Evaluation of Primary Bladder Neck Obstruction in Men

Abstract

Lower urinary tract symptoms (LUTS) are common in young men. While once considered rare, primary bladder neck obstruction (PBNO) is now thought to be the most common underlying pathology in young men (younger than 50 years of age) presenting with LUTS without or without pelvic/testicular pain. This condition, while suggested by a history of mixed voiding and storage complaints in the absence of an antecedent injury or infection, is difficult to diagnose accurately without a diagnostic evaluation including uroflow and urodynamics. PBNO can result in relatively severe voiding dysfunction with long-term consequences if the disease goes unrecognized. Patients with PBNO are frequently misdiagnosed and treated empirically with antibiotics, anticholinergics, or α-blockers, without diagnostic evaluation. As history alone is poorly predictive of the underlying pathology, a comprehensive assessment of patient symptomatology in combination with urinalysis, urine culture, and uroflow can identify patients who should undergo more invasive testing with urodynamics. In symptomatic patients, a combination of uroflow and videourodynamics is highly accurate for the diagnosis. High-pressure voiding and poor funneling of the bladder neck confirm the diagnosis and identify patients most likely to benefit from aggressive treatment. Therapy targeted at the appropriate diagnosis results in effective treatment in the overwhelming majority of patients.