Editing Neurogenic LUT Dysfunction (section)

=== Bladder neck dysfunction ===
* '''Defined as incomplete opening of the bladder neck during voluntary or involuntary voiding; has also been referred to as smooth sphincter dyssynergia'''
* '''The dysfunction is found almost exclusively in young and middle-aged men, who characteristically report long-standing voiding and storage symptoms'''
* These patients have often been seen by many urologists and have been diagnosed as having psychogenic voiding dysfunction because of a normal prostate on rectal examination, a negligible residual urine volume, and a normal endoscopic bladder appearance.
* The differential diagnosis also includes:
** Anatomic bladder neck contracture
** Benign prostatic enlargement (BPE) or BPO
** Dysfunctional voiding
** Prostatitis
** Neurogenic micturition dysfunction
** Low pressure and low flow (anxious) bladder
* '''Objective evidence of outlet obstruction in these patients is easily obtainable by urodynamic study'''. '''Once obstruction has been diagnosed, it can be localized to the level of the bladder neck by video-urodynamic study,''' cystourethrography during a bladder contraction, or micturitional urethral profilometry. The diagnosis may also be made indirectly by the urodynamic findings of outlet obstruction in the absence of urethral stricture, prostatic enlargement, and DSD.
* The exact cause of this problem is unknown. Some have proposed that there is an abnormal arrangement of musculature in the bladder neck region, such that coordinated detrusor contractions cause bladder neck narrowing instead of the normal funneling.
* '''The occurrence of this problem in young, anxious, and “high-strung” individuals, and its partial relief by α-adrenergic blocking agents, have prompted some to speculate that it may in some way be related to sympathetic hyperactivity.'''
* '''Management'''
** '''Although α-adrenergic blocking agents provide improvement in some patients with bladder neck dysfunction, definitive relief in men is best achieved by a bladder neck incision'''