高雄市阮綜合醫院 外科部 泌尿科
Primary Bladder Neck Obstruction in Young Men
Ping-Ju Tsai, Cheng-Chen Su, Chung-Sung Shen, Shih-Ya Hung
Division of Urology, Department of Surgery, Yuan’s General Hospital, Kaohsiung, Taiwan
Primary bladder neck obstruction (PBNO) is a condition in which bladder neck opening is not adequate during voiding without another anatomical obstruction, such as benign prostatic obstruction in men or genitourinary prolapse in women. There are multiple theories of the etiology of PBNO, including increased striated sphincter activity, abnormal amount of non-muscular connective tissue, and abnormal arrangement of the detrusor/trigonal musculature. Its prevalence in male and female population is not known. PBNO is a videourodynamic(VUD) diagnosis. The classic presence of VUD study is high pressure and low flow voiding pattern without dysfunction of extrinsic sphincter relaxation and distal urethral obstruction.
Here we presented a 30-year-old male who has difficulty voiding. Uroflowmetry showed intermittent voiding pattern and low flow rate. Cystoscopy didn’t reveal distal urethral stricture and benign prostatic hyperplasia. Videourodynamic study showed high pressure, low flow voiding pattern. After alpha block medical therapy failed, transurethral bladder neck incision over 5 and 7 o’clock bidirectional was performed. After surgery, his urinary flow rate increased. Uroflowmetry showed normal flow pattern with 37 c.c./sec. maximal flow rate. The recovery course was uneventful and he was satisfied with surgical result.