Bladder neck obstruction is a blockage in the bladder neck, which is the narrow part of the bladder that connects to the urethra and allows urine to leave the body.

Bladder neck obstruction, or bladder outlet obstruction, is a blockage in the opening of the neck of the bladder. In people with bladder neck obstruction, the bladder neck does not open properly during voiding, Voiding is a process that involves emptying urine from the body.

The neck of the bladder is the narrow section of the bladder that connects to the urethra. The urethra is the tube through which urine leaves the body.

Fetal bladder outlet obstruction or lower urinary tract obstruction (LUTO) can occur in a developing fetus. LUTO occurs due to a blockage in the bladder, neck, or urethra.

This article examines the symptoms, causes, diagnosis, treatment, and outlook of bladder neck obstruction.

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Symptoms of bladder neck obstruction may include:

  • a slow stream of urine
  • an irregular stream of urine
  • incomplete emptying when urinating
  • changes in frequency and urgency of urinating
  • urgency incontinence, which is an urgent, uncontrollable need to urinate
  • pelvic discomfort or pain
  • inability to urinate

Possible causes may include hyperplasia of the bladder neck. Hyperplasia is the term for an expansion or enlargement of tissue or organs due to an increase in cell reproduction. It can also be due to a physical obstruction or urethral stenosis — the latter term refers to when the urethra narrows.

A bladder neck obstruction may occur at birth due to connective tissue or muscle issues. This can cause a severe obstruction of the upper urinary tract and can lead to kidney malfunction, which can sometimes be fatal.

Problems with bladder muscles may also affect how the bladder neck can open. Increased sympathetic nervous system activity may also affect how the bladder neck functions. The sympathetic nervous system aids the body in activating its “fight or flight” response.

To diagnose bladder neck obstruction, doctors may use video urodynamic testing.

Urodynamic testing can help show how well the bladder can store and empty urine. It can also assess the pressure and flow of urine, check for bladder neck obstructions, and measure sphincter activity.

Video urodynamic testing involves X-rays or ultrasounds of the bladder to see how it fills and empties. In some cases, a healthcare professional may insert a thin tube known as a catheter into the bladder and fill it with dye to produce more detailed images.

In most cases, people do not need to do anything to prepare for this diagnostic test. However, they may need to alter their fluid intake or stop taking certain medications.

A healthcare professional will let the person know if they need to arrive for the test with a full bladder.

Diagnosis for males may also involve an examination of the prostate to assess size. In females, a pelvic examination may be necessary to check for organ prolapse or any other causes of urinary problems.

Treatment for bladder neck obstruction may involve watchful waiting, medications, or surgery.

Watchful waiting

If people have mild symptoms that are not causing any significant issues, a doctor may suggest watchful waiting. They may also recommend routine checks to assess symptoms and test urine flow rate.

People may need treatment if there are any changes in symptoms or test results.

Medications

Alpha-blockers may help treat bladder neck obstruction. Doctors typically prescribe alpha-blockers to treat high blood pressure or benign prostatic hyperplasia. The latter is a condition in which the prostate gland grows larger.

Using alpha-blockers to treat primary bladder neck obstruction is an off-label use of the drug.

Alpha-blockers may help relax the smooth muscle of the bladder neck. Research suggests these medications may be an effective treatment for bladder neck obstruction. However, they can cause side effects such as fatigue and dizziness.

Surgery

Surgeons perform endoscopic surgery to treat bladder neck obstruction.

The procedure involves inserting an endoscope, a thin, flexible tube with a light and camera on one end, to help cut out the tissue causing the obstruction.

People may have general or spinal anesthesia for bladder neck surgery.

The outlook for bladder neck obstruction depends on:

  • the symptoms a person has
  • the type of treatment they receive
  • how long the obstruction has been present
  • whether there are any changes to the upper urinary tract

People with minimal symptoms may not require any treatment.

Treatment with alpha-blockers for bladder neck obstruction may lead to a significant improvement in symptoms and flow rates. However, some people may find it difficult to continue treatment because of medication side effects.

Outcomes for a transurethral incision of the bladder neck (TUIBN) vary depending on the type of incision.

In males, retrograde ejaculation is a possible risk factor for TUIBN but is less likely to occur with a unilateral incision.

In females, around 84% of TUIBN procedures are effective with no serious complications.

There is no known way to prevent this condition. In some cases, bladder neck obstruction may be present at birth due to anatomical issues.

There is little research on the potential complications of bladder neck obstruction, but there may be a risk of underactive bladder or kidney failure without treatment.

Prompt diagnosis and treatment of bladder neck obstruction may help prevent complications and keep the condition from progressing.

Bladder neck obstruction refers to a blockage of the narrow opening of the bladder.

Symptoms of bladder neck obstruction may include changes in urination, such as decreased flow, incomplete emptying, increased frequency or urgency, or pain.

Treatment for bladder neck obstruction depends on a person’s symptoms but may include watchful waiting, medications, or surgery. Treatment may help prevent the condition from progressing and causing complications.