Bladder outlet obstruction (BOO) is a blockage at the base of the bladder. Most common cause of BOO in men is benign prostatic hyperplasia (BPH). Bladder stones and bladder cancer are also more commonly seen in men and women. As a man ages, the chance of developing these diseases increases dramatically. The condition is common in older men. Due to increased life expectancy there is an increased incidence of BOO. For example, BPH is the most common cause of BOO in men >70 years^1,2,3 There is increased incidence of BOO in younger age group. In young age group, urethral rupture is commonly seen.

Complications of BOO can be devastating. Long-term or high-grade BOO can permanently damage all parts of the urinary system. Complications of BOO include:

- Bladder and kidney stones

- Kidney failure

- Recurrent Urinary Tract Infection (UTI)

- Urinary retention

- Urinary incontinence

Early diagnosis is important and can often lead to a simple and effective cure. Numerous gender-specific aetiologies are responsible for BOO. BOO may be induced by specific functional and anatomical causes. The resulting obstruction frequently produces lower urinary tract symptoms. Categorising and understanding these entities is crucial as specific diagnostic modalities may be used to fully delineate the degree of BOO and any secondary issues. Although urodynamic evaluation and pressure flow evaluation is the gold standard diagnostic tool, other modalities may also be used, including post-void residual analysis, urinary flow rates, cystoscopy and selected radiological ones. Patient self-appraisal of symptoms using various inventories such as the American Urologic Association Symptom Index or the International Prostate Symptom Index or the International Prostate Symptom Score is relevant to the initial assessment and subsequent longitudinal follow-up.

In our institution, BOO is commonly seen. It comprises of various aetiology and various options available for the management of each disease. This study aims at studying incidence of disease, aetiology and management in patients above 18 years with BOO.

A total of 100 cases were admitted in Surgical Department of Yenepoya Medical College Hospital from 30 May 2007 to 30 November 2008 with objective evidence of BOO. Ultrasound scan was the initial modality to diagnose BOO. X-ray KUB was used for bladder stones. Serum PSA4) and prostatic biopsy were done in cases of suspected carcinoma prostate. Cystoscopy is done in cases of suspected bladder cancer and bladder neck stenosis. Biopsy was taken in cases of bladder cancer.

During this study, a total of 100 cases with objective evidence of BOO were studied and the age distribution is as shown in diagram. The mean age is 57 years with the range from 18 to 80 years. The peak incidence is seen in 7^th decade, followed by 6^th and 8^th decade. Least incidence was seen in 9^th decade.

In this study 94% (94 no) were males and 6% (6 no)were females.

The most common cause was BPH followed by urethral rupture (5) vesical calculus, carcinoma prostate, bladder carcinoma (6) and bladder neck stenosis.

The only cause for BOO in females was bladder neck stenosis.

This study is a prospective observational study in which a total number of 100 cases of BOO were studied.

- Males were most commonly affected.

- The most common cause of BOO was beningn prostatic enlargement (BPE) accounting for more than half the number of cases.

- Screening programme and regular health checkup from 5^th decade might help in early diagnosis, especially for males.

BOO is a clinical entity of diverse aetiology, which is a potentially curable illness if diagnosed early, and treated according to the standard guideline of management. A further population-based study is needed to identify the exact prevalence of BOO in different age groups and sex and effectiveness of available modality and long-term complications.

Abbreviation: BPH, benign prostatic hyperplasia.

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