Management of functional bladder neck obstruction in women: Use of alpha-blockers and pediatric resectoscope for bladder neck incision

Purpose: Functional bladder neck obstruction has been definitively diagnose d in the last few years due to detailed synchronous pressure flow, electrom yography and video urodynamics. Clean intermittent self-catheterization and bladder neck incision are the modalities of treatment. To our knowledge th e role of alpha-blockers is not yet defined in women, A new technique was d eveloped to perform bladder neck incision using a pediatric resectoscope, Materials and Methods: A total of 24 women with obstructive voiding symptom s or retention were evaluated with video pressure flow electromyography, an d diagnosed with functional bladder neck obstruction due to high pressure a nd low flow on silent electromyography and bladder neck appearance on fluor oscopy. Patients were initially treated with clean intermittent self-cathet erization and alpha-blockers. Catheterization was stopped when post-void re sidual was less than 50 mi. and only at-blocker therapy was continued. Blad der neck incision was performed in patients who had a poor response to or s ide effects of alpha-blocker therapy, or when therapy was discontinued due to economic reasons. Clean intermittent self-catheterization was continued in patients who had a poor response to a-blockers or refused to undergo bla dder neck incision. Bladder neck incision was performed in the initial 2 ca ses with an adult resectoscope using a Collin's knife and subsequently a pe diatric resectoscope (13F). Uroflow and post-void residual measurements wer e performed in all cases. Results: Of the 24 patients 12 (50%) showed improvement in symptoms, peak f low and post-void residual (p <0.01) with alpha-blocker therapy only. Of th e 12 patients who had a poor response to a-blockers 6 underwent bladder nec k incision subsequently and 6 remained on clean intermittent self-catheteri zation. All 8 patients treated with bladder neck incision, including 2 who had a good response but discontinued alpha-blocker therapy, had sustained i mprovement in post-void residual and peak flow (p <0.01) after a mean follo wup of 3.8 +/- 2.4 years. Grade 1 stress incontinence in 2 adult resectosco pe cases responded to conservative treatment. None of the pediatric resecto scope cases had stress incontinence. Conclusions: Clean intermittent self-catheterization and alpha-blockers are the initial treatment options for functional bladder neck obstruction. The alpha-blockers were successful in 50% of our patients. Bladder neck incisi on should be offered judiciously with minimal risk of curable stress incont inence. The pediatric resectoscope is useful to make a well controlled inci sion safely in the female urethra.