What procedure for a high bladder neck issue involves the use of staples?

Transurethral Incision of Bladder Neck (TUIBN) is the Recommended Procedure for High Bladder Neck Obstruction

The American Urological Association recommends Transurethral Incision of Bladder Neck (TUIBN) as the most effective procedure for high bladder neck obstruction, with success rates of 85-91% and significant improvements in urodynamic parameters and symptom scores. 1

Diagnostic Evaluation Before Treatment

Before proceeding with any surgical intervention for high bladder neck obstruction, proper diagnosis is essential:

• Videourodynamic studies (VUDS) are the gold standard diagnostic tool recommended by the American Urological Association (AUA) and the Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction (SUFU) 1
• VUDS can simultaneously document pressure/flow parameters and localize functional bladder neck obstruction 1
• Pressure-flow studies should be correlated with patient symptoms for accurate diagnosis, especially in women 1

Treatment Options for High Bladder Neck

Transurethral Incision of Bladder Neck (TUIBN)

• First-line surgical treatment with 85-91% success rates 1
• Particularly effective for patients with minimal adenomatous enlargement 1
• Benefits include:
  • Shorter operating times
  • Fewer complications
  • 91% satisfaction rates in women with bladder neck obstruction 1

Bladder Neck Resection

• Modified approach to bladder neck incision that involves resection rather than simple incision 2
• Comparable to transurethral resection of the prostate (TURP) in terms of:
  • Postoperative hospital stay
  • Maximal flow rates
  • Postoperative complications 2
• Superior to TURP regarding:
  • Operating time
  • Transfusion requirements
  • Volume of irrigation fluid needed
  • Lower rates of postoperative urinary infection 2

Endourethral Incision Technique

• Can be performed through an operating nasal speculum with very satisfactory results 3
• Advantages over Y-V plastic reconstruction include:
  • Simpler procedure
  • Shorter operative time
  • Shorter postoperative stay
  • No need for blood transfusion
  • Very low complication rate
  • Can be repeated if necessary 3

Complex Cases and Alternative Approaches

For more complex cases or when standard approaches fail:

Bladder Neck Closure (BNC)

• Used in cases of neurogenic bladder and lower urinary tract dysfunction 4
• Usually performed with simultaneous lower urinary tract reconstruction
• Effective but has a 31% overall complication rate, including 15% risk of vesicourethral fistula 4

Bladder Neck Reconstruction with Cinch Technique

• Uses a bladder muscle flap devoid of mucosa to encircle and compress the reconstructed neourethra 5
• Combines multiple continence-enhancing features:
  • Bladder neck narrowing
  • Urethral elongation
  • Cuff compression
  • Sling suspension
  • Urethropexy 5

Post-Treatment Monitoring

After surgical intervention, follow-up should include:

• Maximum urine flow rate measurements
• Post-void residual volume assessment
• Symptom evaluation using validated questionnaires
• Repeat urodynamic studies if symptoms persist or recur 1

Clinical Pitfalls and Considerations

• Proper patient selection is critical for successful outcomes
• Prior bladder neck surgery increases risk of complications in more invasive procedures 4
• In patients with neurogenic bladder requiring intermittent catheterization, bladder function must be carefully evaluated before any surgical intervention 1
• For elderly patients with minimal adenomatous enlargement, TUIBN is preferred due to shorter operating times and fewer complications 1