Health Encyclopedia

Bladder outlet obstruction

Definition

Bladder outlet obstruction (BOO) is a blockage at the base of the bladder that reduces or prevents the flow of urine into the urethra, the tube that carries urine out of the body.

Alternative Names

BOO; Lower urinary tract obstruction; Prostatism

Causes, incidence, and risk factors

Bladder outlet obstruction can have many different causes, including:

Benign prostatic hyperplasia (BPH)
Bladder stones
Bladder tumors (cancer)
Pelvic tumors (cervix, prostate, uterus, rectum)
Urethral stricture (scar tissue)

Less common causes of bladder outlet obstruction include:

Cystocele
Foreign objects
Posterior urethral valves (congenital birth defect)
Urethral spasms
Urethral diverticula

Bladder outlet obstruction is most common in aging men. It is often caused by BPH. Bladder stones and bladder cancer are also more commonly seen in men than women. As a man ages, the chance of developing these diseases increases dramatically.

Symptoms

The symptoms of bladder outlet obstruction may vary, but can include:

Abdominal pain
Continuous feeling of a full bladder
Delayed onset of urination (urinary hesitancy)
Frequent urination
Inability to urinate (acute urinary retention)
Pain on urination (dysuria)
Slow urine flow
Urinary tract infection
Urine stream starts and stops (urinary intermittency)

Signs and tests

If bladder outlet obstruction is suspected, your health care provider will take a thorough history of your problems. During a physical exam, your provider may find one or more of the following possible causes:

Abdominal mass
Cystocele (women)
Distended bladder
Enlarged prostate (men)

Tests may include:

Blood chemistries to reveal kidney damage
Cystoscopy and retrograde urethrogram (x-ray to look for urethral narrowing)
Ultrasound to locate the blockage of urine, and find out how well the bladder empties
Urinalysis to look for blood or infection
Urine culture to show an infection
Uroflowmetry to determine how fast the urine flows out
Urodynamic testing to see how much the urine flow is blocked and how well the bladder contracts

Treatment

Treatment of bladder outlet obstruction depends on the cause of the problem. For most cases, a Foley catheter (a tube inserted through the urethra into the bladder) will relieve the obstruction temporarily.

Occasionally, a suprapubic catheter (a catheter through the abdomen into the bladder) is needed to drain the bladder.

Long-term treatment of bladder outlet obstruction usually involves surgery. However, medical treatment options are available for many of the diseases that cause BOO. Discuss treatment options with your health care provider.

Expectations (prognosis)

If diagnosed early, most causes of BOO can be treated with great success. However, if diagnosis is delayed, permanent damage can result.

Complications

Complications of BOO can be devastating. Long-term or high-grade bladder outlet obstruction can permanently damage all parts of the urinary system.

Complications of BOO include:

Bladder and kidney stones
Kidney failure
Recurrent urinary tract infections
Urinary incontinence
Urinary retention

Calling your health care provider

If you have symptoms of bladder outlet obstruction, call your provider. Early diagnosis is important and can often lead to a simple and effective cure.

Prevention

The condition may be prevented by identifying and treating the cause of the blockage.

Review Date:5/22/2008
Reviewed By:Scott M. Gilbert, MD, Department of Urology, Columbia-Presbyterian Medical Center, New York, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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