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Purpose of Review <p>The purpose of this review is to better understand the etiology and prevalence of primary bladder neck obstruction (PBNO) in women. In addition, we hope to provide an update on current diagnostic tools and treatment modalities for this condition.</p> Recent Findings <p>New studies show that magnetic resonance imaging may be beneficial for the diagnosis of PBNO. In addition, studies have shown improvement in symptoms and urodynamic parameters for onabotulinumtoxinA (onaBoNTA) injection at the bladder neck. Lastly, surgical technique has been modified to minimize the risk of stress urinary incontinence and vesicovaginal fistula traditionally associated with transurethral incision of the bladder neck (TUIBN).</p> Summary <p>PBNO is a functional obstruction of the bladder when the bladder neck fails to adequately open during voiding. The exact etiology and prevalence are unknown. Patients usually present with obstructive voiding symptoms, and uroflow and post-void residual volumes can be used as an adjunct for screening for this condition. While urodynamic parameters defining outlet obstruction may be beneficial, videourodynamics is the mainstay of diagnosis, as fluoroscopic imaging of the open bladder neck during voiding is critical. Treatment options include expectant management, pharmacotherapy with α-adrenergic receptor blockers, onaBoNTA injection at the bladder neck and/or surgery, where the gold standard for treatment is TUIBN.</p>

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Primary Bladder Neck Obstruction in Women: Current Management Paradigm

  • 期刊论文

  • 发表日期：

    2025年4月17日

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  • Joanna Marantidis,
  • Benjamin M. Brucker,
  • Rachael D. Sussman

摘要

Purpose of Review

The purpose of this review is to better understand the etiology and prevalence of primary bladder neck obstruction (PBNO) in women. In addition, we hope to provide an update on current diagnostic tools and treatment modalities for this condition.

Recent Findings

New studies show that magnetic resonance imaging may be beneficial for the diagnosis of PBNO. In addition, studies have shown improvement in symptoms and urodynamic parameters for onabotulinumtoxinA (onaBoNTA) injection at the bladder neck. Lastly, surgical technique has been modified to minimize the risk of stress urinary incontinence and vesicovaginal fistula traditionally associated with transurethral incision of the bladder neck (TUIBN).

Summary

PBNO is a functional obstruction of the bladder when the bladder neck fails to adequately open during voiding. The exact etiology and prevalence are unknown. Patients usually present with obstructive voiding symptoms, and uroflow and post-void residual volumes can be used as an adjunct for screening for this condition. While urodynamic parameters defining outlet obstruction may be beneficial, videourodynamics is the mainstay of diagnosis, as fluoroscopic imaging of the open bladder neck during voiding is critical. Treatment options include expectant management, pharmacotherapy with α-adrenergic receptor blockers, onaBoNTA injection at the bladder neck and/or surgery, where the gold standard for treatment is TUIBN.