Case Of the Week (COW) 17 April 2016
Primary bladder neck obstruction (PBNO) due to severe muscular hypertrophy.
Findings:
Concentric hypertrophy of the entire urethra. This characteristic imaging finding resembled a bulb of a sphygmomanometer on the sagittal and coronal planes and a doughnut on axial . The affected musculature was isointense on T1- and slightly hyperintense on T2-weighted images compared with unaffected muscles.
Discussion:
PBNO was first described in men by Marion , a condition wherein the bladder neck fails to open adequately during voiding, resulting in increased striated sphincter activity or obstruction of urinary flow in the absence of another anatomic obstruction, such as that caused by benign prostatic enlargement in men or genitourinary prolapse in women . Men typically present with symptoms for years before a correct diagnosis of PBNO is made. PBNO can present with a variety of symptoms including voiding or obstructive symptoms (decreased force of stream, hesitancy, intermittent stream, incomplete emptying), storage or irritative symptoms (frequency, urgency, urge incontinence, nocturia), or a combination of both. Occasionally, the initial presentation may be urinary retentions . Presenting symptoms appear to be similar in men and women, with a combination of voiding and storage symptoms being common . Currently PBNO is diagnosed primarily by videourodynamics and cystourethroscopy, but the increasing use of MRI can introduce new imaging findings .
Reference link :http://www.scielo.br/scielo.php?script=sci_serial&pid=1677-5538&lng=en&nrm=iso
Primary bladder neck obstruction (PBNO) due to severe muscular hypertrophy.
Findings:
Concentric hypertrophy of the entire urethra. This characteristic imaging finding resembled a bulb of a sphygmomanometer on the sagittal and coronal planes and a doughnut on axial . The affected musculature was isointense on T1- and slightly hyperintense on T2-weighted images compared with unaffected muscles.
Discussion:
PBNO was first described in men by Marion , a condition wherein the bladder neck fails to open adequately during voiding, resulting in increased striated sphincter activity or obstruction of urinary flow in the absence of another anatomic obstruction, such as that caused by benign prostatic enlargement in men or genitourinary prolapse in women . Men typically present with symptoms for years before a correct diagnosis of PBNO is made. PBNO can present with a variety of symptoms including voiding or obstructive symptoms (decreased force of stream, hesitancy, intermittent stream, incomplete emptying), storage or irritative symptoms (frequency, urgency, urge incontinence, nocturia), or a combination of both. Occasionally, the initial presentation may be urinary retentions . Presenting symptoms appear to be similar in men and women, with a combination of voiding and storage symptoms being common . Currently PBNO is diagnosed primarily by videourodynamics and cystourethroscopy, but the increasing use of MRI can introduce new imaging findings .
Reference link :http://www.scielo.br/scielo.php?script=sci_serial&pid=1677-5538&lng=en&nrm=iso