To analyze the clinical characteristics of young mainland Chinese men with primary bladder neck obstruction (PBNO) and to evaluate the long-term outcomes of observation or conservative management in this population.

This was a retrospective single-center case series. Eight male patients diagnosed with PBNO between January 2021 and May 2022 were included. Eligible patients were aged 18 to 40 years, unmarried, and childless, and all were managed without surgery during the study period. Among the 8 patients, 2 were managed with observation alone, 3 received intermittent oral alpha-blocker therapy, and 3 underwent intermittent acupuncture or traditional Chinese medicine treatment. Baseline clinical characteristics and follow-up data were collected. Changes in International Prostate Symptom Score (IPSS), quality of life (QoL) score, and maximum flow rate (Qmax) were assessed during follow-up.

Eight patients were included in the analysis. The median age at presentation was 27.5 years (range 20–39), and the median symptom duration before presentation was 11.5 months (range 4–38). The median follow-up duration was 47.9 months (range 43.3–58.8). At baseline, the median IPSS was 18.8 (range 17–25), indicating moderate to severe lower urinary tract symptoms. At the last follow-up, the median IPSS decreased to 12. The QoL score improved from 4.5 at baseline to 2.7 at follow-up. Mean Qmax increased from 13.6 ± 3.5 ml/s at baseline to 16.5 ± 2.9 ml/s at the end of follow-up. None of the 8 patients progressed to surgical treatment during long-term follow-up.

PBNO is a recognized cause of lower urinary tract symptoms in young men, and alpha-blocker therapy has been reported to improve symptom scores, quality of life, and urinary flow parameters in this population [1,2]. Recent evidence synthesis also supports conservative and medical management as a reasonable option in selected young men, although the overall evidence base remains limited [3]. In the present cohort, young mainland Chinese men with PBNO were characterized by young age at presentation, relatively long symptom duration, and clinically significant lower urinary tract symptoms. During long-term follow-up, observation or conservative management was associated with improvement in symptom score, quality of life, and urinary flow parameters compared with baseline. Importantly, no patient required surgery during follow-up. These findings suggest that, in selected young patients with relatively stable symptoms, conservative management may provide sustained clinical benefit and may represent a feasible initial approach.

PBNO in young mainland Chinese men appears to be characterized by young age at presentation and prolonged symptom duration. In selected patients, observation or conservative management may lead to sustained symptom improvement and may delay or avoid surgical intervention. Conservative management may therefore be considered as an initial management option, although individualized treatment decisions and careful long-term follow-up remain essential.

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