Bladder Outflow Obstruction Flashcards
Causes of bladder outflow obstruction?
Causes from most likely to least likely
- BPH
- Prostate cancer
- Bladder cancer (usually only due to blood clots formed in haematuria)
- Bladder stones
- Urethral strictures
Constipation/infection/detrusor dysfunction (this dysfunction is a diagnosis of exclusion, happening due to long-standing obstruction)
What are the commonest zones of BPH and prostatic cancer respectively?
BPH - transitional zone - just around urethra
Prostatic cancer - peripheral zone - the posterior part of prostate, the zone felt in PR exam
What are the different sections in male urethra and type of lining?
Prostatic urethra - urothelium
Membranous urethra - pseudostratified/stratified columnar epithelium
Bulbar urethra - pseudostratified/stratified columnar epithelium
Penile urethra - pseudostratified/stratified columnar epithelium
Urethra meatus - stratified squamous epithelium
How to distinguish between intrinsic bladder problems and outflow problems based on symptoms?
What is the rough process/steps of transurethral catheter insertion?
Indication
Counsel
Clean/Drape
Local Anaesthetic Gel
Gentle slide into urethra
Up to ‘Y’
Inflate balloon
Fix and drain
Change in dietary/lifestyle measures in BPH? Medications after that?
Reduce alcohol/caffeine/citric juice, drink water
If nocturia, don’t drink water the 2-3 hours leading up to sleep
Tamsulosein - alpha-blocker, gold standard for BPH
5a reductase inhibitors - reduce testosterone so shrink prostate, but need to consider the side effect profile
What is indication for surgery in BPH?
Failed medical tx/lifestyle change - Quality of life still compromised
Recurrent retention
High pressure chronic retention - renal impairment
Recurrent haematuria related to enlarged prostate
bladder stones/diverticulum in bladder
Recurrent infections
What is the most up-to-date surgery for BPH?
Holmium Laser Enucleation of the Prostate
