A 48-year-old White man presented with chronic voiding problems. He was evaluated and found to have high urinary residuals ranging up to 1000 cc. He was started on alpha blockers but had persistent urinary retention. The upper urinary tracts were normal on ultrasound. Office cystoscopy showed no obvious pathology. Video-urodynamics were performed (see Figure 1 and 2).

The patient ultimately underwent transurethral incision of the bladder neck and transurethral resection of the prostate. The prostate showed mild enlargement and a hypertrophied and obstructing bladder neck. After incision of the bladder neck, there appeared to be persistent outlet obstruction.  The bladder neck was thus resected, including a portion of the prostate. The patient had his catheter removed on post-operative day 1 and voided with a low post-void residual (PVR <50 cc).

The case was prepared by Kai B. Dallas, MD, Fellow, Female Pelvic Medicine and Reconstructive Surgery, Cedars-Sinai Medical Center, Los Angeles.

Figure 1: Preoperative Urodynamics
Figure 2: Video-urodynamics: Attempted voiding
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