Bladder Neck Obstruction In Men Research Articles

Primary bladder neck obstruction in men: The importance of urodynamic assessment and cystourethrography in measuring its severity.

Primary bladder neck obstruction (PBNO) is a condition primarily affecting young men, characterized by obstruction at the bladder neck, leading to lower urinary tract symptoms. The aim of this study was to identify a correlation between the severity of bladder neck opening impairment and urinary symptoms by means of urodynamic studies. A retrospective analysis was conducted in adult males diagnosed with PBNO at a university neurourology department between 2015 and 2022 who underwent voiding cystourethrography (VCUG) and pressure-flow studies. The cohort was divided into two groups: absence of bladder neck opening on VCUG (Group A) and incomplete bladder neck opening (Group B). Out of the 82 patients with PBNO screened, 53 were included in the analysis. Nocturia was the only symptom more prevalent in Group A (65% in Group A vs. 30% in Group B, p = 0.02) but scores and subscores of the Urinary Symptom Profile questionnaire were not different between groups. In addition, the detrusor pressure at a maximum flow rate (PdetQmax), bladder outlet obstruction index (BOOI), and bladder contractility index (BCI) were higher in Group A than in Group B [PdetQmax (A = 93.7 ± 53.7 cmH2O vs. B = 65.7 ± 26.4 cmH2O; p = 0.01)-BOOI (A = 77 ± 58.3 vs. B = 48 ± 25.7; p = 0.03)-BCI (A = 136 ± 51.3 vs. B = 110 ± 41.7; p = 0.04)]. This study demonstrates a significant association between the extent of bladder neck opening impairment observed on VCUG and obstruction and contraction urodynamic parameters, but no association with the severity of urinary symptoms. Future studies should evaluate the predictive value of treatment response and the occurrence of complications based on clinical and urodynamic parameters.

Urodynamic outcomes of tamsulosin in the treatment of primary bladder neck obstruction in men.

Introduction:Alpha blockers are widely used in the treatment of primary bladder neck obstruction; however, evidence for objective urodynamic efficacy is scarce. We studied the effect of the uroselective α1-blocker tamsulosin on urodynamic parameters in male patients with type I primary bladder neck obstruction.Methods:A single center prospective observational study was carried out from July 2013 to February 2015. Male patients (18–50 years) with type 1 primary bladder neck obstruction were recruited. Selected patients were started on tablet tamsulosin 0.4 mg once daily for 3 months. International prostate symptom score (IPSS), uroflow and urodynamic studies were done pre- and post-treatment. Primary outcome was decreased in minimum detrusor pressure at maximum flow rate by 15%. Wilcoxon-matched pair signed-rank test was used.Results:Of 39 patients recruited, 21 patients completed the follow-up as per protocol and were analyzed. Mean age was 41 years. 57% patients achieved the primary outcome (median detrusor pressure pre- and post-treatment were 71 and 56 cm of water, P < 0.001). Similarly, median values for bladder outlet obstruction index (BOOI) and IPSS decreased from 59 to 38 (P < 0.001) and 22 to 12 (P < 0.001), respectively. Median maximum flow rate increased from 8 to 10 ml (P = 0.05). Pretreatment BOOI of >60 was associated with poor outcomes.Conclusions:Tamsulosin 0.4 mg once a day is effective in reducing bladder outlet obstruction on pressure flow studies in patients with primary bladder neck obstruction type 1.

Primary Bladder Neck Obstruction in Men and Women: an Update on Diagnosis and Management

Primary bladder neck obstruction (PBNO) is a rare condition of the lower urinary tract seen in young and middle-aged patients. The true prevalence of this entity is unknown; however, it has been reported in 5–11 % of young women and 28–54 % of young men with lower urinary tract symptoms (LUTS). The diagnosis of PBNO requires a high index of suspicion and an experienced clinician due to the variety of presenting urinary symptoms, and often a much delayed presentation, which frequently is not reported by patients, and often misdiagnosed by clinicians. Videourodynamics (VUDS) will greatly assist in making the diagnosis. Observation, medical therapy, and surgical therapy are the treatment options with variable success rates. This detailed review focuses on history, presentation, diagnosis, and management of PBNO in both men and women.

Evaluation of Primary Bladder Neck Obstruction in Men

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.

Primary bladder neck obstruction in men, women, and children

The understanding of the presentation, diagnosis, and treatment of primary bladder neck obstruction (PBNO) has evolved over the last 20 years. It was first identified 70 years ago, but the etiology is still unclear. There are multiple theories as to the etiology, including muscular and neurological dysfunction and fibrosis. Over the years, many voiding parameters and cut points and nomograms have been presented for diagnosis of nonneurogenic functional bladder outlet obstruction in young men. Until recently, there was a paucity of data on PBNO in women and children. Videourodynamics provide an accurate diagnosis of PBNO but for some patients are an invasive option. Treatments vary from watchful waiting to alpha-blockade to surgery, depending on the severity of symptoms, urodynamic findings, and response to medical therapy. This paper reviews the theories on etiology, incidence, presentation, and diagnostic evaluation, and briefly discusses treatment options for PBNO.

