bladder outflow obstruction Flashcards
what are the 4 parts of the male urethra?
penile
bulbar
membranous
prostatic
what are the causes of male bladder outflow obstruction?
- Benign Prostatic Hyperplasia (most common)
- Prostate cancer
- Bladder Cancer
- Bladder Stones
- Urethral Strictures
- Other factors - Constipation/Infection/Detrusor Dysfunction
how common is BPH?
very - 50% at age 50
90% at age 80
what are risk factors for BPH?
Infection
Pain/Retention
Family History
what is important in history taking for BPH?
Suspicion of Cancer - family history etc.
red flags for cancer:
Haematuria
Back Pain - bone metastasis
PSA?
what are the 2 types problems with bladder outlfow?
Bladder - (FUN) Frequency/Urgency/Nocturia
Outflow - (SHIP) Straining/Hesitancy/Intermittency/Poor Stream
what examinations do you want to do in a man with urinary outflow obstruction caused by BPH?
General
Abdominal
Pelvic
Inguinal - ? Hernias from excessive straining
PR exam
catheter to look at retention
how do you insert a transurethral catheter?
Counsel
Clean/Drape
Local Anaesthetic Gel
Gentle slide into urethra
Up to ‘Y’ - the fork in the end of the catheter
Inflate balloon
Fix and drain
what is the management of BPH?
lifestyle modification - avoid alcohol and caffeine
meds- tamsulosein, 5a reductase inhibitors- suppresses testosterone
surgery- transurethral resection of the prostate (TURP)
why does BPH cause bladder outflow obstruction?
enlarged prostate compresses urethra so urine can’t pass through
what are indications for surgery in BPH?
Failed medical Tx and lifestyle change – Bothersome LUTS
Recurrent retention
High pressure chronic retention – Renal Impairment
Recurrent haematuria related to enlarged prostate
Bladder stones / Divericulum
Recurrent Infections
