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01-09-2015 | Post-Prostatectomy and Acquired Voiding Dysfunction (V Tse, Section Editor)

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

Authors: Himanshu Aggarwal, Gary E. Lemack

Published in: Current Bladder Dysfunction Reports | Issue 3/2015

Abstract

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.

Marion G, Weijtlandt JA. Surgery of the neck of the bladder. Br J Urol. 1933;5(4):351–80.CrossRef

Nanson EM. Marion’s disease or bladder neck stenosis. Aust N Z J Surg. 1951;20(3):215–23.CrossRefPubMed

Woodside JR. Urodynamic evaluation of dysfunctional bladder neck obstruction in men. J Urol. 1980;124(5):673–7.PubMed

Awad SA, Downie JW, Lywood DW, Young RA, Jarzylo SV. Sympathetic activity in the proximal urethra in patients with urinary obstruction. J Urol. 1976;115(5):545–7.PubMed

Bates CP, Arnold EP, Griffiths DJ. The nature of the abnormality in bladder neck obstruction. Br J Urol. 1975;47(6):651–6.CrossRefPubMed

Leadbetter Jr GW, Leadbetter WF. Diagnosis and treatment of congenital bladder-neck obstruction in children. N Engl J Med. 1959;260(13):633–7.CrossRefPubMed

Smith DR. Critique on the concept of vesical neck obstruction in children. JAMA. 1969;207(9):1686–92.CrossRefPubMed

Farrar DJ, Osborne JL, Stephenson TP, Whiteside CG, Weir J, Berry J, et al. A urodynamic view of bladder outflow obstruction in the female: factors influencing the results of treatment. Br J Urol. 1975;47(7):815–22.CrossRefPubMed

9.•

Diokno AC, Hollander JB, Bennett CJ. Bladder neck obstruction in women: a real entity. J Urol. 1984;132(2):294–8. This was the first description of PBNO in women.PubMed

10.

Toh KL, Ng CK. Urodynamic studies in the evaluation of young men presenting with lower urinary tract symptoms. Int J Urol. 2006;13(5):520–3.CrossRefPubMed

11.•

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(6 Pt 1):2063–5. This article higlights that PBNO is often misdiagnosed as other diagnoses.PubMed

12.

Nitti VW, Lefkowitz G, Ficazzola M, Dixon CM. Lower urinary tract symptoms in young men: videourodynamic findings and correlation with noninvasive measures. J Urol. 2002;168(1):135–8.CrossRefPubMed

13.

Yang SS, Wang CC, Hsieh CH, Chen YT. alpha1-Adrenergic blockers in young men with primary bladder neck obstruction. J Urol. 2002;168(2):571–4.CrossRefPubMed

14.

Karami H, Valipour R, Lotfi B, Mokhtarpour H, Razi A. Urodynamic findings in young men with chronic lower urinary tract symptoms. Neurourol Urodyn. 2011;30(8):1580–5.CrossRefPubMed

15.

Jamzadeh AE, Xie D, Laudano M, Seklehner S, Elterman DS, Shtromvaser L, et al. Urodynamic characterization of lower urinary tract symptoms in men less than 40 years of age. World J Urol. 2014;32(2):469–73.CrossRefPubMed

16.

Groutz A, Blaivas JG, Chaikin DC. Bladder outlet obstruction in women: definition and characteristics. Neurourol Urodyn. 2000;19(3):213–20.CrossRefPubMed

17.

Nitti VW, Tu LM, Gitlin J. Diagnosing bladder outlet obstruction in women. J Urol. 1999;161(5):1535–40.CrossRefPubMed

18.••

Akikwala TV, Fleischman N, Nitti VW. Comparison of diagnostic criteria for female bladder outlet obstruction. J Urol. 2006;176(5):2093–7. This article compares various criteria of female BOO.CrossRefPubMed

19.

Kuo HC. Videourodynamic characteristics and lower urinary tract symptoms of female bladder outlet obstruction. Urology. 2005;66(5):1005–9.CrossRefPubMed

20.

Blaivas JG, Groutz A. Bladder outlet obstruction nomogram for women with lower urinary tract symptomatology. Neurourol Urodyn. 2000;19(5):553–64.CrossRefPubMed

21.

Jamzadeh AE, Xie D, Laudano MA, Elterman DS, Seklehner S, Shtromvaser L, et al. Urodynamic characterization of lower urinary tract symptoms in women less than 40 years of age. Can J Urol. 2014;21(5):7460–4.PubMed

22.

Badenoch AW. Congenital obstruction at the bladder neck. Ann R Coll Surg Engl. 1949;4(5):295–307.PubMedCentralPubMed

23.

Turner-Warwick R, Whiteside CG, Worth PH, Milroy EJ, Bates CP. 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(1):44–59.CrossRefPubMed

24.

