From the Guidelines
An elevated bladder neck is considered an obstruction when it impedes urine flow, and videourodynamic evaluation is the diagnostic tool of choice to document pressure/flow parameters and localize functional bladder-neck obstruction. The bladder neck is the junction between the bladder and urethra, and when positioned abnormally high or when it fails to open properly during urination, it can impede urine flow, leading to symptoms such as weak urine stream, hesitancy, incomplete emptying, and urinary retention 1. This condition can occur in both men and women and may result in significant morbidity and decreased quality of life if left untreated.
Key Points to Consider
- The American Urological Association (AUA) and the Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction (SUFU) guideline on urodynamic studies in adults recommends videourodynamic evaluation as the standard test to diagnose bladder-neck obstruction 1.
- Treatment options for bladder-neck obstruction include alpha-blocker medications, such as tamsulosin or alfuzosin, to relax the smooth muscle at the bladder neck, as well as surgical interventions like bladder neck incision or transurethral resection of the bladder neck.
- The obstruction occurs because the high position or inadequate relaxation of the bladder neck creates increased resistance to urine flow, requiring the bladder to generate higher pressures to empty, which can eventually lead to bladder dysfunction if left untreated.
Diagnostic Approach
- Urodynamic studies, including videourodynamic evaluation, are essential to diagnose bladder-neck obstruction and assess the severity of the obstruction 1.
- Cystoscopy may also be used to visualize the bladder neck and rule out other causes of obstruction.
- A thorough medical history and physical examination are also crucial in diagnosing bladder-neck obstruction and determining the best course of treatment.
From the FDA Drug Label
The dynamic component is a function of an increase in smooth muscle tone in the prostate and bladder neck leading to constriction of the bladder outlet An elevated bladder neck can be considered an obstruction if it leads to constriction of the bladder outlet, which is a component of bladder outlet obstruction.
- Key points:
From the Research
Definition of Bladder Neck Obstruction
Bladder neck obstruction is a condition where the bladder neck, which is the area where the bladder connects to the urethra, is blocked or narrowed, causing difficulty in urinating. This condition can be caused by various factors, including an elevated bladder neck.
Symptoms and Diagnosis
The symptoms of bladder neck obstruction include difficult micturition, urinary retention, and recurrent urinary tract infections. Diagnosis is typically made through a combination of physical examinations, urodynamic studies, cystography, and urethrocystoscopy. According to 3, functional bladder neck obstruction can be definitively diagnosed through detailed synchronous pressure flow, electromyography, and video urodynamics.
Treatment Options
Treatment options for bladder neck obstruction include:
- Alpha-blockers: These medications can help relax the muscles in the bladder neck and improve urine flow. According to 3, alpha-blockers were successful in 50% of patients with functional bladder neck obstruction.
- Bladder neck incision: This is a surgical procedure where the bladder neck is incised to widen the opening and improve urine flow. According to 4, transurethral incision of the bladder neck is effective in relieving voiding difficulty due to anatomic or functional bladder neck obstruction in women.
- Transurethral resection of the bladder neck (TURBN): This is a surgical procedure where the bladder neck is resected to widen the opening and improve urine flow. According to 5, TURBN was successful in treating two cases of primary bladder neck obstruction in women.
Effectiveness of Treatment
The effectiveness of treatment for bladder neck obstruction varies depending on the individual case and the treatment option chosen. According to 6, transurethral incision of the bladder neck resulted in significant improvements in symptom scores, peak urinary flow rates, post-void residual, and peak voiding pressures in men with primary bladder neck obstruction. According to 7, bladder neck incision resulted in symptomatic improvement in 76% of women with bladder neck obstruction.
Elevated Bladder Neck as an Obstruction
An elevated bladder neck can be a cause of bladder neck obstruction. According to 7, an elevated, rigid bladder neck was a constant finding in women with bladder neck obstruction. Treatment of an elevated bladder neck typically involves bladder neck incision or TURBN to widen the opening and improve urine flow.