Obstructive Uropathy: The Bladder

Abstract

Any discussion of the vesical element in urinary obstruction must necessarily centre around the problem of bladder neck obstruction and the changing attitudes to this disease. The classical description of Marion (1940) referred to a disorder closely akin to prostatism in which a hypertrophied internal sphincter alone appeared to be the cause of obstruction which could be relieved by its resection. Since cases were seen in young adults with a long history of difficult micturition a congenital cause was postulated by many (e. g. Badenoch, 1949), but the diagnosis was made seldom and only in adults with clearly recognisable obstructive signs. In subsequent years, however, many urologists came to believe that a large proportion of children of both sexes suffering from recurrent urinary infection and reflux had a bladder neck obstruction as their primary disorder, so that very many operations or endoscopic revisions were performed. The literature of the 1950’s and 1960’s, which has been well summarised by Young (1972), contains many papers reporting good short term results of operations in numerous children, but the diagnostic criteria in most were unreliable and little permanent value can be gained by a study of these statistics. Later, the disappointing long term results, the better understanding of reflux and the failure to establish any histological basis for bladder neck obstruction threw considerable doubt on the validity of this diagnosis.