Increased prevalence of primary bladder neck obstruction in conditions associated with hyperadrenergic signaling

Voiding dysfunction in primary bladder neck obstruction (PBNO) results from incomplete relaxation of the bladder neck, creating a functional obstruction. The efficacy of alpha-adrenergic antagonists supports the contention that adrenergic overactivity may contribute to increased bladder neck tone. This study examines the association between hyperadrenergic conditions and PBNO prevalence.

We conducted an observational study using the TriNetX database from 2004–2024. Males and females ($\ge$18 years) were stratified into cohorts based on common disease states associated with hyperadrenergic signaling: anxiety, hypertension, obstructive sleep apnea, or heart failure. Each cohort was propensity score-matched to controls by age and BMI. Odds ratios (OR) with 95% confidence intervals (CIs) were calculated for PBNO prevalence, with statistical significance set at p < 0.01.

PBNO prevalence was significantly higher in all hyperadrenergic cohorts than in control groups without the diseases. Hypertension showed the strongest association, with ORs of 3.86 (males) and 4.96 (females). Anxiety also demonstrated substantial associations (ORs: 2.68 males, 3.14 females). All comparisons were statistically significant (p < 0.0001).

Our findings demonstrate a significant association between conditions characterized by increased adrenergic signaling and PBNO. The consistently higher ORs observed across all studied conditions, particularly hypertension and anxiety disorders, support the hypothesis that adrenergic overactivity may contribute to PBNO pathogenesis. These results suggest that patients with hyperadrenergic conditions may be at increased risk for PBNO and could benefit from targeted screening. Clinicians should consider the potential impact of these systemic conditions when evaluating and managing patients with lower urinary tract symptoms suggestive of PBNO.