Bladder Outlet Obstruction

Acute urinary retention is not uncommon in cancer patients, particularly those with genitourinary malignancies. Numerous etiologies exist and can be grouped into two broad categories: (1) mechanical bladder outlet obstruction (BOO) and (2) neurophysiologic dysfunction. Localized growth of PCa is a common cause of BOO. While symptomatic presentation is uncommon today, up to 82% of patients with PCa in the pre-PSA era presented with symptoms of urinary obstruction (Brawn et al. 1994). Furthermore, up to 35% of PCa pa tients placed on watchful waiting will eventually require transurethral prostatectomy (TURP) for symptomatic progression or urinary retention (Whitmore et al. 1991). Likewise, surgical and nonsurgical therapies directed toward prostate cancer may predispose to urinary retention. Bladder neck contracture (BNC) is reported in 1.3%-27% of patients after radical prostatectomy and 1.5%-22% of patients will develop urinary retention following prostatic brachytherapy (Anger et al. 2005; Stone and Stock 2002).

Neurophysiologic bladder dysfunction may arise secondary to medication side effects, postoperative pain and immobility, radical pelvic surgery, and chronic disease such as diabetes mellitus. Preexisting bladder dysfunction is common among elderly patients and even minor insults can trigger urinary retention. Medications with anticholinergic, sympathomimetic, and opioid activity are well known for their adverse effects on bladder function in this regard and should be discontinued or substituted if possible. Up to 50 % of patients undergoing abdominoperineal resection or radical hysterectomy will develop bladder dysfunction as a result of interruption of parasympathetic innervation (Eickenberg et al. 1976). Fortunately, urinary retention secondary to radical pelvic surgery will spontaneously resolve in up to 90 % of patients thus affected.

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