Springer Nature medical video. Bladder neck incision / produced by Springer Nature.

9789811913075

Dordrecht, South Holland : Springer Nature, 2022.

1 online resource (10 minutes)

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Primary bladder neck obstruction (PBNO) is a functional obstruction of the bladder caused by abnormal opening of the bladder neck during the voiding phase of micturition. This occurs in the absence of other causes of anatomic obstruction or increased striated sphincter activity. Diokono and colleagues were the first to report PBNO as a clinical entity in women, in 1984. Although there is a lack of data looking at disease progression and risk factors for developing detrusor underactivity and/or renal failure due to prolonged obstruction, early diagnosis and treatment of PBNO should help to ameliorate these sequelae. Treatment options include conservative management with watchful waiting, pharmacologic management, and surgical intervention. The traditional surgical management of PBNO in both men and women is endoscopic incision of the bladder neck (BNI). The extent of the incision extends from just inside the bladder neck through the proximal third of the urethra, making sure to preserve continence by avoiding the external urethral sphincter. It should be "just enough" to relieve the obstruction and never too deep that may put the patient at higher risk for vesicovaginal fistula and stress urinary incontinence. This video gives a comprehensive overview of understanding the concept, evaluation and selection of patient, detailed operative technique with clear demonstration of tips to avoid potential complications like fistula and incontinence. It will be helpful for all those specialists, who are dealing with Female Urology.

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February 27, 2023