Lower urinary tract symptoms (LUTS) caused by organic pathology mostly affect males over 40 years old. The most common cause of these disorders is benign prostatic hyperplasia (BPH) and nowadays we have sufficient information about this pathology.

The guidelines clearly state algorithms of examination in typical cases. But in 30-year-old male with obstructive LUTS, who was observed according to guidelines and neurogenic pathology was excluded, the cause may still remain unclear. Our opportunities in routine examination do not always provide a complete understanding of the cause of problem when it relates to young men. Such patients have been repeatedly treated for chronic prostatitis. They have obstructive uroflowmetry and high IPSS score despite of normal prostate volume.
In some cases, patients undergo urethrography, which may reveals an extended urethral stricture followed by a recommendation for surgical treatment. However subsequent cystoscopy does not reveal any pathology. Then the question arises: what else should be done? Which diagnostic algorithm should be used? Which functional examination should be performed?
Obviously, the problem can be either organic or functional.  
If pelvic MRI is performed in a number of such patients, prostate cysts or ureterocele can be revealed. In order to detect functional abnormalities, we decided to perform a CT-guided miction urethrography.

It turned out that cysts of urinary tract can pushed into prostatic urethra like a valve during urination and partially blocks passage of urine. Considering that the patient is young and the mass is located in the area of internal sphincter of bladder, there is a risk of surgical injury which can lead to retrograde ejaculation, that can be a critical complication for a young man.
In cases of prostate cysts, the most reasonable solution is to perform bipolar enucleation, because it allows to separate masses from intact prostate tissues as delicately as possible without significant thermal effect and carbonization. For young patients of childbearing age the preservation of ejaculation and reproductive function is one of the most important challenges in this type of surgery.

It is not mandatory to treat chronic prostatitis over and over again in young males under 40 years with obstructive LUTS. Further development diagnostic algorithms for verification of obstructive urinary disorders in young males are required. Routine methods of examination mentioned in guidelines do not always reveal functional pathology. It is necessary to modify standard algorithms to make them functional, as we demonstrated on CT-guided miction urethrography. In cases of prostate surgery in young males it is necessary to preserve ejaculation.