Department of Urology, Bichat Claude Bernard Hospital, Paris, France.
Green Group of Clinical Research in Neuro-Urology, AP-HP, Tenon Hospital, Sorbonne University GRC 01, Paris, France.
Neurourol Urodyn. 2024 Apr;43(4):874-882. doi: 10.1002/nau.25429. Epub 2024 Feb 23.
Primary bladder neck obstruction (PBNO) is a condition primarily affecting young men, characterized by obstruction at the bladder neck, leading to lower urinary tract symptoms. The aim of this study was to identify a correlation between the severity of bladder neck opening impairment and urinary symptoms by means of urodynamic studies.
A retrospective analysis was conducted in adult males diagnosed with PBNO at a university neurourology department between 2015 and 2022 who underwent voiding cystourethrography (VCUG) and pressure-flow studies. The cohort was divided into two groups: absence of bladder neck opening on VCUG (Group A) and incomplete bladder neck opening (Group B).
Out of the 82 patients with PBNO screened, 53 were included in the analysis. Nocturia was the only symptom more prevalent in Group A (65% in Group A vs. 30% in Group B, p = 0.02) but scores and subscores of the Urinary Symptom Profile questionnaire were not different between groups. In addition, the detrusor pressure at a maximum flow rate (PdetQmax), bladder outlet obstruction index (BOOI), and bladder contractility index (BCI) were higher in Group A than in Group B [PdetQmax (A = 93.7 ± 53.7 cmHO vs. B = 65.7 ± 26.4 cmHO; p = 0.01)-BOOI (A = 77 ± 58.3 vs. B = 48 ± 25.7; p = 0.03)-BCI (A = 136 ± 51.3 vs. B = 110 ± 41.7; p = 0.04)].
This study demonstrates a significant association between the extent of bladder neck opening impairment observed on VCUG and obstruction and contraction urodynamic parameters, but no association with the severity of urinary symptoms. Future studies should evaluate the predictive value of treatment response and the occurrence of complications based on clinical and urodynamic parameters.
原发性膀胱颈梗阻（PBNO）主要影响年轻男性，其特征为膀胱颈梗阻，导致下尿路症状。本研究旨在通过尿动力学研究确定膀胱颈开口损害严重程度与尿症状之间的相关性。
回顾性分析 2015 年至 2022 年期间在一所大学神经泌尿外科诊断为 PBNO 的成年男性患者，这些患者接受了排尿性膀胱尿道造影（VCUG）和压力流研究。该队列分为两组：VCUG 上无膀胱颈开口（A 组）和不完全膀胱颈开口（B 组）。
在筛选出的 82 例 PBNO 患者中，有 53 例纳入分析。夜尿症是 A 组更常见的唯一症状（65%在 A 组，30%在 B 组，p=0.02），但两组之间尿症状谱问卷的评分和子评分无差异。此外，A 组的逼尿肌压力在最大流量时（PdetQmax）、膀胱出口梗阻指数（BOOI）和膀胱收缩性指数（BCI）均高于 B 组[PdetQmax（A=93.7±53.7cmHO 与 B=65.7±26.4cmHO；p=0.01）-BOOI（A=77±58.3 与 B=48±25.7；p=0.03）-BCI（A=136±51.3 与 B=110±41.7；p=0.04）]。
本研究表明，VCUG 上观察到的膀胱颈开口损害程度与梗阻和收缩性尿动力学参数之间存在显著相关性，但与尿症状严重程度无关。未来的研究应根据临床和尿动力学参数评估治疗反应和并发症发生的预测价值。
