Bladder Obstruction

Question 1

List causes of bladder outflow obstruction

Answer 1

BPH
Urethral stricture
Prostate cancer
Bladder stones
Extrinsic obstruction - e.g. non-urological cancer
Neurological issues - MS or spinal cord injury
Drugs - anticholinergics

Question 2

List the lower urinary tract symptoms relating to urine storage

Answer 2

Frequency
Urgency
Nocturia -waking up to pee

Question 3

List the lower urinary tract symptoms relating to urine voiding

Answer 3

Hesitancy 
Poor flow 
Intermittent flow 
Sensation of incomplete emptying 
Post-micturition dribbling

Question 4

What are the red flag urinary symptoms

Answer 4

haematuria
suprapubic pain
recurrent UTI

Suggestive of bladder symtpoms

Question 5

What does bedwetting suggest

Answer 5

High pressure chronic retention

Question 6

What aspects of PMH could affect the bladder

Answer 6

Urethral injury/ instrumentation.
Pelvic surgery
Neurological disorders

Question 7

How can you assess the severity of urinary symptoms

Answer 7

IPSS questionnaire - 7 questions

AUA

Question 8

Can the IPSS questionnaire be used to diagnose BPH

Answer 8

No

Variety of disorders can give a high score

Question 9

What might you look for on examination of someone with bladder outflow obstruction

Answer 9

Palpable bladder
Enlarged (ballotable) kidneys
Prostate – size, consistency, nodules.
Anal tone on PR 
Any changes to external genitalia

Question 10

What investigations are done for bladder outflow obstruction

Answer 10

Frequency-volume chart 
Measure flow rate 
Urinalysis 
Serum 
Creatinine 
PSA - after counselling

Question 11

When might a renal US be needed

Answer 11

Impaired renal function
Loin pain
Haematuria
Renal mass on examination

Question 12

When might cystoscopy be needed

Answer 12

Previous urological surgery
Haematuria
Profound symptoms
Pain
Recurrent UTIs

Question 13

When might transrectal ultrasound be used

Answer 13

If there is elevated PSA and abnormalities on PR

If need to plan surgical treatment

Question 14

Which drugs can be used to shrink the prostate

Answer 14

5-aplha reductase inhibitors

Inhibit the processing of testosterone

Question 15

Which drugs are used to relax the prostate

Answer 15

alpha blockers

Tamulosin

Question 16

Which drugs are used to relax the bladder muscles

Answer 16

anti-cholinergic

Inhibits contraction

Question 17

Which surgical treatment may be used for prostate problems

Answer 17

Transurethral resection of prostate gland

Holmium laser enucleation of prostate

Question 18

What is the difference between acute and chronic urinary retention

Answer 18

Pain with residual up to 800mls = Acute
Will feel relived by catheter insertion

Painless with residual volume over 800ml = Chronic

Question 19

How would you treat acute retention

Answer 19

Catheterise and record residual volume 
FBC, renal function 
Urine dipstick 
Treat the precipitating cause 
Start on an alpha blocker

Question 20

How do you treat high pressure chronic retention

Answer 20

Admit
Catheterise
Monitor for post-obstruction diuresis (more fluid will be released when the bladder is allowed to function properly again)
Long term: will need surgery or long term catheterisaion