Yalla SV, Gabilondo FB, Blunt KJ, Fam BA, Castello A, Kaufman JM. Functional striated sphincter component at the bladder neck: clinical implications. J Urol. 1977;118(3):408–11.PubMed

25.

Yalla SV, Blute RD, Snyder H, Yap W, Fraser L, Friedman E. Isolated bladder neck obstruction of undetermined etiology (primary) in adult male: recognition and management. Urology. 1981;17(1):99–108.CrossRefPubMed

26.

Yalla SV, Waters WB, Snyder H, Varady S, Blute R. Urodynamic localization of isolated bladder neck obstruction in men: studies with micturitional vesicourethral static pressure profile. J Urol. 1981;125(5):677–84.PubMed

27.

Crowe R, Noble J, Robson T, Soediono P, Milroy EJ, Burnstock G. 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(3):1231–6.CrossRefPubMed

28.

Margulis V, Lin VK, Wang S-Y, Tang J, Zimmern PE. Characterization of primary bladder neck obstruction: immunohistochemical and gene expression analysis. Curr Urol. 2007;1(2):95–9.CrossRef

29.

Trockman BA, Gerspach J, Dmochowski R, Haab F, Zimmern PE, Leach GE. Primary bladder neck obstruction: urodynamic findings and treatment results in 36 men. J Urol. 1996;156(4):1418–20.CrossRefPubMed

30.

Suri A, Srivastava A, Singh KJ, Dubey D, Mandhani A, Kapoor R, et al. Endoscopic incision for functional bladder neck obstruction in men: long-term outcome. Urology. 2005;66(2):323–6.CrossRefPubMed

31.

Huckabay C, Nitti VW. Diagnosis and treatment of primary bladder neck obstruction in men. Curr Urol Rep. 2005;6(4):271–5.CrossRefPubMed

32.

Norlen LJ, Blaivas JG. Unsuspected proximal urethral obstruction in young and middle-aged men. J Urol. 1986;135(5):972–6.PubMed

33.

Hruz P, Danuser H, Studer UE, Hochreiter WW. Non-inflammatory chronic pelvic pain syndrome can be caused by bladder neck hypertrophy. Eur Urol. 2003;44(1):106–10. discussion 110.CrossRefPubMed

34.

Axelrod SL, Blaivas JG. Bladder neck obstruction in women. J Urol. 1987;137(3):497–9.PubMed

35.

Nitti VW. Primary bladder neck obstruction in men and women. Rev Urol. 2005;7 Suppl 8:S12–7.PubMedCentralPubMed

36.

Delaere KP, Debruyne FM, Moonen WA. Bladder neck incision in the female: a hazardous procedure? Br J Urol. 1983;55(3):283–6.CrossRefPubMed

37.

Gronbaek K, Struckmann JR, Frimodt-Moller C. The treatment of female bladder neck dysfunction. Scand J Urol Nephrol. 1992;26(2):113–8.PubMed

38.

Kumar A, Mandhani A, Gogoi S, Srivastava A. Management of functional bladder neck obstruction in women: use of alpha-blockers and pediatric resectoscope for bladder neck incision. J Urol. 1999;162(6):2061–5.CrossRefPubMed

39.

Bates CP, Whiteside CG, Turner-Warwick R. Synchronous cine-pressure-flow-cysto-urethrography with special reference to stress and urge incontinence. Br J Urol. 1970;42(6):714–23.CrossRefPubMed

40.••

Padmanabhan P, Nitti VW. Primary bladder neck obstruction in men, women, and children. Curr Urol Rep. 2007;8(5):379–84. Excellent prior review of PBNO.CrossRefPubMed

41.

Yalla SV, Resnick NM. Initiation of voiding in humans: the nature and temporal relationship of urethral sphincter responses. J Urol. 1997;157(2):590–5.CrossRefPubMed

42.

Lim CS, Abrams P. The Abrams-Griffiths nomogram. World J Urol. 1995;13(1):34–9.CrossRefPubMed

43.

Marks BK, Goldman HB. Videourodynamics: indications and technique. Urol Clin North Am. 2014;41(3):383–91. vii-viii.CrossRefPubMed

44.

Haylen BT, de Ridder D, Freeman RM, Swift SE, Berghmans B, Lee J, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Neurourol Urodyn. 2010;29(1):4–20.PubMed

45.

King AB, Goldman HB. Bladder outlet obstruction in women: functional causes. Curr Urol Rep. 2014;15(9):436.CrossRefPubMed

46.

Kaplan SA, Ikeguchi EF, Santarosa RP, D’Alisera PM, Hendricks J, Te AE, et al. Etiology of voiding dysfunction in men less than 50 years of age. Urology. 1996;47(6):836–9.CrossRefPubMed

47.

