Background: Primary bladder neck obstruction (PBNO) is an under-recognized cause of bladder outlet obstruction (BOO) in young men, characterized by failure of the bladder neck to open during voiding without other anatomic causes. Patients may present with voiding and/or storage symptoms. While alpha-blockers are the first-line therapy, surgical intervention with bladder neck incision (BNI) is indicated in refractory cases. Major concerns with BNI are retrograde ejaculation and incontinence. We report our single-center experience. Methods: This prospective study was conducted at Nil Ratan Sircar Medical College, Kolkata, over 18 months. Eleven men aged ≤50 years with videourodynamically confirmed PBNO were included. Patients with benign prostatic enlargement, urethral stricture, neurogenic bladder, underactive detrusor, or prior alpha-blocker therapy were excluded. Preoperative evaluation included history, clinical examination, blood tests, cystoscopy, uroflowmetry, urodynamic studies, and ultrasonography. Surgical criteria were Qmax <10 ml/s, bladder contractility index (BCI) >100, and cystoscopic evidence of high bladder neck. All underwent bilateral BNI at 5 and 7 o’clock positions under regional anesthesia. Foley catheter was removed after 5–7 days, and follow-up uroflowmetry and ultrasound were performed. Retrograde ejaculation was confirmed by post-ejaculatory urine analysis. Results: Mean age was 34 years. Preoperative mean Qmax was 6.6 ml/s. Ten patients (91%) had significant postoperative improvement, with mean Qmax rising to 22.18 ml/s (average gain: 14 ml/s). One patient required redo BNI due to incomplete incision. No incontinence occurred. Retrograde ejaculation was observed in one patient (9%). Conclusion: BNI is a safe and effective treatment for PBNO in young men, with excellent symptomatic and objective outcomes. Complication rates were low, with retrograde ejaculation occurring less frequently than in prior reports and no incontinence. Larger studies are needed to confirm these findings.