The Long-term Effect of Superficial Bladder Neck Incision on Ejaculation and Incontinence in Boys with Primary and Secondary Bladder Neck Obstruction.

Pauline M L Hennus,Tom P V M De Jong,Laetitia M O De Kort,Jan H Kieft,Esther Hoenjet

doi:10.3389/fped.2017.00152

Abstract

Superficial bladder neck incision (SBNI) is controversial at young age, with retrograde ejaculation after puberty as main concern. The aim of the study is to investigate the long-term effect of SBNI on ejaculation and incontinence in boys with primary and secondary bladder neck obstruction (BNO). In boys with infravesical obstruction, SBNI was performed in case of a persistent BNO after earlier desobstruction or in case of primary severely obstructive bladder neck. SBNI was performed with a diathermy hook, always superficially (2-3 mm) and unilaterally at 7 O'clock. Males that had SBNI during childhood after posterior urethral valve incision or relief of other obstruction between 1986 and 2003 were included. Evaluation was done by International Continence Society male sex questionnaire, International Prostate Symptom Score, developmental International Consultation Modular Questionnaire on Urinary Incontinence, frequency volume chart, and uroflowmetry. Of 79 traceable patients, 40 (50.6%) participated. Of these, 37 (92.5%) completed all questionnaires and 28 (70%) performed uroflowmetry. Median age at SBNI was 4.7 years [interquartile range (IQR) 0.6-8.5] and was 19.6 years (IQR 17.3-20.9) at follow-up. All men had antegrade ejaculation, 4/37 (10.8%) reported possibly reduced ejaculatory volume. Eight (22%) had moderate lower urinary tract symptoms and two (5.4%) had moderate incontinence. Median maximum flow rate was 30.1 mL/s (IQR 24.4-42.6). SBNI in boys with severe infravesical obstruction can be done safely with preservation of antegrade ejaculation and no additional lower urinary tract dysfunction.

Highlights

Bladder neck obstruction (BNO) is a condition described as an insufficient opening of the bladder neck during voiding due to a functional or anatomic narrowing of the bladder neck and was first described by Marion in 1933 [1]
Persistent BNO after posterior urethral valves (PUV) or other obstruction incision may contribute to lower urinary tract symptoms (LUTS), urinary incontinence (UI), urinary tract infections (UTIs), and vesicoureteral reflux [3,4,5,6]
Thirteen patients had bladder neck incision (BNI) combined with another desobstruction than PUV

Summary

Introduction

Bladder neck obstruction (BNO) is a condition described as an insufficient opening of the bladder neck during voiding due to a functional or anatomic narrowing of the bladder neck and was first described by Marion in 1933 [1]. The underlying cause of primary BNO remains unclear. In boys with posterior urethral valves (PUV), BNO is often present and caused by detrusor hypertrophy with subsequent narrowing of the bladder neck [2, 3]. In most cases of PUV, BNO disappears spontaneously over time after PUV incision due to disappearance of detrusor hypertrophy. Persistent BNO after PUV or other obstruction incision may contribute to lower urinary tract symptoms (LUTS), urinary incontinence (UI), urinary tract infections (UTIs), and vesicoureteral reflux [3,4,5,6]. Untreated persistent bladder outlet obstruction may lead to progressive symptoms, as well as upper and lower urinary tract decompensation [2, 7]

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Results

Conclusion