PRIMARY BLADDER NECK OBSTRUCTION - URODYNAMIC FINDINGS AND TREATMENT RESULTS IN 36 MEN

Purpose: We reviewed the urodynamic findings and treatment outcomes of a large series of men with primary bladder neck obstruction. Material s and Methods: A retrospective review was done of the presenting sympt oms and urodynamic findings of 36 men with primary bladder neck obstru ction. Outcomes after treatment with alpha-blockers, transurethral inc ision of the bladder neck and prostate, or no long-term therapy were d etermined by chart review and patient survey in the majority of cases. Results: Mean age of the men was 41 years. Patients had significant l ower urinary tract symptoms, decreased peak urinary flow rates, elevat ed post-void residual, markedly elevated peak voiding pressures and po or funneling of the bladder neck during voiding. Although most patient s initially chose alpha-blocker therapy, only 30% of those beginning a lpha-blockers continued them long term, usually due to inadequate symp tomatic improvement. A total of 18 men underwent transurethral incisio n, which resulted in significant improvements in symptom scores, peak urinary flow rates, post-void residual and peak voiding pressures. Pat ients reported a mean 87% overall improvement in symptoms after transu rethral incision. Conclusions: Video urodynamics facilitate diagnosis of primary bladder neck obstruction. Transurethral incision is the mos t effective therapy for primary bladder neck obstruction.