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Journal of Peking University(Health Sciences) ›› 2019, Vol. 51 ›› Issue (6): 1052-1055. doi: 10.19723/j.issn.1671-167X.2019.06.013

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Outcome of surgical management and pathogenesis of female primary bladder neck obstruction

Xiao-peng ZHANG1,Wei-yu ZHANG1,Fei HUO2,Hao HU1,Qi WANG1,Ke-xin XU1,△()   

  1. 1. Department of Urology, Peking University People’s Hospital, Beijing 100044, China
    2. Department of Anesthesiology, Peking University People’s Hospital, Beijing 100044, China
  • Received:2017-12-14 Online:2019-12-18 Published:2019-12-19
  • Contact: Ke-xin XU E-mail:cavix@sina.com

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Abstract:

Objective: To investigate the effect of transurethral resection of bladder neck on primary female bladder neck obstruction and to analyze the expression of three kinds of sex hormone receptor (SR) in female bladder neck tissues diagnosed as primary bladder neck obstruction by the immunochemistry and statistics.Methods: The clinical data of 40 female patients, admitted into Peking University People’s Hospital for difficulty of voiding during Oct.2008 and Dec.2013 and eventually diagnosed as bladder outlet obstruction (BOO) by urodynamics, were retrospectively reviewed. BOO was defined as a maximum flow rate (Qmax) less than 12 mL/s together with a detrusor pressure at maximum flow rate (Pdet Qmax) more than 25 cmH2O in urodynamic study in the absence of neurological disorders. Diagnosis was confirmed by the cystoscopy. Preoperative and postoperative AUASS scores were recorded and analyzed for observation of curative effects and complications. The immunochemical expression of SR of primary female bladder neck obstruction (PBNO) tissues and normal control was examined and applied to statistical analysis.Results: There were significant changes postoperatively in voiding scores, storage scores and total scores (P<0.001). Postoperatively, 1 patient newly presented with overactive bladder (OAB), 4 patients newly presented with hematuria, and 1 patient underwent cystostomy. The symptoms of urinary retention with overflow incontinence in 2 patients disappeared after the surgery, and 3 patients complicated with OAB complained without urgency. In addition, pre-hydronephrosis improved postoperatively in six patients. The subjective satisfactory rate to the surgery of TURBN was 77.5% (31/40). Sex hormone receptor, including androgen receptor (AR), estrogen receptor (ER), progesterone receptor (PR), expressed in both bladder neck tissues of normal control and PBNO patients. In PBNO group, the expression of PR was significantly lower than that of control group (P<0.05), while the other 2 SRs expressed with no significantly statistical difference. PBNO patients were divided into 2 groups, according to their symptoms scores, and the expression of SRs showed no significant differences among the mild, moderate and severe groups (P>0.05).Conclusion: The transurethral bladder neck resection is valid in treating with female PBNO patients, with rarely occurrence of complications. PR expressed less in the female bladder neck tissues, and is possibly correlated with the occurrence of female PBNO.

Key words: Bladder neck obstruction, Transurethral resection of bladder neck, Sex hormone receptor, Immunohistochemistry

CLC Number: 

  • R695.1

Table 1

AUAss comparison before and after TURBN"

Items Before operation After operation P
AUAss storage phase 13.38±4.68 7.48±4.69 <0.001
AUAss urinating phase 11.85±3.92 5.95±3.40 <0.001
AUAss total score 25.22±7.47 13.42±4.99 <0.001
QoL 5.22±0.95 2.17±1.62 <0.001

Figure 1

Results of immunohistochemical staining (×400) A,AR expressed negatively in bladder neck smooth muscle tissue; B,AR expressed positively in bladder neck smooth muscle tissue; C,ER expressed negatively in bladder neck smooth muscle tissue; D, ER expressed positively in bladder neck smooth muscle tissue; E,PR expressed negatively in bladder neck smooth muscle tissue; F,PR expressed positively in bladder neck smooth muscle tissue."

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