BLADDER OUTLET OBSTRUCTION

Obstruction of urinary tract anywhere below the bladder, causing distension and incomplete emptying of the bladder. It can be acute (Acute Urinary Retention) or chronic.

Causes

  • BPH/ prostate cancer
  • Bladder tumors, stones
  • Pelvic masses (rarely pregnancy)
  • Rarely neurological causes
  • Infections can precipitate acute retention
  • Chronic obstruction can cause hydronephrosis and chronic kidney damage

Clinical features

  • Acute: painful and tender pelvic mass, difficulty in passing urine
  • Chronic: obstructive and irritative symptoms (see BPH), painless pelvic mass

Investigations

  • Urine analysis, C&S
  • Abdominal ultrasound
  • Renal function tests
  • Other specialised investigations (Cystourethrogram)

Management

  • Urethral catheter to relieve obstruction (≥ 18 F)
  • Suprapubic catheter if urethral fails
  • Treat infection if present
  • Refer to specialist for assessment/care