Unlike the elderly population, where the predominant cause of bladder outlet obstruction is a benign enlargement of the prostate, many young males have primary bladder neck dysfunction/obstruction (PBNO). This systematic review was done to critically appraise the various evidence available in the literature for the presenting symptoms, diagnosis, and management modalities for PBNO.

The review was registered in PROSPERO with registration number CRD42021216042. This review included the following subjects:
·       Human male subjects
·       Age 18-50 years
·       Primary bladder neck obstruction on invasive urodynamic evaluation
 A systematic search of the PubMed, Embase and Cochrane Central Register of Controlled Trials databases was performed to identify relevant studies published in the English language. The Methodological index for non-randomized studies was used for risk assessment of bias in this review.

MINORS scale was modified according to the studies in this review. Intermediate risk of bias was present in 3 studies and low risk of bias in 7 studies. 
a) The difference in IPSS between baseline and after 12 months: (Figure 1)
The pooled estimate in the sub-group of medical treatments is -7.69, whereas, for the sub-group of surgical treatments, it is found to be -17.70. 
 
b) Difference in Qmax between baseline and after 12 months: (Figure 2)
The pooled estimate in the sub-group of medical treatments is 4.54, whereas for the sub-group of surgical treatments it is found to be 7.74.

c) Difference in PVR between baseline and after 12 months: 
The pooled estimate in the sub-group of medical treatments is -31.49, whereas for the sub-group of surgical treatments it is found to be -156.00.

This review summarises the effect of alpha-blocker therapy on IPSS, Qmax, and PVR at 3 months and 12 months. Although it improves the IPSS and Qmax at 3 months and 12 months the results are more significantly in favor of surgical treatment at 12 months. Therefore, alpha-blockers improve the parameters in the short term but the effects are not sustained until long. Transurethral incision of bladder neck (TUIBN)/Bladder neck incision (BNI) is considered the gold standard treatment option for PBNO. The long-term success rate is more statistically significant than that achieved with medical management. The natural history of PBNO is not known. A subset of patients with severe obstructive patterns may experience long-term repercussions due to delays in diagnosis, ineffective diagnosis, or therapy. Long-standing obstruction, in any case, can lead to reflux, hydroureteronephrosis, impaired functioning of the detrusor muscle, and eventually renal impairment.

PBNO is not an uncommon diagnosis among young men with LUTS. It needs careful evaluation with videourodynamics and appropriate early management. Behavioral therapies along with alpha-blockers and Onabotulinum toxin A are successful in the short term, but bladder neck incision is the only technique found to have long-term results.

Continence 2S2 (2022) 100221
DOI: 10.1016/j.cont.2022.100221