Diagnosis and treatment of primary bladder neck obstruction in men

Although primary bladder neck obstruction was first described approximately 70 years ago, it is within the past 20 years that the symptoms, signs, and methods of diagnosis and treatment have been elucidated. This article describes its typical presenting symptoms and signs that commonly may lead to a missed diagnosis for a number of years in many cases. The treatments typically available are pharmacologic or surgical. Unfortunately, most treatments have not been studied in prospective, randomized trials to assess true efficacy. The natural history of this disorder, both treated and untreated, demands much further study to determine its effect on progression of symptoms and bladder and renal function.

Diagnosis and Treatment of Primary Bladder Neck Obstruction in Men

Although primary bladder neck obstruction was first described approximately 70 years ago, it is within the past 20 years that the symptoms, signs, and methods of diagnosis and treatment have been elucidated. This article describes its typical presenting symptoms and signs that commonly may lead to a missed diagnosis for a number of years in many cases. The treatments typically available are pharmacologic or surgical. Unfortunately, most treatments have not been studied in prospective, randomized trials to assess true efficacy. The natural history of this disorder, both treated and untreated, demands much further study to determine its effect on progression of symptoms and bladder and renal function.

Endoscopic incision for functional bladder neck obstruction in men: Long-term outcome

Objectives To evaluate the long-term outcomes of endoscopic bladder neck incision (BNI) for functional bladder neck obstruction. Functional and/or mechanical obstruction of the bladder neck in men causes lower urinary tract symptoms. Although alpha-blockers are the initial treatment, they often fail to alleviate the symptoms. Methods The records of 45 men with obstructive voiding symptoms treated between 1988 and 1996 were reviewed. The symptom score, renal parameters, urine routine microscopy, urine culture and sensitivity, uroflowmetry, voiding cystourethrography, and videourodynamic results were reviewed. Patients with a peak flow rate of less than 10 mL/s, inadequate funneling of the bladder neck, more than 40 cm H 2O opening pressure with a relaxed external sphincter, a postvoid residual urine volume greater than 100 mL, no neurologic defect, and a normal urethral caliber were included. They were treated with clean intermittent catheterization and alpha-blockers. Clean intermittent catheterization was stopped when the postvoid residual urine volume was less than 50 mL. BNI was performed in patients with a poor response, noncompliance, or side effects from the alpha-blockers. Postoperatively, patients were assessed by symptom score, uroflowmetry, and postvoid residual urine volume. Results Of the 45 men, 22 responded to alpha-blockers, 5 chose clean intermittent catheterization, and 18 underwent BNI. The mean patient age was 33.42 ± 6.56 years. The mean follow-up was 96 months (range 46 to 140). After BNI, all patients showed improvement, with the symptom score improving from 26.9 to 3.6 ( P <0.001). The peak flow rate improved from 8.5 to 19.6 mL/s ( P <0.001). This improvement persisted in more than 80% of the 18 patients. Two required a second BNI and were also doing well at the last follow-up visit. Conclusions BNI is an effective treatment for functional bladder neck obstruction refractory to alpha-blockers and provides durable results.

Diagnosis and treatment of primary bladder neck obstruction in men

Although primary bladder neck obstruction was first described approximately 70 years ago, it is within the past 20 years that the symptoms, signs, and methods of diagnosis and treatment have been elucidated. This article describes its typical presenting symptoms and signs that commonly may lead to a missed diagnosis for a number of years in many cases. The treatments typically available are pharmacologic or surgical. Unfortunately, most treatments have not been studied in prospective, randomized trials to assess true efficacy. The natural history of this disorder, both treated and untreated, demands much further study to determine its effect on progression of symptoms and bladder and renal function.

Diagnosis and treatment of primary bladder neck obstruction in men

Diagnosis and treatment of primary bladder neck obstruction in men

Urodynamic Evaluation of Dysfunctional Bladder Neck Obstruction in Men

Dysfunctional bladder neck obstruction in young men has received increasing interest in recent years. The urodynamic characteristics of this disorder include elevated voiding pressure, normal reflex relaxation of the urethral rhabdosphincter, increased pressure gradient between the membranous urethra and the bladder, and inadequate radiographic bladder neck opening during detrusor activity. The functional changes occurring at the internal sphincter in 3 patients with dysfunctional bladder neck obstruction are described herein. It is demonstrated that the obstruction may result from either an active dyssynergic bladder neck contraction or failure of bladder neck relaxation. While the pathophysiology of dysfunctional bladder neck obstruction is uncertain possible mechanisms are discussed.