Purpose: Little has been reported on the occurrence of primary bladder neck dysfunction (PBND) in the pediatric patient, particularly as it relates to the use of alpha-blocker therapy, the mainstay of medical therapy in adults. Diagnosed on videourodynamics (VUDS), PBND is characterized by the constellation of prolonged opening time, incomplete bladder neck funneling, quiet pelvic floor electromyogram (EMG) during voiding and abnormal pressure flow parameters. We report the VUDS findings in PBND and our experience with alpha-blocker therapy in the pediatric and adolescent population.
Materials and methods: A total of 34 symptomatic patients met all VUDS criteria for PBND, and alpha-blocker therapy was initiated in 26. All patients were monitored with serial noninvasive uroflow studies with pelvic floor EMG (uroflow/EMG) before and after initiation of alpha-blocker therapy. Objective clinical response was assessed by measuring average and maximum uroflow rates, post-void residual urine volumes and pelvic floor EMG lag time, a correlate of opening time.
Results: A total of 26 patients with PBND (20 males, 6 females) 5.5 to 20 years old at initiation of therapy (mean age 12.8 years) were treated with alpha-blockers. Mean average and maximum uroflow rates improved from 5.5 to 12.6 cc per second and from 10.3 to 19.7 cc per second, respectively, while mean EMG lag time decreased from 24.4 to 5.7 seconds and post-void residual urine volume from 98.9 to 8.9 cc (all p <0.001). Mean followup was 31 months, with all patients reporting significant symptomatic improvement. No patient experienced any major adverse side effects. The 8 patients with PBND who refused alpha-blocker therapy had no improvement symptomatically or urodynamically with time, and those who discontinued therapy had a return to pretreatment values.
Conclusions: PBND is an often overlooked but significant cause of voiding dysfunction in children and adolescents. In our experience alpha-blockers are clinically effective therapy for PBND and have been reasonably well tolerated in our young patients for what may possibly be a lifelong problem.