Primary bladder neck obstruction is one of the rare causes for renal failure in young adult males

Abstract

BackgroundPrimary bladder neck obstruction (PBNO) is one of the causes of bladder outlet obstruction (BOO) and rarely results in renal failure. We are presenting the clinical characteristics of young male patients with PBNO and renal failure.MethodsMedical records of patients between 18 and 40 years old with PBNO and renal failure were retrospectively reviewed (2014–2020). Patients with anatomical cause of BOO, and any urological or systemic disease or previous history of any surgical procedure associated with renal failure and/or lower urinary tract dysfunction were excluded. Serum creatinine measurement, ultrasonography, uroflowmetry, cystoscopy, and videourodynamics were performed.ResultsSeven male patients were identified, and the mean age of the patients was 28.8 years. Symptom duration was > 5 years in all patients. Two patients presented with difficult voiding, and five patients presented with both storage and voiding lower urinary tract symptoms (LUTS). Three patients were previously misdiagnosed as overactive bladder. At presentation, serum creatinine levels were between 1.7 and 2.4 mg/dl. One patient was under hemodialysis treatment and waiting for renal transplantation. Mean detrusor pressure at maximum measured flow rate, mean maximum flow rate (Qmax), and mean average flow rate (Qave) was 67.6 cm H2O, 9.5 ml/s, and 5.5 ml/s, respectively. With α-blocker treatment, serum creatinine levels were stable or decreased after 12 months follow-up and mean Qmax and Qave were increased to 14.8 ml/s and 10.1 ml/s, respectively.ConclusionsPBNO is a common disease in young men presenting with a long history of LUTS. Videourodynamics is mandatory for accurate diagnosis, but having a high clinical suspicion for PBNO is key to ensure the diagnosis. Clinicians should pay more attention to PBNO in young male patients with a long history of LUTS to prevent misdiagnosis, incorrect treatment, and possible decrease in renal function by years.