Critique on the Concept of Vesical Neck Obstruction in Children

Abstract

It is doubtful that vesical neck obstruction in children is the common cause of urinary infection, reflux, and enuresis. Routine revision of the bladder neck, in association with ureterovesicoplasty, does not improve the cure rate of the antireflux operation. Most agree that it is difficult, if not impossible, to diagnose such obstruction with endoscopy or cystourethrography. Outlet obstruction, through trigonal hypertrophy, tends to further protect the ureterovesical "valve" from incompetency. Voiding pressure studies reveal no significant gradient on either side of the vesical neck. Recent investigations show that the area of increased resistance in young girls is not at the vesical neck but in the midurethra and is caused by involuntary spasm of the periurethral striated muscle. Treatment of the accompanying distal urethral stenosis usually relieves this spasm.