Primary bladder neck obstruction (PBNO) is a functional bladder outlet obstruction (BOO) due to inadequate bladder neck opening. It mainly affects young men with lower urinary tract symptoms (LUTS) and is less common in women (4.6–8% of female BOO). Diagnosis depends on videourodynamic studies (VUDS). Although treatments like α-blockers, BoNT-A, and TUI-BN are available, optimal strategies—especially for women—remain unclear. This study assessed PBNO treatment outcomes.

This retrospective study included patients ≥18 years diagnosed with PBNO via VUDS between January 1, 2023, and January 1, 2024. Exclusions were neurological disorders, prior urological surgeries, other BOO types, or inadequate follow-up. Treatments included α-blockers, BoNT-A, and TUI-BN. Outcomes were changes in uroflowmetry and post-void residual (PVR). One-way ANOVA (SPSS) was used, with p < 0.05 as significant.

Seventeen patients were included (10 females, 7 males; mean age 54.8 years), treated with α-blockers (n=13), TUI-BN (n=3), or BoNT-A (n=1). Among 11 patients with follow-up uroflowmetry, TUI-BN showed the greatest improvements in voided volume (+3.90%), Qmax (+6.17%), and mean flow rate (+6.25%), followed by modest gains in the α-blocker group and minimal changes with BoNT-A. Differences were not statistically significant (p=0.215, 0.139, 0.158).(Figure 1) PVR grade (0–5) was available in 11 patients; α-blockers showed the greatest reduction (mean −1.00), with no change in the other groups (p=0.645).(Figure 2) Twelve patients reported symptom scores (1=poor, 2=stable, 3=improved); TUI-BN and BoNT-A groups scored 3.00, α-blockers 2.89 (p=0.871).

This study offers real-world data on PBNO management in both sexes. While limited by sample size, trends suggest α-blockers and TUI-BN may enhance voiding efficiency and reduce PVR in selected patients. Findings underscore the need for greater awareness in women and further prospective studies to determine optimal treatment.