Bladder Outlet Obstruction in Children: Symptoms, Causes & Care

A] Causes of Urinary Obstruction in Children

• Abnormality in the urethra: The abnormalities include Urethral Atresia, a rare condition in which the urethra (the tube that carries urine from the bladder) is completely closed or absent. Urethral Stricture is another condition due to scarring narrowing the urethra. This scarring could result from infections, surgeries, or trauma.
• Posterior urethral valve: Posterior urethral valves (PUV) are one of the abnormalities in the urethra, particularly in male infants. These obstructive membranes develop in the urethra, near the bladder. The valves can impede or block the normal flow of urine, potentially damaging the bladder and kidneys if left untreated.
• Hernias: Although rare, a hernia, particularly an inguinal bladder hernia, can lead to bladder outlet obstruction in children. It is most commonly found in boys. In this condition, a portion of the bladder protrudes into the inguinal canal, compressing or dislocating the urinary tract and causing difficulty urinating.
• Chromosomal disorder: In some cases, bladder outlet obstruction is linked to chromosomal abnormalities. It can be seen in babies with trisomy 13, 18, and 21. A healthcare provider may recommend a chromosome test to identify an underlying condition.
• Pelvic tumour: Among the other possibilities, tumours in the pelvic area may affect the nerves responsible for the normal functioning of the bladder, resulting in the obstruction of urine flow.

B] Symptoms of Urinary Obstruction in Children

• Frequent urination: An obstruction in the urinary tract may prevent the normal flow of urine. In this case, the sensation of bladder fullness leads to the frequent need to urinate.
• Frequent urinary tract infections:  Urine stagnation, which is caused by urinary obstruction, heightens the risk of bacterial growth and results in UTI.
• Bedwetting during nighttime: Though bedwetting is common in children, if it persists beyond the age of 5, it can be a concern and might need a pediatric urologist consultation. The obstruction leading to urinary retention increases bladder pressure, contributing to bedwetting.
• Pain in the lower abdomen: Pain or discomfort can often be experienced in the lower abdomen due to increased bladder pressure.  

C] Bladder Outlet Obstruction Treatments for Children

Before treatment, the paediatric urologist will conduct a physical examination, imaging tests, and other assessments to determine the severity of the condition. The treatment options can range from surgeries and medications to even monitoring and lifestyle changes when preventable. Below are a few surgical treatment options for urinary bladder obstruction in children:

1. Endoscopic Resection: A thin, flexible tube with a camera and tools (endoscope) is inserted into the urethra. This minimally invasive procedure is used for posterior urethral valves and ureteroceles. The endoscope visualises,  cuts or punctures using electrocautery or laser energy to relieve the obstruction.
2. Vesicostomy: This is an open surgery for newborns and infants with severe posterior urethral valves. It is considered a temporary urinary diversion, in which a small opening in the bladder wall allows urine to be expelled directly outside.

3. Bladder Augmentation (Enterocystoplasty): This is one of the complex surgeries performed in older children with neurogenic bladder, small bladder capacity, or chronic bladder outlet obstruction. It is treated by using a segment of the intestine to enlarge the bladder.

4. Bladder Neck Reconstruction (BNR): A surgical procedure to correct bladder neck dysfunction. It typically involves an incision in the lower abdomen to reconstruct the bladder and surrounding tissues.
   

While surgical intervention is required to resolve the obstruction itself, some medications can be used to manage symptoms. For example, anticholinergics are used as bladder relaxants to reduce bladder spasms; alpha-blockers reduce obstruction and improve urine flow; diuretics help manage fluid retention and reduce bladder pressure. However, it is important to consult a doctor first before taking medications. 

D] Which Healthcare Professionals Should Be Consulted for Bladder Outlet Obstruction?

A urologist specialising in the genitourinary tract is consulted for bladder outlet obstruction. They are the primary healthcare professionals who treat conditions that affect the kidneys, bladder, urethra, and related organs.

A pediatric urologist should be the first to consult children with bladder outlet obstruction as they provide expert treatment for urinary tract conditions. Depending on the severity of the affected organs, a paediatric nephrologist, pediatric radiologist, and pediatric surgeon may be involved.