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Bladder outlet obstruction

  • Definition
    • Bladder outlet obstruction (BOO) is a blockage at the base of the bladder. It reduces or stops the flow of urine into the urethra. The urethra is the tube that carries urine out of the body.

  • Alternative Names
    • BOO; Lower urinary tract obstruction; Prostatism; Urinary retention - BOO

  • Causes
    • This condition is common in aging men. It is often caused by enlarged prostate. Bladder stones and bladder cancer are also more commonly seen in men than women. As a man ages, his chance of getting these diseases increases greatly.

      Other common causes of BOO include:

      Less common causes include:

      • Cystocele (when the bladder falls into the vagina)
      • Foreign objects
      • Urethral spasms
      • Inguinal (groin) hernia
  • Symptoms
    • The symptoms of BOO may vary, but can include:

      • Abdominal pain
      • Continuous feeling of a full bladder
      • Frequent urination
      • Pain during urination (dysuria)
      • Problems starting urination (urinary hesitancy)
      • Slow, uneven urine flow, at times being unable to urinate
      • Urinary tract infection
      • Waking up at night to urinate (nocturia)
  • Exams and Tests
    • Your health care provider will ask about your symptoms and medical history. You will undergo a physical exam.

      One or more of the following problems may be found:

      • Abdominal growth
      • Cystocele (women)
      • Enlarged bladder
      • Enlarged prostate (men)

      Tests may include:

      • Blood chemistries to look for signs of kidney damage
      • Cystoscopy and retrograde urethrogram (x-ray) to look for narrowing of the urethra
      • Tests to determine how fast urine flows out of the body (uroflowmetry)
      • Tests to see how much the urine flow is blocked and how well the bladder contracts (urodynamic testing)
      • Ultrasound to locate the blockage of urine and find out how well the bladder empties
      • Urinalysis to look for blood or signs of infection in the urine
      • Urine culture to check for an infection
  • Treatment
    • Treatment of BOO depends on its cause. A tube, called a catheter, is inserted into the bladder. The insertion is done through the urethra to relieve the blockage.

      Sometimes, a catheter placed through the belly area into the bladder is needed to drain the bladder.

      Most often, you will need surgery for long-term cure of BOO. However, many of the diseases that cause this problem can be treated with medicines. Talk to your provider about possible treatments.

  • Outlook (Prognosis)
    • Most causes of BOO can be cured if diagnosed early. However, permanent damage to the bladder or kidneys can result if the diagnosis is delayed.

  • When to Contact a Medical Professional
    • Call your provider if you have symptoms of BOO. Early diagnosis can often lead to a simple and effective cure.

  • References
    • Andersson K, Wein AJ. Pharmacologic management of lower urinary tract storage and emptying failure. In: Wein AJ, Kavoussi LR, Partin AW, Peters CA, eds. Campbell-Walsh Urology. 11th ed. Philadelphia, PA: Elsevier; 2016:chap 79.

      Boone TB, Stewart JN. Additional therapies for storage and emptying failure. In: Wein AJ, Kavoussi LR, Partin AW, Peters CA, eds. Campbell-Walsh Urology. 11th ed. Philadelphia, PA: Elsevier; 2016:chap 87.

      McNicholas TA, Speakman MJ, Kirby RS. Evaluation and nonsurgical management of benign prostatic hyperplasia. In: Wein AJ, Kavoussi LR, Partin AW, Peters CA, eds. Campbell-Walsh Urology. 11th ed. Philadelphia, PA: Elsevier; 2016:chap 104.

      Zeidel ML. Obstructive uropathy. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 25th ed. Philadelphia, PA: Saunders Elsevier; 2016:chap 123.