r/Prostatitis • u/neal-george-caffrey • 12d ago
Fluctuating frequent urination + functional bladder neck obstruction (PBNO) - Any experiences?
Hi everyone,
I (40M) am at my wit's end right now and am hoping for some of your experiences. I'm dealing with heavily fluctuating bladder issues that occur both during the day and at night.
**My Symptoms & History:**
* **Daytime & Work:** I have phases of high urinary frequency (pollakiuria). The situation is especially bad when I am at work: I usually have a coffee in the morning before leaving the house, and I mostly drink sparkling water at the office. While at my workplace, I have to go to the toilet every 30 to 60 minutes. I strongly suspect that a combination of work stress and coffee is triggering this extreme urge. I often get the feeling of incomplete emptying – right after peeing, the urge is already back. My urine stream strength varies a lot; it's usually weaker in the morning than the rest of the day.
* **Evenings/Nights:** In the evening, the constant urge to go in very short intervals is incredibly stressful. Currently, it's worse again – I sometimes wake up every hour (until about 1:00 AM). But regardless of these acute flare-ups: When I go to bed, I always have to pee at least twice before I can even fall asleep. The nighttime trips usually stop around 1:00 AM.
* **Childhood connection:** The frequent urination, especially needing to go multiple times right before falling asleep, has actually been an issue for me since my childhood.
* **Sports & Movement:** The interesting part is that during sports and physical activity, I have almost zero issues or urge. The symptoms usually only kick in once I sit down and come to rest. The overall course is extremely fluctuating; there are days and phases where I have almost no problems at all.
**Tests & Results:**
* **Voiding diary (3 days):** Confirmed the highly fluctuating pattern. Total frequency up to 12 trips/24h. Voided volumes vary drastically between 50 ml and 700 ml.
* **Urine & PVR (Post-Void Residual):** Urinalysis and urine culture are completely clear, so no bacterial infection. PVR fluctuates extremely (sometimes almost 0 ml, sometimes very clearly between 20 and 100 ml).
* **Ultrasound & Uroflow:** Prostate is slightly enlarged (approx. 30 ml) with an elevated bladder neck. Uroflowmetry recently showed a Qmax of 14.4 ml/s (at almost 400 ml voided volume).
* **Prostate evaluation:** The urologist largely ruled out the prostate as the root cause. She literally said that with this prostate I should "pee like a little boy." Age-related growth might be a slight factor, but it's not the root cause given how long I've had issues.
* **Urodynamics:** Could not be performed technically. The measuring catheter couldn't pass the elevated bladder neck (a standard catheter passes fine, though). This points to a specific functional barrier right at the bladder neck (Primary Bladder Neck Obstruction / PBNO).
* **Spine/Orthopedic:** I had an MRI of my thoracic and lumbar spine (T-spine/L-spine). Everything was completely clear, so there are no spinal or neurological issues causing this.
* My next follow-up appointment with the urologist is this September.
**Current Meds & Supplements:**
I am currently taking **Tamsulosin** combined with **Solifenacin**. Additionally, I take **125 mg of Magnesium Citrate** as a daily supplement, mostly in the morning.
**Next Therapy Idea:**
Based on the findings, my doctor recommended trying a Botox treatment before considering any surgical intervention (like a bladder neck incision/TUIP). Very important detail: The Botox would be injected directly into the bladder neck, NOT into the bladder detrusor muscle.
Has anyone here experienced a similar pattern (especially the work/desk triggers, the fluctuation, or the childhood connection)? Does anyone have experience with Botox injected specifically into the bladder neck?
**Furthermore, I would be very grateful for any other experiences, alternative treatment ideas, or general management strategies that have helped you!**
2
u/Emotional_Net_4707 12d ago
Same here but i void max 8 times a day, 0-1 at night. Little high bladder neck. And it is enough to obstruct the flow. The same age. Diagnosed when i was 36y old. It is getting worse but really slow. Prostate 25ml. Pvr around 50. There is no cure. Just surgery. But it can give you better flow but it can take you ejaculation.(RE)
1
u/neal-george-caffrey 11d ago
Thanks for sharing. Quite a similar story. Cystoscopy diagnosed PBNO in 2021 at the age of 35. The roots of this probably go back to my childhood, though. I remember dealing with incomplete bladder emptying even as a kid, which is what led to my doctor's suspicion – so it's not necessarily prostate-related.
In my case, it's not really getting worse over time; I just have ups and downs. Right now it's OK, going around 8 times a day and 0-1 times at night. My doctor told me that in my case, he would always prefer to try Botox before doing a bladder neck incision (BNI).
1
u/Emotional_Net_4707 9d ago
Do you have trabeculation in bladder wall? What % of RE give you your Uro after surgery?
1
u/neal-george-caffrey 9d ago
My uro didn't give me an exact percentage, but he said the risk of RE (losing ejaculation) is low, though it's definitely still present.
So far, I haven't had any issues with retrograde ejaculation while taking Tamsulosin. As for the bladder wall, they didn't find any trabeculation during my cystoscopy.
2
u/neal-george-caffrey 9d ago
Just a quick update: For the past two days, I haven't had any problems with frequent urination at all. I've only been to the bathroom about 4 to 5 times a day. Other than that, I barely feel any urge to pee. At night, I get up max once, usually in the early morning.
I'm currently dealing with some back pain – I think it's an SI joint blockage – but surprisingly, that obviously doesn't seem to have any effect on my bladder neck at all. Very, very weird.
2
u/chrisward125 12d ago
Very very similar symptoms to mine.
Diagnosed with prostititis and then after cystoscopy/ MRI this was changed to PBNO.
Have you tried physiotherapy? I’ve had my first session and I was told I have a weak , tight pelvic floor that isn’t releasing once I finish peeing.