Functional bladder neck obstruction in females--a revisit

Area of Science:

• Urology
• Female Voiding Dysfunction

Background:

• Functional bladder neck obstruction is considered rare in women.
• Previous understanding suggested limited clinical evidence for this condition.

Purpose of the Study:

• To investigate the existence and characteristics of functional bladder neck obstruction in female patients.
• To evaluate diagnostic methods and treatment outcomes for this condition.

Main Methods:

• Detailed synchronous video pressure flow and electromyography (EMG) studies were performed.
• Nine female patients with obstructed voiding, poor flow, and retention were analyzed.
• Exclusion criteria included anatomical obstruction, neurogenic disorders, and systemic diseases.

Main Results:

• Nine female patients met stringent criteria for functional bladder neck obstruction.
• These patients exhibited high detrusor pressure, high opening pressure, low uroflow, and a silent sphincter.
• Urovideo recordings showed a closed, inadequately funneling, or improperly opening bladder neck during voiding.
• Five patients had acute/chronic retention, and three had renal failure.
• Clean intermittent self-catheterization (CIC) was the initial management.
• Alpha-blockers showed variable results; bladder neck incision (BNI) was successful in two patients.

Conclusions:

• Functional bladder neck obstruction can occur in women and is associated with significant voiding dysfunction.
• Pressure-flow EMG and urovideo studies are crucial for diagnosis.
• Management may involve CIC, alpha-blockers, or surgical intervention like BNI.