Primary bladder neck obstruction in men – what´s new in the pathophysiology of this underestimated problem?

Abstract

Abstract Primary bladder neck obstruction (PBNO) is a dysfunction of the bladder neck (BN) in which the collum vesicae is narrow or fails to open adequately during voiding, resulting in a bladder outlet obstruction. PBNO causes storage or voiding LUTS often years before a correct diagnosis of PBNO is made. These patients have often been seen by many physicians and misdiagnosed as having psychogenic voiding dysfunction because of a normal prostate on rectal examination, a negligible residual urine volume, and a normal endoscopic bladder and prostate appearance. The cause of PBNO has not yet been clarified and has so far been a clinical differential diagnosis after the exclusion of the usual differential diagnoses of LUTS and bladder emptying disorders. Several publications let assume that PBNO could be induced by inflammatory processes, possibly by the same inflammatory patterns that have been previously described for BPH development, leading to an initially reversiblel and later irreversible remodeling of the connective tissue of the BN. The clinical value of these observations consists of a correct and precise diagnostic framework especially in young men referring pelvic pain and LUTS despite their small prostate volumes. The proper diagnosis could provide a tempestive calculated therapy proposal that can stop illness progression or in same cases reverse inflammation and collagenic deposition, limiting the risk of future obstruction and symtomatic progression.