Bladder Health Program of South Florida

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Urinary Retention/Bladder Outlet Obstruction/Bladder Stones/Urethral Stricture

Urinary retention is the inability to empty the bladder. With chronic urinary retention, a person may be able to urinate, but has trouble starting a stream or emptying the bladder completely. People with urinary retention may urinate frequently or feel an urgent need to urinate but have little success when they get to the toilet; or they may feel they still have to go after finishing. Chronic urinary retention may not seem life threatening, but it can lead to serious problems and should also receive attention from a health provider. With acute urinary retention, people can't urinate at all, even though they have a full bladder. Acute urinary retention is a medical emergency requiring immediate action.

Anyone can experience urinary retention, but it is most common in men in their 50s and 60s because of prostate enlargement. Most elderly men experience some sort of difficulty in commencing and controlling the force and stream of urination.

A woman may experience urinary retention if her bladder sags or moves out of the normal position, a pelvic prolapse condition of the bladder called cystocele. The bladder can also sag or be pulled out of position by a sagging of the lower part of the small intestine, a pelvic prolapse condition called rectocele.

If urinary retention is not treated, it can lead to such complications as a urinary tract infection and/or bladder damage if the organ becomes stretched too far or for long periods of time. If urine backs up into the kidneys, permanent kidney damage can lead to reduced kidney function and chronic kidney disease. Urinary retention can be caused by an obstruction in the urinary tract or bladder outlet.

Bladder Outlet Obstruction

Bladder outlet obstruction (BOO) is a blockage at the base of the bladder that reduces or prevents the flow of urine into the urethra, the tube that carries urine out of the body. The condition is most common in aging men and often caused by an enlarged prostate, bladder stone or even a tumor.

Bladder outlet obstruction is rare in women, but when it does occur, it is usually caused by a cystocele or a neurological disorder. If the nerves that signal between the brain and the bladder aren't working properly, the brain may not get the message that the bladder is full. This is a neuro-urology disorder or neurogenic bladder. Someone whose bladder is too obstructed to void must have the urine drained through a catheter through the urethra and into the bladder or by passing a tube, called a suprapubic cystostomy, through the skin of the lower abdominal wall into the bladder.

Bladder Stones

Bladder stones are hard buildups of minerals that crystallize in the bladder when urine is not emptied properly. When urine builds up in the bladder, it can become infected or contain too much acid, creating an environment for stones to form. They are more prevalent in men and far less common than kidney stones. Bladder stones are often the result of a more serious urologic disorder, such as an enlarged prostate or a urinary tract infection, and should be examined by a doctor.

Many bladder stones may eventually be expelled naturally without permanent damage, but may return if the cause is not treated. If surgery is required to remove the stones, they may be broken up and removed with the use of tiny tools inserted into the urethra with a cystoscope. Untreated the condition can lead to recurring urinary tract infections and long-term damage to the bladder or kidneys.

Urethral Stricture

A urethral stricture or urethral narrowing (stenosis) is an abnormal narrowing of the tube that carries urine out of the body from the bladder (urethra). Urethral stricture may be caused in men by inflammation or scar tissue from surgery, disease or injury to the pelvic area.

If a man is diagnosed with urethral stricture, a doctor can perform a procedure called urethral dilation, in which increasingly wider tubes are inserted into the urethra to widen the passage. An alternate method is to inflate a small balloon at the end of a catheter inside the urethra. A surgeon can repair a stricture by performing an internal urethrotomy (http://bladder-health.net/urethral-reconstruction.htm). The surgeon advances a catheter up to the stricture and uses a knife or laser to make an incision that widens the opening. Another treatment for urethral stricture in men is placement of a wire mesh tube, called a stent, to keep the passage open. Longer strictures or recurring conditions often require a reconstructive surgical procedure called urethroplasty.

Symptoms

• Blood in the semen
• Bloody or dark urine
• Decreased urine output
• Diminished urinary stream
• Difficulty urinating
• Discharge from the urethra
• Frequent or urgent urination
• Inability to urinate (urinary retention)
• Incontinence
• Painful urination (dysuria)
• Pain in the lower abdomen
• Pelvic pain that may worsen with activity or exercise
• Slow or weak urine stream (may develop suddenly or gradually)
• Spraying of urine stream
• Swelling of the penis

Testing

• Blood test
• Bladder scan ultrasound
• Bladder or pelvic X-ray usually reveals bladder stones
• Cytoscopy
• Post-void residual (PVR) volume
• Retrograde urethrogram
• Tests for sexually transmitted diseases
• Urinalysis
• Urinary flow rate
• Urine culture
• Urodynamic testing

Treatment

• Catheterization to drain the bladder
• Percutaneous urinary procedures
• Urethral dilation for urethral stricture
• Endoscopic urethrotomy
• Urethral reconstruction (urethroplasty)
• Urinary diversion

Medical Disclaimer: The information provided in the Bladder Health Program of South Florida website should be used solely for educational purposes. It is not intended to replace the independent judgment of a healthcare provider. The appropriateness of a course of treatment for a patient may vary from the medical information provided herein due to individual conditions and/or complications. Always ask your physician about all treatment options, as well as the risks and benefits.