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Outcome of surgical management and pathogenesis of female primary bladder neck obstruction
Received date: 2017-12-14
Online published: 2019-12-19
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.
Xiao-peng ZHANG , Wei-yu ZHANG , Fei HUO , Hao HU , Qi WANG , Ke-xin XU . Outcome of surgical management and pathogenesis of female primary bladder neck obstruction[J]. Journal of Peking University(Health Sciences), 2019 , 51(6) : 1052 -1055 . DOI: 10.19723/j.issn.1671-167X.2019.06.013
| [1] | Panicker JN, Anding R, Arlandis S , et al. Do we understand voiding dysfunction in women? Current understanding and future perspectives: ICI-RS 2017[J]. Neurourol Urodyn, 2018,37(S4):S75-S85. |
| [2] | King AB, Goldman HB . Bladder outlet obstruction in women: functional causes[J]. Curr Urol Rep, 2014,15(9):436. |
| [3] | Meier K, Padmanabhan P . Female bladder outlet obstruction: an update on diagnosis and management[J]. Curr Opin Urol, 2016,26(4):334-341. |
| [4] | Gammie A, Kirschner-Hermanns R, Rademakers K . Evaluation of obstructed voiding in the female: how close are we to a definition[J]. Curr Opin Urol, 2015,25(4):292-295. |
| [5] | Speakman MJ, Brading AF, Gilpin CJ , et al. Bladder outflow obstruction: a cause of denervation supersensitivity[J]. J Urol, 1987,138(6):1461-1466. |
| [6] | Hoffman DS, Nitti VW . Female bladder outlet obstruction[J]. Curr Urol Rep, 2016,17(4):31. |
| [7] | Ammirati E, Manassero A, Giammò A , et al. Female primary bladder neck obstruction: role of videourodynamics and treatment options in a rare clinical entity[J]. Urologia, 2017,84(2):109-112. |
| [8] | Hickling D, Aponte M, Nitti V . Evaluation and management of outlet obstruction in women without anatomical abnormalities on physical exam or cystoscopy[J]. Curr Urol Rep, 2012,13(5):356-362. |
| [9] | Tam NN, Zhang X, Xiao H , et al. Increased susceptibility of estrogen-induced bladder outlet obstruction in a novel mouse model[J]. Lab Invest, 2015,95(5):546-560. |
| [10] | Zhang SY, Pei XL, Hu H , et al. Functional characterization of the tumor suppressor CMTM8 and its association with prognosis in bladder cancer[J]. Tumour Biol, 2016,37(5):6217-6225. |
| [11] | White N, Iglesia CB . Overactive bladder[J]. Obstet Gynecol Clin North Am, 2016,43(1):59-68. |
| [12] | Aoki Y, Brown HW, Brubaker L , et al. Urinary incontinence in women[J]. Nat Rev Dis Primers, 2017,3:17042. |
| [13] | Smith PP, Birder LA, Abrams P , et al. Detrusor underactivity and the underactive bladder: Symptoms, function, cause-what do we mean? ICI-RS think tank 2014[J]. Neurourol Urodyn, 2016,35(2):312-317. |
| [14] | Jhang JF, Jiang YH, Kuo HC . Transurethral incision of the bladder neck improves voiding efficiency in female patients with detrusor underactivity[J]. Int Urogynecol J, 2014,25(5):671-676. |
| [15] | Jin XB, Qu HW, Liu H , et al. Modified transurethral incision for primary bladder neck obstruction in women: a method to improve voiding function without urinary incontinence[J]. Urology, 2012,79(2):310-313. |
| [16] | Zhang P, Wu ZJ, Xu L , et al. Bladder neck incision for female bladder neck obstruction: long-term outcomes[J]. Urology, 2014,83(4):762-766. |
| [17] | Shen W, Ji H, Yang C , et al. Controlled transurethral resection and incision of the bladder neck to treat female primary bladder neck obstruction: description of a novel surgical procedure[J]. Int J Urol, 2016,23(6):491-495. |
| [18] | Gammie A, Kaper M, Dorrepaal C , et al. Signs and symptoms of detrusor underactivity: an analysis of clinical presentation and urodynamic tests from a large group of patients undergoing pressure flow studies[J]. Eur Urol, 2016,69(2):361-369. |
| [19] | Shen J, Isaacson D, Cao M , et al. Immunohistochemical expression analysis of the human fetal lower urogenital tract[J]. Differentiation, 2018,103:100-119. |
| [20] | Gobet R, Bleakley J, Cisek L , et al. Fetal partial urethral obstruction causes renal fibrosis and is associated with proteolytic imbalance[J]. J Urol, 1999,162(3 Pt 1):854-860. |
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