Symptomatology and urodynamic findings in younger males with bladder neck dysfunction

We studied consecutively 46 males, median age 36 years (range 16-59), diagnosed as bladder neck dysfunction (BND) according to a urodynamic investigation. The diagnosis was based on a prolonged opening time (greater than 04 sec) in the pressure-flow investigation and absence of organic obstruction and neurologic disease. Median duration of symptoms was 24 months (range 1-240). The most frequent symptoms were poor stream (in 70%), frequency (50%) and dribbling (37%), while 30 % had nocturia, and 20% urgency, dysuria or perineal pain during voiding. Thirty-two % had one or more urinary tract infections. We found no correlation between urodynamic findings and symptomatology in terms of total symptom-score or -duration. Median opening time was 10 sec. Patients with shorter opening time were found to have significantly greater Qmax, while the rest of the parameters did not differ. Concerning single symptom-items we found a significant correlation between small bladder capacity and frequency and nocturia but no correlation between obstructive symptoms and the pressure at the bladder neck or the urethral resistance factor. Previously used classifications of BND patients on basis of micturition pressure or response to acute alpha-blockade were not found to be of use and it is concluded that future research should be directed towards a better definition of outflow resistance which then may be used both diagnostically, prognostically and as a therapeutic aid.