You Have Bladder Neck Dyssynergia, But What Exactly Is It?

Symptoms And Treatment Of Bladder Neck Dyssynergia

Elderly men with reduced urine stream are often diagnosed to have “Benign Prostatic Hyperplasia”. You are somewhat younger. Your symptoms are similar in that you have a slow stream and you don’t feel you that you have emptied your bladder completely during voiding. Are you, or is your prostate, aging too soon? After initial tests, your doctor diagnosed “Bladder Neck Dyssynergia”. Here is more information on the condition.

The condition is also known as “Bladder Neck Dysfunction”. It is often found in young and middle aged men but women are not immune. It is associated with an incomplete opening of the bladder neck during voiding (rather than having the urethra squashed by the prostate, as in “Benign Prostatic Hyperplasia”). The prostate is usually normal in size and consistency to the examining doctor when examined rectally. Uroflow graphs, obtained by getting patients to void with a fully distended bladder into a flow measuring instrument, often demonstrate flat reduced flow rates. The diagnosis is often established by voiding cystogram (a special X ray) or cystoscopy (endoscopy of the bladder and urethra).

Drug treatment with an alpha receptor blocker is often tried first. Side effects are infrequent but include impotence and lethargy. Surgical treatment with cystoscopic incision of the bladder neck is definitive, but is often not advisable in young patients who may wish to remain fertile, as the incidence of retrograde or absent ejaculation may occur in 15% to 50% of patients.

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Comments 8 comments

funnebone profile image

funnebone 8 years ago from Philadelphia Pa

"retrograde or absent ejaculation may occur in 15% to 50% of patients." yeah they are odds that I am not willing to gamble on.


curious 6 years ago

Thanks for this article. I could not find much about this problem on the net at all. I have been diagnosed with this problem since I was 35. My residual urine has been even as high as 125 ml. The symptoms don't bother me too much tho'. If untreated, will it cause bladder failure / kidney failure ? I am 41 now but don't want the surgery yet. I was given alpha blocker alfuzosin but I hated it. But if it will minimize risk to kidney / bladder then I will take it of course. My urodynamics clearly showed Bladder outlet obstruction but my prostate was normal (no enlargement at the time). This was 2 yrs ago. No cystoscopy was done, urologist guessed that it is most likely bladder neck dyssynergia.

For the above, please let me know whether it can be left untreated and risks of long term damage to body.


Benson Yeung profile image

Benson Yeung 6 years ago from Hong Kong Author

Dear curious,

it should be treated with an alpha blocker, even though some patients might recover without treatment. You sound like someone who needs treatment in view of your urodynamic study findings.


curious 6 years ago

Thanks again Benson.

From urodynamics study 2 years ago I know that my bladder capacity is 450 to 500 ml. Now here is an interesting thing I observed last week : When I wake up in the morning, I usually have a very full bladder. And when I pass urine, the flow is not bad at all. I also measure the amount of urine, and every morning, on a full bladder, with decent flow, I get a full 450 to 500 ml. This means that in the morning, on a full bladder, my voiding is not bad at all. In fact I would love to do an ultrasound postvoid study in the morning just to see what my residue is. I don't think it will be much at all.

However, in the doctor's chamber, when they ask me to drink lots of water and make the bladder full, only then I have poor flow and significant postvoid residue. Perhaps there is something wrong with this method of artificially drinking lots of water and then measuring ? Why do they do this study ? It does not bear any relevance to real life. In real life nobody will drink one litre of water in 30 mins to 1 hr.

The other thing is : There are 2 hospitals near my house. In one, when I do a post void study (done by the nurse), I always get only 50 ml residue. But in the other ( the hospital where the urologist does the post void residue, I get 100 to 120 ml). I trust the former (nurse) because I go there specifically for postvoid residue test, so I tell the nurse when I am ready. But in the latter (urologist's office), he will say : 'come to meet me at 5 pm, on a full bladder'. Now, how can I decide that I will be on a full bladder at 5 pm ?

Any thoughts on all these points ?

Thanks.


Benson Yeung profile image

Benson Yeung 6 years ago from Hong Kong Author

hi curious,

thanks for commenting.

Residue urine is measured after voiding.

A scan done when the bladder is full is more useful in measurement of prostate size.

I also think the measurement done by the nurse will be more reliable.


Greg 5 years ago

If you are only at 125 I wouldn't worry about it yet; almost in normal range.


ivor 5 years ago

I Have had a bladder neck incision six months ago but i am getting pains when i walk between my scrotum and bladder. Also burning sensasions. Any ideas please


Andrew 5 years ago

I was diagnosed 2 months ago, and am on tamsulosin. seems to slowly be working, though it's 2 steps forward, one step back. I'm trying to find possibles causes of this condition? My Uro said it often shows up in Type A individuals and people with stress and anxiety. Mine started two days after sex with a new partner, originally leading me to think it was an STD, though I've tested negative for everything so far, and so did she. Does anyone have any info?

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