What Is Bladder Neck Obstruction?
Bladder neck obstruction is when the bladder neck fails to open adequately during urination. The bladder neck means a group of muscles that link the urinary bladder to the urethra. 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 first identified in men in 1933. Later, in 1987, bladder neck obstruction was reported in women. In rare conditions, bladder neck obstruction can also happen in utero and is called fetal lower urinary tract obstruction (LUTO) or fetal bladder outlet obstruction. This occurs when there is a blockage in the fetal voiding, which reduces the amniotic fluid amount, increases the bladder size, and can cause many other problems.
Treatment for bladder neck obstruction should not be delayed because it can permanently weaken the bladder, which can lead to many complications like kidney damage, urinary tract infections, urinary incontinence, and bladder diverticula (a sac or pouch that protrudes out of the bladder wall).
What Are the Causes of Bladder Neck Obstruction?
Bladder neck obstruction can arise from a variety of causes, including:
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Scar tissue in the bladder and urethra.
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Enlarged prostate like benign prostatic hyperplasia (BPH) or prostate cancer.
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Bladder stones.
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Rectum tumors.
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The vaginal, uterus, or cervix tumors.
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Benign lesions or cysts in the bladder and ureter.
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Surgery for stress urinary incontinence (SUI) surgery.
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Bladder or uterus falling into the vaginal area (pelvic organ prolapse).
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Severe constipation or impaction of stool.
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Complicated delivery.
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Multiple births.
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Advanced age.
What Is the Symptom of Bladder Neck Obstruction?
People with bladder neck obstruction may have a variety of symptoms, which will begin as mild symptoms and then gradually worsen over time. In mild cases, the symptoms will be intermittent, occurring occasionally. The symptoms will be more pronounced if there is a large tumor within the bladder, infection within the prostate, or nerve damage due to surgeries or trauma. The symptoms are bladder neck obstruction is common in both men and women. However, pelvic pain is more prevalent in men than women. Other symptoms include:
Urinary retention is the initial sign in most cases.
Decreased force of urine stream.
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Hesitancy (reluctance to urinate).
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Intermittent stream (urinary stream that is not continuous).
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Incomplete emptying of the urine.
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Strong urge to urinate (urge incontinence).
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Increased frequency of urination.
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Hematuria (blood in urine).
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Nocturia (often waking up in-between sleep to urinate).
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Feeling of fullness and a urine remaining sensation in the bladder even after urination.
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Pelvic pain.
What Are the Diagnostic Procedures for Bladder Neck Obstruction?
The healthcare provider will analyze the condition by taking a medical history and asking questions about the general and urinary symptoms. They will also conduct a physical examination by looking at the abdomen and placing pressure on it to assess for discomfort or swelling. By performing a physical examination, healthcare professionals can rule out an STD by checking the signs such as redness or discharge.
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Blood Test - To detect kidney damage.
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Urine Test - To detect any infections.
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Video Urodynamics - These are a series of tests performed to evaluate bladder function. A catheter will be inserted into the bladder to empty the urine, and then a fluid is filled inside the bladder using the catheter. When the bladder is full, the patient is asked to cough and then urinate as much as possible. X-rays or an ultrasound take detailed images of the bladder during urination. These images help the doctor to visualize bladder neck obstruction during the filling and emptying of the bladder. This image also helps in detecting structural problems in the bladder and urethra.
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Cystoscopy - During this test, a device called a cystoscope is used to visualize the bladder cavity. A cystoscope consists of a thin, long tube with a light and camera attached at its tip. It will be inserted into the bladder through the urethra, filling a fluid inside the bladder for better visualization.
What Is the Treatment for Bladder Neck Obstruction?
Men and women with bladder neck obstruction have the same treatment options, including watchful waiting, medication, and surgical intervention.
Watchful Waiting - It is an option for patients whose symptoms are not severe and do not interfere with their daily life. In such cases, doctors recommend simply monitoring the condition and having regular follows to evaluate the development in symptoms. Watchful waiting has no complications or side effects. Still, sometimes, a progression of presenting symptoms or the development of decompensation can occur if it is not treated in due time.
Medications - Alpha-blocker drug therapy is usually the mainstay treatment for bladder neck obstruction. Prazosin, Phenoxybenzamine, Terazosin, or Doxazosin are commonly used alpha-blockers that help to relax the bladder muscles. Some cases require temporary or ongoing self-catheterization, along with an alpha-blocker. Self-catheterization is a safe and painless procedure helping empty bladder urine. The catheterization type depends on the condition's severity and the patient's response to medication.
Surgery - Surgery is recommended if the symptoms do not improve with pharmacotherapy and self-catheterization. Bladder neck obstruction surgery often involves making incisions on the bladder neck. A resectoscope is used in the procedure, it is a long, thin tube with a camera attached at the end that allows the doctor to have better visualization of the bladder neck. After inserting the resectoscope, a cutting instrument makes a small incision in the bladder wall neck. Then, a catheter may be inserted to open the gap after the incision and allow healing. The main complication of the bladder neck incision is postoperative retrograde ejaculation (where the semen enters the bladder instead the penis during orgasm). However, retrograde ejaculation is less likely to happen with a unilateral incision.
Conclusion
Bladder neck obstruction is a condition commonly affecting elderly males. However, it is seen affecting women and also babies before birth. The symptoms and causes vary from individual to individual. Urinary retention, decreased urine force, hesitancy, and a strong urge to urinate are some frequent complaints. Medication is an effective treatment, but in some cases is treated with unilateral or bilateral transurethral incision of the neck of the bladder. But the most important thing is not to delay the treatment, or else permanent bladder weakness can happen.