Brucker BM, Fong E, Shah S, Kelly C, Rosenblum N, Nitti VW. Urodynamic differences between dysfunctional voiding and primary bladder neck obstruction in women. Urology. 2012;80(1):55–60.CrossRefPubMed

48.

Kumar A, Banerjee GK, Goel MC, Mishra VK, Kapoor R, Bhandari M. Functional bladder neck obstruction: a rare cause of renal failure. J Urol. 1995;154(1):186–9.CrossRefPubMed

49.

Li B, Gao W, Dong C, Han X, Li S, Jia R, et al. Long-term safety, tolerability, and efficacy of alpha1-adrenergic blocker in young men with primary bladder neck obstruction: results from a single centre in China. Int Urol Nephrol. 2012;44(3):711–6.CrossRefPubMed

50.

Cisternino A, Zeccolini G, Calpista A, De Marco V, Prayer Galetti T, Iafrate M, et al. Obstructive primary bladder neck disease: evaluation of the efficacy and safety of alpha1-blockers. Urol Int. 2006;76(2):150–3.CrossRefPubMed

51.

Boyd K, Hilas O. alpha-adrenergic blockers for the treatment of lower-urinary-tract symptoms and dysfunction in women. Ann Pharmacother. 2014;48(6):711–22.CrossRefPubMed

52.

Athanasopoulos A, Gyftopoulos K, Giannitsas K, Perimenis P. Effect of alfuzosin on female primary bladder neck obstruction. Int Urogynecol J Pelvic Floor Dysfunct. 2009;20(2):217–22.CrossRefPubMed

53.

Costantini E, Lazzeri M, Bini V, Zucchi A, Fioretti F, Frumenzio E, et al. Open-label, longitudinal study of tamsulosin for functional bladder outlet obstruction in women. Urol Int. 2009;83(3):311–5.CrossRefPubMed

54.

Chang SJ, Chiang IN, Yu HJ. The effectiveness of tamsulosin in treating women with voiding difficulty. Int J Urol. 2008;15(11):981–5.CrossRefPubMed

55.

Goldman HB, Zimmern PE. The treatment of female bladder outlet obstruction. BJU Int. 2006;98(2):359–66.CrossRefPubMed

56.••

Sacco E, Tienforti D, Bientinesi R, D’Addessi A, Racioppi M, Pinto F, et al. OnabotulinumtoxinA injection therapy in men with LUTS due to primary bladder-neck dysfunction: objective and patient-reported outcomes. Neurourol Urodyn. 2014;33(1):142–6. Role of Botox in PBNO.CrossRefPubMed

57.

Kochakarn W, Lertsithichai P. Unilateral transurethral incision for primary bladder neck obstruction: symptom relief and fertility preservation. World J Urol. 2003;21(3):159–62.CrossRefPubMed

58.

Yang SS, Tsai YC, Chen JJ, Peng CH, Hsieh JH, Wang CC. Modified transurethral incision of the bladder neck treating primary bladder neck obstruction in young men: a method to improve voiding function and to preserve antegrade ejaculation. Urol Int. 2008;80(1):26–30.CrossRefPubMed

59.

Jonas U, Petri E, Hohenfellner R. Indication and value of bladder neck incision. Urol Int. 1979;34(4):260–5.CrossRefPubMed

60.

Zhang P, Wu ZJ, Xu L, Yang Y, Zhang N, Zhang XD. Bladder neck incision for female bladder neck obstruction: long-term outcomes. Urology. 2014;83(4):762–6.CrossRefPubMed

61.

Jin XB, Qu HW, Liu H, Li B, Wang J, Zhang YD. Modified transurethral incision for primary bladder neck obstruction in women: a method to improve voiding function without urinary incontinence. Urology. 2012;79(2):310–3.CrossRefPubMed

62.•

Blaivas JG, Flisser A, Tash JA. Treatment of primary bladder neck obstruction in women with transurethral resection of the bladder neck. J Urol. 2004;171(3):1172–5. Technique of bladder neck incision in women.CrossRefPubMed

63.

Markic D, Maricic A, Oguic R, Spanjol J, Rahelic D, Rubinic N, et al. Transurethral bladder neck incision in women with primary bladder neck obstruction. Wien Klin Wochenschr. 2014;126(7–8):217–22.CrossRefPubMed

Title: Primary Bladder Neck Obstruction in Men and Women: an Update on Diagnosis and Management
Authors: Himanshu Aggarwal
Gary E. Lemack
Publication date: 01-09-2015
Publisher: Springer US
Published in: Current Bladder Dysfunction Reports / Issue 3/2015
Print ISSN: 1931-7212
Electronic ISSN: 1931-7220
DOI: https://doi.org/10.1007/s11884-015-0315-6

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

Abstract

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Abstract

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