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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.

  • It is characterized by a marked natruresis and diuresis with excretion of large amounts of sodium and water.
  • In addition to the potential for severe volume depletion, electrolyte disorders such as hypokalemia, hyponatremia, hypernatremia, and hypomagnesemia may occur.
  • 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.
  • 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 - please click the links to find out more:
 

Bladder

- Cystotomy (all types)

- Litholaplaxy - Standard

- Bladder tumor (all types - closed)

- Repair of bladder fistula (all types)

- Relief of Bladder Neck Obstruction (closed - all types)

- Operations for Incontinence male
- Operations for Incontinence
female

- Insertion of Artificial Sphincter

             - Urinary
             - Anal

Penis  
Uretha  
Prostate  
Bladder  
Ureter  
Kidney  
Scrotal Contents  
Miscellaneous  
Diagnostic Procedures  





 

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