bladder neck obstruction

Bladder Neck Obstruction: A Blockage at the Base of the Bladder

Bladder neck obstruction (BNO) is a condition where there is a blockage or narrowing at the base of the bladder, which can reduce or stop the flow of urine into the urethra. This obstruction can be caused by various factors, including:

• Scar tissue from surgery to remove the prostate or radiation treatments for prostate cancer
• Connective tissue or muscle issues present at birth
• Bladder neck muscle hypertrophy or abnormal muscle fiber orientation

Symptoms of Bladder Neck Obstruction

The symptoms of BNO can vary depending on the severity and duration of the obstruction. Some common symptoms include:

• Difficulty urinating (hesitancy)
• Decreased force of stream
• Slow flow of urine
• Frequency, urgency, urge incontinence, and nocturia (storage symptoms)
• Urine backflow into the system, leading to difficulty urinating and other uncomfortable urinary symptoms

Causes and Risk Factors

BNO can occur at any age in both men and women. However, it is more likely to affect men over 50 years old with an enlarged prostate. Other risk factors include:

• Age: Men over 50 are more prone to develop BNO
• Sex: Men are more likely to be affected than women
• Genetics: Family history may play a role in the development of BNO

Treatment Options

The treatment for BNO depends on the underlying cause and severity of the obstruction. Treatment options include:

• Medication: Alpha-blocker drug therapy is the first line of treatment, which helps relax the bladder muscles
• Surgery: Surgical intervention may be necessary to remove scar tissue or correct anatomical issues

Complications

If left untreated, BNO can lead to complications such as:

• Permanent weakening of the bladder
• Kidney damage
• Urinary tract infections (UTIs)
• Bladder diverticula
• Long-term lack of urinary control

Common Signs and Symptoms of Bladder Neck Obstruction

Bladder neck obstruction (BNO) can cause a range of symptoms, which may vary from person to person. Here are some common signs and symptoms associated with BNO:

• Difficulty initiating urination: The blockage at the bladder neck can impede the flow of urine from the bladder into the urethra, making it difficult to start urinating.
• Slow or interrupted urinary stream: The obstruction can cause a slow or interrupted flow of urine, which may be accompanied by straining to empty the bladder.
• Continuous feeling of a full bladder: People with BNO may experience a persistent sensation of having a full bladder, even after urination.
• Abdominal pain: Pain in the abdominal area is another symptom associated with BNO.
• Frequent urination: Some individuals may experience frequent urination due to the obstruction at the bladder neck.

Additional Symptoms

In some cases, people with BNO may also experience:

• Pain during urination (dysuria)
• Problems starting urination
• Urinary retention: In severe cases, the blockage can cause urine to accumulate in the bladder, leading to urinary retention.

It's essential to note that these symptoms can be similar to those experienced by people with other urinary tract conditions. Therefore, a proper diagnosis and consultation with a healthcare professional are necessary to determine the underlying cause of the symptoms.

References

• [1] Symptoms caused by PBNO include storage symptoms (frequency, urgency, urge incontinence, nocturia) and voiding symptoms (decreased force of stream, hesitancy, incomplete emptying). [5]
• [2] The signs of bladder neck obstruction include: Difficulty in initiating urination. The blockage may impede the flow of urine from the bladder into the urethra. ... The above signs and symptoms may be indicative of various urinary conditions and a healthcare professional needs to be consulted for proper diagnosis. What Causes Bladder Neck ... [14]
• [3] Men and women with PBNO may present with a variety of symptoms including voiding symptoms (slow urinary stream, intermittent stream, incomplete emptying), storage symptoms (frequency, urgency, urge incontinence, nocturia). [7]
• [4] The bladder neck obstruction can increase sphincter muscle activity or obstruct urine flow, even in the absence of anatomic obstruction, which usually obstructs urine flow. Men over 50 years are more prone to develop bladder neck obstruction than other groups. However, bladder neck obstruction can occur at any age in both men and women. It was ... [15]

Bladder neck obstruction (BNO) can be diagnosed using various tests, which help determine the cause and extent of the blockage. Here are some diagnostic tests used to diagnose BNO:

