7: Bladder outflow obstruction Flashcards
Which muscles make up the detrusor of the bladder?
Inner LONGITUDINAL muscle
Outer CIRCULAR muscle
External LONGITUDINAL muscle
What is found between the urothelium and the detrusor muscles of the bladder?
Lamina propria
nerves, connective tissue, blood vessels
What are bladder causes of obstruction?
Stenosis
Renal calculus
Tumour
What are the general causes of bladder outlet obstruction in males and females?
Compression - e.g tumour
Stones
Stricture
What enlarges to cause obstruction of the posterior urethra in males?
Prostate gland
either BPH or prostate cancer
What is phimosis?
Inability to retract the foreskin which can cause obstruction in men
What are vaginal causes of bladder outlet obstruction?
Atrophy
Prolapse
Cysts
Obstruction is more common in (males / females).
males
Overactivity of the bladder causes which symptoms?
Is it more common in men or women?
Increased frequency
Urgency
Females
What QOL score is filled out by male patients with prostate problems?
International prostate symptom score
Which causes of haematuria in men are suggested by
a) initial
b) mixed
c) terminal
blood in the stream?
a) Urethral
b) Bladder
c) Highly specific for prostate
What is hypospadias?
External urethral orifice is found below the glans:
so anywhere between the glans and the pubic symphysis
In males presenting with obstruction, what should be examined?
Abdomen
Rectum
Penis
In females presenting with obstruction, what should be examined?
Abdomen
Rectum
Vagina
What is a menopause-related cause of obstruction in females?
Urethral stenosis
What investigations should be done for someone presenting with obstruction?
Urinalysis, urine culture
Imaging - USS or CT (with contrast if you suspect stones)
What are tests used to investigate and diagnose suspected prostate disease in men?
PSA (screening test in all men aged over 50)
TRUS - transrectal ultrasound-guided biopsy
What is an emergency complication of obstruction?
Acute urine retention
If you retain large volumes of urine for a prolonged period of tme, what happens to the bladder?
Becomes unresponsive to nerve impulses - low compliance
Diverticulae - which stones can lodge in
What is a complication of obstruction which affects the kidneys and causes renal failure if untreated?
Hydronephrosis
People with urine retention due to obstruction are more likely to develop ___ and ___ ___.
infections
renal calculi
Which type of incontinence is caused by obstruction?
Overflow incontinence
How does obstruction cause epididymo-orchitis?
Passage of infection through vas deferens
Does overflow incontinence empty the bladder?
No
How is BPH treated?
Alpha blockers
Finasteride (5α-reductase inhibitor)
Surgery
How are renal calculi treated?
Analgesia (diclofenac +/- opiates)
Alpha blockers and hope for spontaneous passage for small stones
Surgical fragmentation / removal for big stones
