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At least 19 recordsLinked to original sources
PubMed1985

Functional bladder neck obstruction. Results of endoscopic bladder neck incision in 131 consecutive patients.

Endoscopic diathermy incision of the bladder neck was carried out as a routine procedure in 131 consecutive male patients with an established diagnosis of functional bladder neck obstruction. Follow-up after 3 months revealed excellent symptomatic and urodynamic results. Morbidity was low and the post-operative stay in hospital short (median 2 days). Patients must be informed of the risk of retrograde ejaculation associated with the procedure and objective evidence of the diagnosis is essential.

Adult↗
PubMed2005

Use of alpha1-blockers in female functional bladder neck obstruction.

INTRODUCTION: Bladder outflow obstruction may cause obstructive or irritative symptoms. The diagnosis of female functional bladder neck obstruction requires a pressure/flow study and electromyography performed by videourodynamics. The treatment includes self-catheterization or bladder neck incision. We administered tamsulosin, an alpha1A/alpha1D-selective adrenergic antagonist, in women with functional bladder neck obstruction to evaluate its potential therapeutic effects. PATIENTS AND METHODS: A group of 18 women affected by functional bladder neck obstruction was selected. The diagnosis was made by means of a pressure/flow study combined with electromyography and a fluoroscopic test. The diagnostic criteria were: high detrusor pressure with reduced maximum flow, silent electromyography activity, and bladder neck nonfunnelling during the fluoroscopic test. Tamsulosin 0.4 mg once daily was administered for at least 30 days. Patients with a postvoid residual urine volume > or = 100 ml performed intermittent self-catheterization. Patients with a postvoid residual urine volume < 100 ml performed self-catheterization every 7 days. After 30 days of therapy, all patients underwent a new pressure/flow study and a micturition fluoroscopic test. RESULTS: 10 (56%) out of 18 treated patients showed a statistically significant improvement in symptoms, maximum flow, and postvoid residual urine volume (p < 0.01). CONCLUSION: The use of alpha1-blockers may be an initial treatment option for female functional bladder neck obstruction, as this therapeutic option proved to be effective in more than 50% of our patients suffering from this voiding dysfunction.

Adrenergic alpha-1 Receptor Antagonists↗
PubMed1980

Functional bladder neck obstruction. Late results after endoscopic bladder neck incision.

The effect of endoscopic bladder neck incision for functional bladder neck obstruction was assessed in 28 consecutive patients with a follow-up period of up to 50 months. The operation had excellent effect on the patients' symptoms consisting mainly of weak stream and/or recurrent urinary infections. Uroflowmetry at the postoperative follow-up study showed a statistically significant increase in as well maximum flow rate as mean flow rate. The bladder neck incision carried very few complications, and the average postoperative stay in hospital was 2.8 days. It is important to be aware of the condition functional bladder neck obstruction, and the diagnosis should be based upon uroflowmetry and voiding cystourethrography. In borderline cases with only slightly reduced urinary flow rate, additional pressure-flow studies should be applied to demonstrate infravesical obstruction.

Adult↗
PubMed1989

[Obstructive bladder neck syndrome in women].

Primary bladder neck obstruction in women is quite rare and its symptoms--dysuria, frequency, and urgency--are equivocal. Routine radiological investigations alone do not allow a diagnosis to be made, due to the lack of simultaneous measurements of detrusor pressure and urine flow. A precise diagnosis is thus to be obtained by synchronous video urodynamic studies which allow the depiction of nonfunneling or tight bladder neck during the entire phase of detrusor contraction, of bladder trabeculae and diverticula, vesico-ureteral reflux, long micturition time and incomplete voiding. When these radiological signs are associated with a rise in detrusor voiding pressure over 60 cm of water and with peak urine flow lower than 15 ml/s, the diagnosis of bladder neck obstruction is unquestionable, and the appropriate pharmacologic/endoscopic treatment can be administered.

Adult↗
PubMed1987

Bladder neck obstruction in women.

Bladder neck obstruction in women is rare. The symptoms are confounding and nonspecific. The diagnosis depends on demonstrating poor uroflow, a detrusor contraction of adequate magnitude and duration, and radiographic evidence of obstruction at the vesical neck. We treated successfully 3 women with vesical neck obstruction by transurethral vesical neck incision.

Adult↗
PubMed1980

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.

Adult↗
PubMed2005

Transurethral incision of bladder neck in treatment of bladder neck obstruction in women.

