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Relief of Bladder Neck Obstruction
What is
Relief of Bladder Neck Obstruction?
Primary bladder neck obstruction (PBNO) is a
condition in which the bladder neck fails to
open adequately during voiding, resulting in
increased striated sphincter activity or
obstruction of urinary flow in the absence of
another anatomic obstruction, such as that
caused by benign prostatic enlargement in men or
genitourinary prolapse in women.
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Effects
of Relief of Bladder Neck Obstruction
This
procedure is effective in repairing the
obstruction in the bladder neck.
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Candidates for Relief of Bladder Neck
Obstruction
Bladder neck obstruction in women is uncommon.
It should be suspected in patients with chronic
symptoms of obstruction and irritation, and with
signs including bladder trabeculation,
diverticula, and vesicoureteric reflux.
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Your Consultation
PBNO is a
videourodynamic diagnosis, the hallmark of which
is relative high-pressure, low-flow voiding with
radiographic evidence of obstruction at the
bladder neck with relaxation of the striated
sphincter and no evidence of distal obstruction.
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The
Relief of Bladder Neck Obstruction Procedure
PBNO
can be treated surgically with unilateral or
bilateral transurethral incision of the bladder
neck. The main concern with bladder neck
incision is the development of post-operative
retrograde ejaculation. Retrograde ejaculation
is less likely to occur with unilateral incision
as opposed to bilateral incision.
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Recovery
Depending upon specific complications of
obstruction, relief of bladder neck obstruction
by urethral catheterization requires prompt
(within 1 week) follow-up care with a urologist
for definitive therapy. Partial recovery of
function frequently is observed after less than
three weeks of obstruction.
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Risks
Post-obstructive diuresis is an uncommon but
clinically significant complication following
the release of urinary obstruction.
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It
is characterized by a marked natruresis and
diuresis with excretion of large amounts of
sodium and water.
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In
addition to the potential for severe volume
depletion, electrolyte disorders such as
hypokalemia, hyponatremia, hypernatremia, and
hypomagnesemia may occur.
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Etiology of this massive diuresis and
electrolyte loss is multifactorial. It is
related to fluid and urea overloads during
obstruction and acquired tubular resistance to
antidiuretic hormone and aldosterone.
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Treatment of postobstructive diuresis consists
of judicious fluid replacement with 0.45%
saline (at a rate slightly less than urine
output) and replacement of electrolytes.
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Frequently Asked Questions
Q:
What are the symptoms of bladder neck
obstruction?
A:
PBNO can present with a variety of symptoms,
including voiding symptoms (decreased force of
stream, hesitancy, intermittent stream,
incomplete emptying), storage symptoms
(frequency, urgency, urge incontinence, nocturia),
or a combination of both.
Q: What
are the treatment options for bladder neck
obstruction?
A:
The treatment
options for men and women with PBNO are the same
and include watchful waiting, pharmacotherapy,
and surgical intervention.
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The following list of Urology procedures are
performed at Beverly Hills Medical Group -
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