Primary Bladder Neck Obstruction: Clinical Characteristics and the Effectiveness of Endoscopic Incision of Bladder Neck

Abstract

Purpose: We evaluated the clinical characteristics of primary bladder neck obstruction and assessed the effectiveness of endoscopic incision of the bladder neck for the treatment of men with this lesion. Materials and Methods: From January 1995 to February 1998, 26 men whose age of less than 50 with primary bladder neck obstruction who did not respond to α-adrenergic receptor blockers were treated with the endoscopic incision of bladder neck. Endoscopic incision was made at 5 o`clock portion from approximately 1cm distal to the left ureteral orifice through the bladder neck to just proximal to the verumontanum. Urethral catheter was removed the next day of operation. At 3 weeks after the incision, the effectiveness of treatment was evaluated by changes of IPSS(international prostate symptom score) and parameters of uroflowmetry. Complications including retrograde ejaculation were also evaluated. Results: Mean age of patients was 36.1(19-49) years. 18 of all 26(69%) had suffered from the refractory prostatitis symptoms. Obsturctive symptoms of weak stream and hesitancy were more prominent than irritative symptoms. Most patients(24) were diagnosed to have mechanical obstruction, otherwise 2 patients were considered to have functional obstruction(severely delayed initiation of micturition). After incision of bladder neck, all patients experienced marked symptomatic relief of the voiding symptoms, change of mean IPSS was from 22.7 to 4.8(p<0.001) and Qmax from 11.5 to 22.6ml/sec(p<0.001). Retrograde ejaculation recorded in only 2 patients(7.7%) Conclusions: Endoscopic incision of the bladder neck is an effective and safe treatment modality for patients with primary bladder neck obstruction.