Current Urology Reports

, Volume 6, Issue 4, pp 271–275 | Cite as

Diagnosis and treatment of primary bladder neck obstruction in men

  • Chad Huckabay
  • Victor W. Nitti
Article

Abstract

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.

Keywords

Lower Urinary Tract Symptom Bladder Neck Terazosin Retrograde Ejaculation Primary Bladder Neck Obstruction 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
This is a preview of subscription content, log in to check access.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References and Recommended Reading

  1. 1.
    Marion G: Surgery of the neck of the bladder. Br J Urol 1933, 5:351–357.Google Scholar
  2. 2.
    Turner-Warwick R, Whiteside CG, Worth PH, et al.:A urodynamic view of the clinical problems associated with bladder neck dysfunction and its treatment by endoscopic incision and trans-trigonal posterior prostatectomy. Br J Urol 1973, 45:44–49.PubMedGoogle Scholar
  3. 3.
    Norlen LJ, Blaivas JG: Unsuspected proximal urethral obstruction in young and middle-aged men. J Urol 1986, 135:972–976.PubMedGoogle Scholar
  4. 4.
    Leadbetter GW Jr, Leadbetter WF: Diagnosis and treatment of congenital bladder-neck obstruction in children. N Engl J Med 1959, 260:633–637.PubMedCrossRefGoogle Scholar
  5. 5.
    Awad SA, Downie JW, Lywood DW, et al.: Sympathetic activity in the proximal urethra in patients with urinary obstruction. J Urol 1976, 115:545–547.PubMedGoogle Scholar
  6. 6.
    Crowe R, Noble J, Robson T, et al.: An increase of neuropeptide Y but not nitric oxide synthase-immunoreactive nerves in the bladder neck from male patients with bladder neck dyssynergia. J Urol 1995, 154:1231–1236.PubMedCrossRefGoogle Scholar
  7. 7.
    Tanagho EA, Miller ER, Meyers FH, et al.: Observations on the dynamics of the bladder neck. Br J Urol 1966, 38:72–84.PubMedCrossRefGoogle Scholar
  8. 8.
    Tanagho EA, Miller ER: Initiation of voiding. Br J Urol 1970, 42:175–183.PubMedGoogle Scholar
  9. 9.
    Yalla SV, Resnick NM: Initiation of voiding in humans: the nature and temporal relationship of urethral sphincter responses. J Urol 1997, 157:590–595.PubMedCrossRefGoogle Scholar
  10. 10.
    Yalla SV, Gabilondo FB, Blunt KJ, et al.: Functional striated sphincter component at the bladder neck: clinical implications. J Urol 1977, 118:408–411.PubMedGoogle Scholar
  11. 11.
    Kaplan SA, Ikeguchi EF, Santarosa RP, et al.: Etiology of voiding dysfunction in men less than 50 years of age. Urology 1996, 47:836–839.PubMedCrossRefGoogle Scholar
  12. 12.
    Nitti VW, Lefkowitz G, Ficazzola M, et al.: Lower urinary tract symptoms in young men: videourodynamic findings and correlation with noninvasive measures. J Urol 2002, 168:135–138. This paper describes urodynamic findings in a cohort of young men presenting with LUTS. The most common diagnosis in this cohort was PBNO.PubMedCrossRefGoogle Scholar
  13. 13.
    Yang SS, Wang CC, Hsieh CH, et al.: Alpha1-Adrenergic blockers in young men with primary bladder neck obstruction. J Urol 2002, 168:571–574. A recent report of á-blocker therapy in PBNO.PubMedCrossRefGoogle Scholar
  14. 14.
    Kaplan SA, Te AE, Jacobs BZ: Urodynamic evidence of vesical neck obstruction in men with misdiagnosed chronic nonbacterial prostatitis and the therapeutic role of endoscopic incision of the bladder neck. J Urol 1994, 152:2063–2065.PubMedGoogle Scholar
  15. 15.
    Woodside JR: Urodynamic evaluation of dysfunctional bladder neck obstruction in men. J Urol 1980, 124:673–677.PubMedGoogle Scholar
  16. 16.
    Webster GD, Lockhart JL, Older RA: The evaluation of bladder neck dysfunction. J Urol 1980, 123:196–198.PubMedGoogle Scholar
  17. 17.
    Trockman BA, Gerspach J, Dmochowski R, et al.: Primary bladder neck obstruction: urodynamic findings and treatment results in 36 men. J Urol 1996, 156:1418–1420.PubMedCrossRefGoogle Scholar
  18. 18.
    Kumar A, Banerjee GK, Goel MC, et al.: Functional bladder neck obstruction: a rare cause of renal failure. J Urol 1995, 154:186–189.PubMedCrossRefGoogle Scholar
  19. 19.
    Hruz P, Danuser H, Studer UE, et al.: Non-inflammatory chronic pelvic pain syndrome can be caused by bladder neck hypertrophy. Eur Urol 2003, 44:106–110.PubMedCrossRefGoogle Scholar
  20. 20.
    Yalla SV, Blute RD, Snyder H, et al.: Isolated bladder neck obstruction of undetermined etiology (primary) in adult male: recognition and management. Urology 1981, 17:99–108.PubMedCrossRefGoogle Scholar
  21. 21.
    Kaplan SA, Santarosa RP, D’Alisera PM, et al.: Pseudodyssynergia (contraction of the external sphincter during voiding) misdiagnosed as chronic nonbacterial prostatitis and the role of biofeedback as a therapeutic option. J Urol 1997, 157:2234–2237.PubMedCrossRefGoogle Scholar
  22. 22.
    Jorgensen TM, Djurhuus JC, Schroder HD: Idiopathic detrusor sphincter dyssynergia in neurologically normal patients with voiding abnormalities. Eur Urol 1982, 8:107–110.PubMedGoogle Scholar
  23. 23.
    Gerber GS, Kim JH, Contreras BA, et al.: An observational urodynamic evaluation of men with lower urinary tract symptoms treated with doxazosin. Urology 1996, 47:840–844.PubMedCrossRefGoogle Scholar
  24. 24.
    Yamanishi T, Yasuda K, Sakakibara R, et al.: The effectiveness of terazosin, an alpha1-blocker, on bladder neck obstruction as assessed by urodynamic hydraulic energy. BJU Int 2000, 85:249–253.PubMedCrossRefGoogle Scholar
  25. 25.
    Sirls LT, Ganabathi K, Zimmern PE, et al.: Transurethral incision of the prostate: an objective and subjective evaluation of long-term efficacy. J Urol 1993, 150:1615–1621.PubMedGoogle Scholar
  26. 26.
    Kochakarn W, Lertsithichai P: Unilateral transurethral incision for primary bladder neck obstruction: symptom relief and fertility preservation. World J Urol 2003, 21:159–162. A recent report of men with PBNO with a description of interval follow-up symptom scores and flow rates. The finding of decreased sperm counts is really not interpretable at this point and this is the only such paper to report the phenomenon.PubMedCrossRefGoogle Scholar

Copyright information

© Current Science Inc 2005

Authors and Affiliations

  • Chad Huckabay
  • Victor W. Nitti
    • 1
  1. 1.Department of UrologyNew York University School of MedicineNew YorkUSA

Personalised recommendations