7: Bladder outflow obstruction

Question 1

Which muscles make up the detrusor of the bladder?

Answer 1

Inner LONGITUDINAL muscle

Outer CIRCULAR muscle

External LONGITUDINAL muscle

Question 2

What is found between the urothelium and the detrusor muscles of the bladder?

Answer 2

Lamina propria

nerves, connective tissue, blood vessels

Question 3

What are bladder causes of obstruction?

Answer 3

Stenosis

Renal calculus

Tumour

Question 4

What are the general causes of bladder outlet obstruction in males and females?

Answer 4

Compression - e.g tumour

Stones

Stricture

Question 5

What enlarges to cause obstruction of the posterior urethra in males?

Answer 5

Prostate gland

either BPH or prostate cancer

Question 6

What is phimosis?

Answer 6

Inability to retract the foreskin which can cause obstruction in men

Question 7

What are vaginal causes of bladder outlet obstruction?

Answer 7

Atrophy

Prolapse

Cysts

Question 8

Obstruction is more common in (males / females).

Answer 8

males

Question 9

Overactivity of the bladder causes which symptoms?

Is it more common in men or women?

Answer 9

Increased frequency

Urgency

Females

Question 10

What QOL score is filled out by male patients with prostate problems?

Answer 10

International prostate symptom score

Question 11

Which causes of haematuria in men are suggested by

a) initial
b) mixed
c) terminal

blood in the stream?

Answer 11

a) Urethral

b) Bladder

c) Highly specific for prostate

Question 12

What is hypospadias?

Answer 12

External urethral orifice is found below the glans:

so anywhere between the glans and the pubic symphysis

Question 13

In males presenting with obstruction, what should be examined?

Answer 13

Abdomen

Rectum

Penis

Question 14

In females presenting with obstruction, what should be examined?

Answer 14

Abdomen

Rectum

Vagina

Question 15

What is a menopause-related cause of obstruction in females?

Answer 15

Urethral stenosis

Question 16

What investigations should be done for someone presenting with obstruction?

Answer 16

Urinalysis, urine culture

Imaging - USS or CT (with contrast if you suspect stones)

Question 17

What are tests used to investigate and diagnose suspected prostate disease in men?

Answer 17

PSA (screening test in all men aged over 50)

TRUS - transrectal ultrasound-guided biopsy

Question 18

What is an emergency complication of obstruction?

Answer 18

Acute urine retention

Question 19

If you retain large volumes of urine for a prolonged period of tme, what happens to the bladder?

Answer 19

Becomes unresponsive to nerve impulses - low compliance

Diverticulae - which stones can lodge in

Question 20

What is a complication of obstruction which affects the kidneys and causes renal failure if untreated?

Answer 20

Hydronephrosis

Question 21

People with urine retention due to obstruction are more likely to develop ___ and ___ ___.

Answer 21

infections

renal calculi

Question 22

Which type of incontinence is caused by obstruction?

Answer 22

Overflow incontinence

Question 23

How does obstruction cause epididymo-orchitis?

Answer 23

Passage of infection through vas deferens

Question 24

Does overflow incontinence empty the bladder?

Answer 24

No

Question 25

How is BPH treated?

Answer 25

Alpha blockers

Finasteride (5α-reductase inhibitor)

Surgery

Question 26

How are renal calculi treated?

Answer 26

Analgesia (diclofenac +/- opiates)

Alpha blockers and hope for spontaneous passage for small stones

Surgical fragmentation / removal for big stones