title: Primary bladder neck dysfunction: an overlooked entity in children.
abstract: Primary bladder neck dysfunction is a non-neurogenic voiding disorder commonly diagnosed in young and middle age adult men, but frequently overlooked in children. Because these children typically present with lower urinary tract symptoms that also are associated with other more common forms of dysfunctional voiding, the diagnosis may be missed and treated with a variety of empiric modalities that ultimately fail. Although its underlying pathogenesis remains debated, the hallmark of the diagnosis is a failure of the bladder neck to properly open and allow for unimpeded urine flow. Videourodynamic evaluation is the only diagnostic tool that can urodynamically document the obstructive pressure/flow parameters of the condition while simultaneously localizing the functional obstruction to the bladder neck fluoroscopically. This article reviews the clinical and urodynamic findings of this entity in children and adolescents and our experience with a adrenergic antagonists, the current approach in medical therapy.
authors.affiliation: Division of Pediatric Urology, SUNY Downstate Medical Center, 600 Columbus Avenue #8K, New York, NY 10024, USA. ngrafstein@yahoo.com
authors.forename: Neil H
authors.initials: NH
authors.lastname: Grafstein
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Combs
authors.forename: Kenneth I
authors.initials: KI
authors.lastname: Glassberg
mesh_terms: D000317:Adrenergic alpha-Antagonists / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D004576:Electromyography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome; D001748:Urinary Bladder Neck Obstruction / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D014552:Urinary Tract Infections / Q000517:prevention & control; D014555:Urination Disorders / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology; D014563:Urodynamics
chemical_list: D000317:Adrenergic alpha-Antagonists
references.citation: Urology. 2003 Jan;61(1):37-49
references.pmid: 12559262
references.citation: Urology. 1998 Aug;52(2):312-5
references.pmid: 9697801
references.citation: J Urol. 1994 Dec;152(6 Pt 1):2063-5
references.pmid: 7966675
references.citation: J Urol. 1986 May;135(5):972-6
references.pmid: 3959251
references.citation: Scand J Urol Nephrol Suppl. 1989;125:59-63
references.pmid: 2633320
references.citation: Br J Urol. 1975 Dec;47(6):651-6
references.pmid: 1225456
references.citation: Urol Int. 1984;39(4):207-10
references.pmid: 6485181
references.citation: J Urol. 1997 Feb;157(2):590-5
references.pmid: 8996365
references.citation: J Urol. 2002 Jul;168(1):135-8
references.pmid: 12050507
references.citation: J Urol. 1998 Sep;160(3 Pt 2):1019-22
references.pmid: 9719268
references.citation: J Urol. 1995 Sep;154(3):1231-6
references.pmid: 7543611
references.citation: Urol Clin North Am. 1980 Jun;7(2):337-47
references.pmid: 7404872
references.citation: J Urol. 1999 Sep;162(3 Pt 2):1064-7
references.pmid: 10458432
references.citation: J Urol. 1973 Apr;109(4):727-32
references.pmid: 4695119
references.citation: Urology. 1996 Jun;47(6):836-9
references.pmid: 8677573
references.citation: Scand J Urol Nephrol. 1989;23(1):15-20
references.pmid: 2537998
references.citation: J Urol. 1976 May;115(5):545-7
references.pmid: 1271547
references.citation: J Urol. 1999 May;161(5):1535-40
references.pmid: 10210391
references.citation: J Urol. 1987 Jun;137(6):1196-201
references.pmid: 3586155
references.citation: J Urol. 1996 Oct;156(4):1418-20
references.pmid: 8808886
references.citation: Br J Urol. 1973 Feb;45(1):44-59
references.pmid: 4690150