Unsuspected proximal urethral obstruction in young and middle-aged men.
Proximal urethral obstruction, a common cause of prostatism in young and middle-aged men, often is misdiagnosed as prostatitis, neurogenic bladder or a psychogenic voiding disorder. Simple urodynamic studies (uroflowmetry and cystometry) do not distinguish a poor flow owing to bladder neck obstruction from that caused by poor detrusor contractility in these patients. Only the simultaneous measurement of detrusor pressure and uroflowmetry can make this distinction. A total of 23 patients with unsuspected proximal urethral obstruction underwent synchronous video-pressure-flow electromyography studies, and were treated and followed for a minimum of 1 year. Treatment by transurethral prostatic resection or bladder neck incision almost always was curative but alpha-adrenoceptor blocking agents have not been effective. All patients who underwent transurethral prostatic resection or bladder neck incision at the 5 and 7 o'clock positions have had retrograde ejaculation but both patients who underwent unilateral bladder neck incision reported antegrade ejaculation.
D000328:Adult; D003558:Cystoscopy; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D014521:Urethra / Q000000981:diagnostic imaging / Q000601:surgery; D014524:Urethral Obstruction / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy; D001743:Urinary Bladder / Q000000981:diagnostic imaging / Q000503:physiopathology; D001748:Urinary Bladder Neck Obstruction / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy; D014563:Urodynamics