OBJECTIVES: To report our preliminary experience with transurethral incision of the bladder neck in the treatment of female voiding dysfunction due to bladder neck obstruction. Bladder neck obstruction in women is an infrequently diagnosed urologic condition. METHODS: Bladder neck obstruction was diagnosed in 11 women 41 to 80 years of age, who presented with difficult micturition or urinary retention. Preoperative investigations included a full urodynamic examination and urethrocystoscopy. Transurethral bladder neck incision was performed in all patients. Urodynamic results and clinical improvement in voiding symptoms were assessed. RESULTS: Of the 11 patients, 5 had chronic urinary retention and 6 had difficult micturition; 3 also had recurrent urinary tract infection or upper urinary tract deterioration. The most frequent findings on video-urodynamic study were a high voiding pressure plus low flow rate and a narrow bladder neck during voiding on cinefluoroscopy. After treatment, the lower urinary tract symptoms were resolved or improved in all patients. Ten patients resumed spontaneous voiding with a small postvoid residual urine volume; the remaining patient was able to void by abdominal straining after adjuvant urethral botulinum A toxin injection. Urodynamic study revealed a decreased voiding pressure and postvoid residual urine volume and an increased maximal flow rate. The overall satisfactory rate was 91%. CONCLUSIONS: Transurethral incision of the bladder neck is effective in relieving voiding difficulty owing to anatomic or functional bladder neck obstruction in women. A full video-urodynamic evaluation is essential in making the correct diagnosis and formulating a treatment plan.

Adult↗
PubMed2004

Effect of cyclohexenonic long-chain fatty alcohol on rat overactive bladder induced by bladder neck obstruction.

We attempted to clarify the preventive effects of cyclohexenonic long-chain fatty alcohol on detrusor overactivity induced by mild bladder neck obstruction. Bladder neck obstruction was created by partial ligation of the urethra. Female Sprague-Dawley rats were divided into three groups: those with bladder neck obstruction treated without long-chain fatty alcohol, those with bladder neck obstruction with long-chain fatty alcohol (8 mg/kg, i.p., every day) and the sham-operated control group (A, B, and C groups, respectively). Six weeks after the induction of bladder neck obstruction, voiding behavior was observed in the metabolic cage, and a cystometrogram was performed in the experimental animals. Furthermore, Hematoxylin and Eosin, Azan-Mallory, and Bodian stainings were performed in these bladders. Bladder weight, voiding behaviors and a cystometry indicated that rats in the A group showed detrusor overactivity, which was improved by treatment with long-chain fatty alcohol. The proportion of connective tissue and the density of bundles of neurofibers in the bladder of the A group was significantly less than that in the other bladders. Mild bladder neck obstruction induces detrusor overactivity, which is improved by treatment with long-chain fatty alcohol.

Animals↗
PubMed1993

[The influence of combined surgery for bladder cancer and bladder-neck obstruction on the recurrence of bladder cancer].

A comparative retrospective study with follow-up survey was performed on 75 male bladder cancer patients, in order to investigate the relation between bladder carcinoma and bladder-neck obstruction, and effect of combined surgical treatment for both lesion on the recurrence of bladder cancer. All the bladder cancers were confirmed by cystoscopy and histopathological examination. The pathological findings included: 69 cases of transitional cell carcinoma, 5 cases of squamous cell carcinoma and 1 case of adenocarcinoma. All patients were treated by partial cystectomy and followed-up by cystoscopy and urine exfoliative cytologic examination. Thirty patients (group I) who had bladder cancer and bladder-neck obstruction received simultaneous partial cystectomy and cystauchenotomy were compared to 21 patients (group II) who had both lesions but received partial cystectomy only, and to 24 patients (group III) who had bladder cancer only and underwent partial cystectomy. Evaluation of recurrence of bladder cancer in each group showed that recurrence occurred in 6 patients (20%) in group I, 10 patients (47.1%) in group II, and 4 patients (16.6%) in group III. The data showed that partial cystectomy combined with cystauchenotomy in patients with bladder cancer accompanied by bladder-neck obstruction significantly decreased the postoperative recurrence of tumor in comparison with the group treated by partial cystectomy alone. It is suggested that the presence of bladder-neck obstruction may exert some effects on the genesis and postoperative recurrence of bladder cancer.

Adult↗
PubMed2004

Treatment of primary bladder neck obstruction in women with transurethral resection of the bladder neck.

