Bladder neck incision in the female: a hazardous procedure?

Anterior bladder neck incision was carried out in 32 female patients suffering from difficult, mostly incomplete, bladder emptying. All patients underwent a full urodynamic investigation with voiding cystourethrography and endoscopy. Detrusor failure was observed in 20 patients; in the remainder, a mechanical iatrogenic bladder neck obstruction was held responsible for inefficient voiding. Twenty-eight patients (56%) benefited in some degree from the procedure. Six were submitted to a repeat incision and two of them developed severe stress incontinence later on. As the results are far from promising, intermittent self-catheterisation may be proposed in some cases as an alternative to bladder neck incision for fear of incontinence. The urodynamic findings and the results of bladder neck incision, which are very different in the two sexes, are analysed. The poorer results in the female are presumably due to the decompensated state of the bladder, mostly responsible for incomplete bladder evacuation.