Primary bladder neck obstruction in men and women.

Primary bladder neck obstruction (PBNO) is a condition in which the bladder neck does not open appropriately or completely during voiding. Although the true prevalence of PBNO is difficult to ascertain, studies in both men and women with voiding dysfunction demonstrate a marked prevalence of the condition. Symptoms caused by PBNO include storage symptoms (frequency, urgency, urge incontinence, nocturia) and voiding symptoms (decreased force of stream, hesitancy, incomplete emptying). There are multiple theories as to the etiology of PBNO, including muscular and neurologic dysfunction and fibrosis. The diagnosis of PBNO can be made precisely with videourodynamics, urodynamic testing with simultaneous pressure-flow measurement, and visualization of the bladder neck during voiding. Treatments vary from watchful waiting to medical therapy to surgery, depending on the severity of symptoms, urodynamic findings, and response to therapy. This article reviews the current state of the art with respect to the prevalence, etiology, diagnosis, and treatment of PBNO.