Bladder outlet obstruction can be a significant problem for older males. Clinical signs and symptoms can be nonspecific for a diagnosis of outlet obstruction.
Differential diagnosis of lower urinary tract symptoms in a male:
(1) benign prostatic hyperplasia
(2) urethral stricture
(3) primary bladder neck contracture
(4) meatal stenosis
(5) bladder dysfunction
(6) prostate or bladder cancer
(7) chronic pelvic pain syndrome (interstitial cystitis, prostatitis)
(8) medications (drug-induced)
(9) congestive heart failure
(10) neurologic disease (stroke, Parkinson's disease)
A bladder scan for residual urine can be useful in evaluating the patient.
(1) Scans tend to underestimate the actual residual volume but can determine if residual urine is present.
(2) Scans can avoid catheterization to identify residual urine.
(3) Serial scans over time can monitor severity of the urine retention.
