Primary obstruction of the bladder neck: a strange and at the same time quite common functional pathology.
Rodríguez Cabello, M.A.; Platas Sancho, A.
Hospital Universitario la Moraleja
I Congreso Nacional Virtual de Urología, 2020
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INTRODUCION: Primary bladder neck obstruction (PBNO) is an uncommon modality of dysfunction of the lower urinary tract that affects almost exclusively young men. It is a functional obstruction of the bladder outlet, whose diagnosis is hindered by the heterogeneous symptoms that it causes and can vary from mild irritative symptoms that simulate a prostatedynia, to severe symptoms of obstruction and even retention, which causes a frequent delay in the establishment of a correct treatment.

MATERIAL AND METHODS: We present the case of a 49-year-old male who consulted for several years of severe mixed low urinary track symptoms with obstructive predominance, refractory to management with alpha-blockers. No other interesting medical history. IPSS: 27. QoL: 4. ULTRASONOGRAPHY: fight bladder, homogeneous prostate 44 cc. Double bilateral excretory system, without other renal alterations. FLOWMETRY: voided volume 595 ml, Qmax: 10 ml / sec, Qmed 4 ml / sec, very compressive morphology. PSA: 1.14 ng / ml. The surgery was performed with a 26F resectoscope armed with a Thulium laser fiber. The incision was made in the 5, 7 and 12-hours positions of the endoscopic field, making a deep cut from approximately one centimeter distal to the ureteral meatus on the bladder neck until it reaches the proximity of the verumontanum, deepening until the pericervical fat and the periprostatic fibers. Surgical time was 20 minutes, the time to removal of bladder catheter was 10 hours and the hospital admission time was 15 hours. No complications were described. We evaluated him 6 months later: IPSS: 2. QdV: 0.  Ejaculation preserved. FLOWMETRY: voided volume: 299 mL, Qmax: 23 ml / sec, Qmed: 13 ml / sec, normal morphology, PVR: 0 ml.

CONCLUSIONS: Patients with primary bladder neck obstruction are often misdiagnosed because their symptoms are confused with some type of prostatic inflammatory disease and even psychogenic voiding dysfunction, so their detection requires a high index of suspicion. The endoscopic incision of the bladder neck represents the treatment of choice for this dysfunction, and it is imperative to inform the patient of the risk of retrograde ejaculation as a postoperative sequel, since this entity occurs in young subjects, in which fertility may be a priority.

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