Bladder outflow obstruction and Lower Urinary Track Symptoms

A 74 year old gentlemen who is diagnosed to have benign prostatic hyperplasia  presented with inability to pass urine and suprapubic pain.
On examination there is an abdominal lump arising from the pelvis up to the level of umbilicus.
X-ray KUB

He is having bladder outflow track obstruction caused by benign prostatic hyperplasia complicated by acute retention of urine and stone formation.

Bladder outflow tract obstruction

What are the causes for Bladder outflow tract obstruction?

Mechanical causes for Bladder outflow tract obstruction

• Bladder neck
• Bladder neck hypertrophy
• Stenosis due to prostectomy
•  Prostate
• Benign Prostatic Hyperplasia
• Prostatic carcinoma
• Prostitis                                                                     
• Urethra 
• Urethral srictures
• Post traumatic -
• Accidental
• Iatrogenic (Instrumentation, Catheterization )
• Inflammatory - Gonocaccal urethritis
• Neoplasms
• Balanitis xerotica obliterans (a premalignant condition)
• Congenital
• External meatal stenosis
• Tight phimosis
• calculi
• External compression by Pelvic tumors

Functional causes for Bladder outflow tract obstruction

• Neurogenic causes
• Spinal code injury
• Cauda equina syndrome
• Prolapsed intervertibral disc
• Multiple sclerosis
• Diabetic autonomic neuropathy 

what are the features of Bladder outflow track obstruction?

These are called as Lower Urinary Track Symptoms

Lower Urinary Track Symptoms

There are two group of symptoms.

Voiding ( obstructive ) symptoms

• Hesitancy (He want to pass urine, but there is difficulty in initiation. This worsened when bladder is full)
• Poor flow ( unimproved by straining) 
• Dribbling
• Intermittent stream (Urine flow stops and starts on one or more occasions during voiding )
• Feeling of incomplete emptying
• Episodes of near reteintion

Storage ( irritative ) symptoms

• Frequency
• Urgency ( Want to pass urine where he can not hold it. This can be associated with or without of incontinence )
• Urge incontinence ( Involuntary leakage of urine accompanied or immediately preceded by urgency)
• Nocturnal incontinence (Recent onset Nocturnal enuresis )

What are the complication of bladder outflow track obstruction? 

Complication of bladder outflow track obstruction

• Acute urine retention
• Chronic urine retention
• urinary stones formation
• Urinary track infection
• Obstructive uropathy (chronic renal failure)

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