An-Najah Staff

PURPOSE: Bladder neck obstruction in women is an infrequently diagnosed urologic condition and no standardized approach has been achieved. Here in we sought to evaluate the efficacy of transurethral resection (TUR) of bladder neck and urethra in the treatment of female patients with urinary retention (UR).
MATERIAL METHODS: Four female patients with mean age of 50.5 year (range; 18-80) who were diagnosed to have UR and underwent TUR of the bladder neck between October 2013 and June 2014 were included. All patients were unable to urinate and had Foley catheter except one had significant post voiding residue(PVR). Two patients had UR after vaginal surgeries and underwent urethral release beside TUR, the other two patients were primary cases and only TUR was done. Transurethral resection was done using the slandered resectoscope; active working element with 24f working sheet. During resection caution was given not to harm external sphincter. All patients underwent urodynamic evaluation, all of them were unable to evacuate the bladder with high voiding pressure. All patients had normal upper urinary system and normal renal function test except one of the primary cases who had hydronephrosis with high serum creatinine level. Foley catheter was left for 3 days after operation. Measurement of PVR, uroflowmetry and ultrasound were done for all patients in the postoperative period. The mean follow up duration was 5.5 months ( range; 1-9 ).
RESULTS: Three patients completely benefited from the procedure and get red of the Foley catheter without significant PVR. One patient with previous history of vaginal surgery partially benefited and significant PVR was present thus the patient started clean intermittent catheterization (CIC). One patient of the primary cases had urge incontinence and she benefited from anti cholinergic therapy.
CONCLUSION: Urinary retention is uncommon in women. Careful evaluation and detailed history physical examination with urodynamic evaluation is required. Transurethral resection in women is feasible treatment option in relieving voiding difficulties owing to anatomic or functional bladder neck obstruction. It should be done with caution as it carries risk of injury to sphincter and incontinence.