Bladder Outlet Obstruction: Symptoms, Causes, Treatment & Tests (2024)

FAQs

What are the major causes of bladder outlet obstruction? ›

In men, benign prostatic obstruction (BPO) is the most common cause of BOO and stems from a variety of etiologies. Other causes of BOO include urethral stricture disease, dysfunctional voiding, neurogenic-based detrusor-sphincter dyssynergia (DSD), and primary bladder neck obstruction.

Voiding pressure flow studies remain the gold standard for the diagnosis of BOO.

A blockage stops or slows down the flow of pee. Possible blockages include scar tissue, bladder stones, a large gland, cancer or a tumor.

I almost always start with an alpha-blocking agent to relieve symptoms of bladder outlet obstruction. Doxazosin, terazosin, tamsulosin, and alfuzosin are all effective. The latter two are slightly easier to dose because they are taken once daily.

Treatment of BOO depends on its cause. A tube, called a catheter, is inserted into the bladder through the urethra. This is done to relieve the blockage. Sometimes, a catheter is placed through the belly area into the bladder to drain the bladder.

Symptoms can include pain in the side, decreased or increased urine flow, and urinating at night.

Uroflowmetry is one of the useful tests for detecting voiding difficulties and bladder outlet obstruction indicated when peak flow is less than 15 mL/s with a minimum total bladder volume of 150 mL. The normal mean peak flow rate in women is 23.5 mL/s.

During bladder neck sling surgery, a small piece of tissue is wrapped around the bladder neck to make it narrower. That tissue is then pulled up like a sling and attached to more tissue on the pubic bone. This creates a kink or bend in the urethra that makes it harder for urine to leak down the tube on its own.

What medication is used for urinary blockage? ›

Commonly used antibiotics include trimethoprim-sulfamethoxazole, nitrofurantoin, cephalosporins, and fluoroquinolones. Pain secondary to urinary tract obstruction is often managed with oxycodone, hydrocodone, acetaminophen, and nonsteroidal anti-inflammatory drugs.

Passing a catheter in the bladder may be all that is needed to relieve the obstruction (a catheter is a soft tube that is inserted into the urethra). Medication can sometimes help if the obstruction is due to an infection, or sometimes in the case of an enlarged prostate.

Enlarged prostate, also known as benign prostatic hyperplasia (BPH) — this is the most common cause of bladder outlet obstruction in men. Scarring of the urinary channel (urethra) or bladder neck, as a result of injury or surgery.

Treatment of Urinary Obstruction

Treatment usually aims to relieve the cause of obstruction. For example, if the urethra is blocked because of a benign enlarged or cancerous prostate, treatment can include medications (such as hormonal therapy for prostate cancer), surgery, or enlargement of the urethra with dilators.

If a person has a constant urge to pee but nothing comes out when they go, they may have an infection or other health condition. If a person frequently needs to pee but little comes out when they try to go, it can be due to a urinary tract infection (UTI), pregnancy, an overactive bladder, or an enlarged prostate.

The most common causes of intraluminal obstruction are calculi, blood clots, tumors, or sloughed papilla. These obstructions present acutely, leading to severe renal colic with flank pain, hematuria, nausea, vomiting, and fever.

The Mitrofanoff procedure creates a new tube for urine to exit the body, often through a hole in the belly, specifically the belly button. Children must then drain their bladders by catheterizing through the new hole. Bladder outlet surgery is not an emergency surgery. You will schedule the operation in advance.

Chronic bladder outlet obstruction (BOO) secondary to BPH may lead to urinary retention, impaired kidney function, recurrent urinary tract infections, gross hematuria, and bladder calculi. The image below illustrates normal prostate anatomy. Benign prostatic hyperplasia. Normal prostate anatomy is shown.