• Ultrasound: This imaging test uses sound waves to locate the blockage of urine and find out how well the bladder empties [6][7]. It can also detect internal blockages in the bladder neck, such as stones or tumors.
• Urinalysis: This test checks for blood or signs of infection in the urine [6][7].
• Pressure-flow studies ± fluoroscopy: This is a common test used to diagnose BNO in women, which measures the pressure and flow of urine during voiding [4]. It can also help assess the bladder neck obstruction.
• Videourodynamic testing: This test uses video imaging to show how well the bladder stores and empties urine, and can also measure sphincter activity [13].
• Cystoscopy: This procedure allows a healthcare professional to view the inside of the bladder using a camera, which can help diagnose BNO by visualizing any blockages or abnormalities in the bladder neck [9][13].

These diagnostic tests can help determine the cause and extent of BNO, and guide treatment decisions. It's essential to consult with a healthcare professional for an accurate diagnosis and proper care.

References: [4] KH Pang (2022) - The most common test used was pressure-flow studies ± fluoroscopy, which remains the current standard for diagnosing bladder outlet obstruction in women. [6][7] 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. [9] Tests include imaging the bladder with sound waves (ultrasound) and viewing the bladder with a camera (cystoscopy). Treatment might include medications or surgery. [13] For diagnosing bladder neck obstruction video urodynamic testing may be used. This test can help show how well the bladder can store and empty urine. It can also help assess the pressure and flow of urine, check bladder neck obstructions, and measure sphincter activity.

Medication Options for Bladder Neck Obstruction

Bladder neck obstruction can be effectively treated with medication, particularly alpha-blockers and 5-alpha-reductase inhibitors.

• Alpha-Blockers: These medications are the first line of treatment for bladder neck obstruction. They work by relaxing the muscles around the bladder neck and prostate, thereby relieving the obstruction. Examples of alpha-blockers include tamsulosin and alfuzosin [10][11].
• 5-Alpha-Reductase Inhibitors: These medications may also be prescribed to treat bladder neck obstruction. They work by reducing the size of the prostate gland, which can help relieve the obstruction. Examples of 5-alpha-reductase inhibitors include finasteride and dutasteride [7].

In some cases, other medications such as decongestants, antihistamines, antidepressants, and drugs used to treat an overactive bladder may also be prescribed to manage symptoms of bladder neck obstruction [14]. However, these medications can interfere with the bladder's ability to contract and empty itself of urine.

Effectiveness of Medication

Medication has been shown to be effective in managing primary bladder neck obstruction in the short term. Alpha-blockers have been found to be particularly effective in reducing symptoms of bladder outlet obstruction [13]. However, long-term outcomes may vary depending on the individual case.

It's essential to note that medication should only be used under the guidance of a healthcare professional and as part of a comprehensive treatment plan. Prompt diagnosis and treatment are crucial to prevent serious problems caused by urine backing up into your system [5].

References: [1] - [14]

Differential Diagnosis of Bladder Neck Obstruction

Bladder neck obstruction (BNO) can be challenging to diagnose, and a thorough differential diagnosis is essential to rule out other conditions that may present with similar symptoms. Here are some possible causes of BNO:

• Urethral stricture disease: A narrowing or blockage of the urethra, which can cause difficulty urinating and obstruct urine flow.
• Dysfunctional voiding: Abnormalities in the way the bladder contracts and relaxes during urination, leading to obstruction.
• Neurogenic-based detrusor-sphincter dyssynergia (DSD): A condition where there is an abnormal coordination between the bladder muscle (detrusor) and the urethral sphincter, leading to obstruction.
• Posterior urethral valves: A congenital condition in males where small folds of tissue obstruct the flow of urine from the bladder to the penis.
• Vesico-ureteral reflux: A condition where urine flows back up from the bladder into the kidneys, which can cause obstruction and damage to the urinary tract.

These conditions can be diagnosed through a combination of medical history, physical examination, imaging studies (such as ultrasound or CT scans), and urodynamic tests. It's essential to work with a healthcare provider experienced in diagnosing and treating BNO to determine the underlying cause of symptoms.

References:

• [5] Other causes of BOO include urethral stricture disease, dysfunctional voiding, neurogenic-based detrus