The evaluation of urodynamic function by symptomatology, clinical examination, static radiography and endoscopy is considerably less reliable than is sometimes appreciated.Since the establishment of our Urodynamic Clinic we have reviewed more than 6,000 patients with dysfunctional voiding (Turner-Warwick and Whiteside, 1969) ; synchronous cine/pressure/ flow cystography has been used in the last 3,000 of these (Bates, Whiteside and Turner-Warwick, 1970). This communication is an attempt to summarise some aspects of our present thinking related to problems of bladder neck dysfunction and outflow impairment.In considering bladder outflow obstruction we must seriously question some commonly held precepts relating to the significance of various facets: symptomatology ; the absence of post-voiding residual urine; the endoscopic evaluation of the bladder neck ; trabeculation of the bladder; the actual size of the prostate; etc.

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