The Long-term Effect of Superficial Bladder Neck Incision on Ejaculation and Incontinence in Boys with Primary and Secondary Bladder Neck Obstruction.

OBJECTIVE: Superficial bladder neck incision (SBNI) is controversial at young age, with retrograde ejaculation after puberty as main concern. The aim of the study is to investigate the long-term effect of SBNI on ejaculation and incontinence in boys with primary and secondary bladder neck obstruction (BNO). MATERIALS AND METHODS: In boys with infravesical obstruction, SBNI was performed in case of a persistent BNO after earlier desobstruction or in case of primary severely obstructive bladder neck. SBNI was performed with a diathermy hook, always superficially (2-3 mm) and unilaterally at 7 O'clock. Males that had SBNI during childhood after posterior urethral valve incision or relief of other obstruction between 1986 and 2003 were included. Evaluation was done by International Continence Society male sex questionnaire, International Prostate Symptom Score, developmental International Consultation Modular Questionnaire on Urinary Incontinence, frequency volume chart, and uroflowmetry. RESULTS: Of 79 traceable patients, 40 (50.6%) participated. Of these, 37 (92.5%) completed all questionnaires and 28 (70%) performed uroflowmetry. Median age at SBNI was 4.7 years [interquartile range (IQR) 0.6-8.5] and was 19.6 years (IQR 17.3-20.9) at follow-up. All men had antegrade ejaculation, 4/37 (10.8%) reported possibly reduced ejaculatory volume. Eight (22%) had moderate lower urinary tract symptoms and two (5.4%) had moderate incontinence. Median maximum flow rate was 30.1 mL/s (IQR 24.4-42.6). CONCLUSION: SBNI in boys with severe infravesical obstruction can be done safely with preservation of antegrade ejaculation and no additional lower urinary tract dysfunction.

Long-term follow-up after transurethral treatment of infravesical obstruction in boys.

OBJECTIVE: To study whether boys who underwent transurethral treatment of (mild) infravesical obstruction during childhood have lower urinary tract symptoms and complications at young adult age. MATERIALS AND METHODS: Young adult men who underwent transurethral treatment for infravesical obstruction as a child were contacted. The following measurements were done: International Prostate Symptom Score (IPSS), International Consultation on Incontinence Modular Questionnaire on Urinary Incontinence, frequency volume chart uroflowmetry, and postvoid residual. A group of 151 male students who completed IPSS and underwent uroflowmetry was used as reference group to compare with patients. RESULTS: Of 135 traceable patients, 87 men (median age 21.9 years; interquartile range [IQR] 19.6-25.6) returned the questionnaires, and 71 underwent uroflowmetry. Median age at initial treatment was 7.9 years (IQR 1.0-10.8). Compared with men in the reference group, patients had similar IPSS and quality of life scores; median IPSS was 3, and IPSS-quality of life 1 (IQR 0.0-1.0). Urgency incontinence and postmicturition incontinence were reported in 2.4% and 8.5%, respectively. Frequency volume charts (n = 29) showed normal frequency and voided volumes. Uroflowmetry results were comparable with the reference group, although 16 (22.5%) patients voided volumes >600 mL. One patient had urethral stricturing, and one a significant postvoid residual. CONCLUSION: Young adult men treated for (mild) urethral obstruction in childhood have few micturition symptoms and good uroflowmetry results, not different from a reference group. Some patients, however, report incontinence, and this group deserves close attention. Late complications were rare.