Conceptualizing the “High” Bladder Neck – Anatomic Rabbit Hole or Functional Gold Mine?

Abstract

Describing a “high bladder neck” is common practice, yet it is not a standardized entity, and it lacks an evidence base in diagnostics and therapy. Recent systematic reviews report few trials, yet incision of the bladder neck remains a first-line therapy. The concept insinuates a basis for bladder outlet obstruction, so it is during voiding that such an issue should be assessed. For cystourethroscopy, the urinary tract is in the storage phase. A pressure-flow study in videourodynamics can visualize when the bladder neck is deflected into the proximal prostatic urethra by the force of bladder contraction, but this is rarely undertaken. Standard urodynamics may infer this diagnosis, but only by assuming the cause. Other forms of imaging are being evaluated, though they remain remote from delivering evidence based on therapy outcomes. Proper consensus regarding the “high bladder neck” is needed, primarily for standardization of terminology and agreement on justifiable endoscopic and imaging approaches.