PURPOSE: We describe the presentation, clinical characteristics, treatment and followup of a series of women with primary bladder neck obstruction (PBNO). MATERIALS AND METHODS: A patient data base was searched for women who underwent transurethral resection for bladder outlet obstruction diagnosed by videourodynamic study (VUDS) according to the Blaivas-Groutz nomogram for female bladder outlet obstruction between 1993 and 2002. A total of 37 women with obstruction were identified. Patients with neurogenic, traumatic, anatomical or iatrogenic causes of obstruction were excluded. Seven patients remained who had been diagnosed with PBNO, of whom all underwent transurethral bladder neck resection. Office records were reviewed for history, presentation, surgical treatment and clinical outcome. RESULTS: Seven patients were diagnosed with PBNO. Age was 39 to 81 years. Six of 7 patients presented with symptoms of obstruction, including a weak or intermittent stream and urinary hesitancy. These 6 patients had unremarkable physical examination findings with normal perianal sensation, anal sphincter tone and lower extremity reflexes. One patient presented with abdominal swelling, which on physical examination was found to be a markedly distended bladder containing more than 1000 cc urine. All patients had overt urethral obstruction on VUDS. In 6 of 7 patients obstruction was clearly at the vesical neck and in 1 the obstruction site was equivocal. Three patients were treated or had previously been treated pharmacologically with alpha-blockers. All patients were subsequently treated with intermittent self-catheterization. All patients then underwent transurethral bladder neck resection at the vesical neck and proximal urethra. Surgical specimens weighed 1 to 5 gm and showed urethral fragments or fibromuscular tissue without specific pathological findings. Followup was 1 to 10 years (median 3) and it included physical examination, uroflowmetry, post-void residual urine measurement and videourodynamic study. Six patients considered themselves cured of lower urinary tract symptoms and 1 was improved. In 1 patient the obstruction site was not clear. One patient had mild stress incontinence under rare circumstances not severe enough to require protective pads. The average change in flow was 6 +/- 10 vs 30 +/- 17 ml per second (p <0.03). The average change in voided volume was 194 +/- 170 vs 416 +/- 206 ml per second (p <0.06). Average change in post-void residual urine was 680 +/- 445 vs 173 +/- 366 ml (p <0.05). CONCLUSIONS: PBNO is an exceedingly rare condition, which is easily treatable when properly diagnosed by VUDS. The presentation of patients in urinary retention in middle age suggests that PBNO may be more common in less apparent forms than has previously been recognized.

Adult↗
PubMed2001

Bladder neck obstruction in the female.

Bladder neck dysfunction is a rare cause of obstruction in women. The symptoms are nonspecific and diagnosis relies on video-urodynamic evaluation. In this case study, a woman presented with urinary retention, recurring urinary tract infections, and bilateral hydronephrosis, in whom video-urodynamics revealed bladder neck obstruction. Her clinical presentation, as well as the pertinent literature on the diagnosis and treatment of bladder neck obstruction in women, are reviewed.

Aged↗
PubMed1997

[Diagnosis of bladder neck obstruction in women].

Bladder outlet obstruction in women is a rare entity, and difficult to diagnose. In our series most of the patients had previous history of gyneco-obstetric or urological procedures. Cystometry enabled us to diagnose the coexistence of bladder instability and obstruction in 48% of the patients. We did not find statistically significant differences between the patients with and without BI in terms of degree of obstruction measured by uroflowmetry and pressure/flow studies. Pressure/flow studies and Uroflowmetry had been the essential key in the diagnosis of obstruction in our series. Cysto-urethrography and urethroscopy were normal in over 50% of patients. The urethral calibration was abnormal in 16% of the cases.

Adolescent↗
PubMed1984

Bladder neck obstruction in women: a real entity.

Bladder neck obstruction in women is rare. Recently, we encountered 3 cases with similar findings. Clinically, the patients had chronic bladder symptoms of obstruction and irritation. The bladder showed trabeculation, diverticula and/or vesicoureteral reflux. Urinary flow rates were poor or absent. Endoscopy was unreliable in evaluating the outlet. The voiding pressure-flow cystourethrography study established the diagnosis. Specific operations to relieve bladder neck obstruction may be justified with proper urodynamic documentation.

Adult↗
PubMed2001

Endoscopic treatment of complete bladder neck obstruction by transurethral Seldinger technique.

Bladder neck contracture is usually a complication of prostatectomy and the treatment of choice in such a condition should be endoscopic surgery. However, in a few patients the bladder neck may be completely obstructed preventing retrograde access into the bladder. A case is presented of complete bladder neck obstruction occurring after transurethral resection of prostate, which was treated after an access was provided by using transurethral Seldinger technique.

Aged↗