Functional bladder neck obstruction in females--a revisit

Functional bladder neck obstruction is supposed to be nonexistent or a very rare clinical disorder. In the past two and a half years, detailed synchronous, video pressure flow EMG studies were done in all the female patients who had evidence of obstructed voiding, poor flow and acute or chronic retention. The subjects of this study are nine females who had high sustained detrusor pressure, high opening pressure, low uroflow and silent sphincter during pressure-flow EMG study. A simultaneous urovideo recording showed either a closed bladder neck, inadequate funneling, intermittent or improper opening during voiding (when Pdet was high and sustained). These patients did not have any anatomical urethral obstruction, neurogenic disorder or systemic disease (like diabetes) affecting voiding. This stringent criteria of functional bladder neck obstruction was observed in nine patients. Five patients had acute or chronic retention and three patients had varying degree of renal failure. Initially all patients were managed by clean intermittent self catheterisation (CIC). Alpha blockers were empirically tried in six patients and had shown variable results. Bladder neck incision (BNI) was performed in two patients with rewarding success.