynamic obstruction (PTR < 90% ) had genuine stress incontinence (GSI) compared to 5% of those with PTR gr eater than or equal to 90% (P = .00002). Of those with excessive obstructio n (PTR > 110%), 32% had detrusor instability (DI) and 47% had emptying phas e dysfunction (EPD) compared to 6% and 24%, respectively, of those with PTR less than or equal to 110% (P = .006 and P = .04). At 6 months, subjects w ith excessive obstruction were more likely to have EPD than other subjects (75% vs. 27%, P = .001). Those with optimal dynamic obstruction (PTR greate r than or equal to 90% but less than or equal to 110%) were more likely to have normal function (no GSI, no DI, and no EPD) than those with higher or lower PTRs (59% vs. 34%, P = .04). Urethral axis measurements did not corre late with functional status at either follow-up session. The magnitude of d ynamic urethral obstruction is related to function after bladder neck surge ry. Excessive obstruction is associated with DI and EPD, inadequate obstruc tion with GSI, and optimal obstruction with normal function. (C) 1999 Wiley -Liss, Inc.