Bladder Outflow Obstruction Flashcards
Causes of BOO (5)
BPH
urethral stricture
prostate ca.
stones
neurological disease affecting lower urinary tract-parasympathetic, S2/3/4
Causes of urethral strictures (3)
infections
trauma
iatrogenic
Ix and Rx of urethral strictures (2)
urine flow rate shows characteristic plateau w. prolonged voiding cycle.
endoscopic urethrotomy
McNeal’s zones of the prostate (3)
around urethra: transitional zone-only 20% of ca.
central zone
peripheral zone: 70% of ca.
BPH occurs mainly in central and peripheral zones=>still risk of ca. after surgery for BPH
Presentation of BPH (4)
hesitancy
poor flow
nocturia
frequency
Features of AUR (7)
onset over hrs
painful
tender, tense bladder
no nocturnal/overflow incontinence
no impaired renal function
no post catheter diuresis/haematuria
residue <1L
Features of CUR (8)
onset over days-weeks
painless
flabby, non-tender bladder
nocturnal incontinence and marked overflow incontinence
renal impairment common but now always present
post obstructive diuresis. can> dehydration and low Na and HCO3
post catheter haematuria common
residue >1/5-2L
Causes of retention in men (7)
BPH-most common
prostate ca.
prostatitis
meatal stenosis
phimosis
paraphimosis
penile constricting bands
Causes of prostatitis (3)
strep faecalis
E.coli
chlamydia
Features of prostatitis (5)
urinary retention
pain
haematospermia
UTIs
swollen, boggy prostate
Ix for prostatitis
urine sample
Rx of prostatitis
analgesia+ciprofloxacin/levofloxacin
Causes of urinary retention in women (3)
prolapse
gynae mass
retroverted gravid uterus
Causes of urinary retention in both men and women (13)
cystoscopy
drugs-anticholinergics, antispasmodics, antihistamines
peri-aortitis>retroperitoneal fibrosis
bladder calculi
bladder ca.
foecal impaction/constipation
neurological-sacral problems e.g. cauda equina, check perineal sensation
GI/retroperitoneal malignancy
urethral strictures
foreign body
trauma
clot retention
infection
Ix for BOO (8)
DRE
urine dip
PSA
Urodynamic flow: non invasive, 25ml/s normal, <10ml/s significant
USS of urinary tract
full urodynamic studies:
- pressure transducer in bladder
- differentiates between, high pressure-low flow, detrusor dysfunction and atonic bladder
voiding diary/frequency-volume chart
IPSS-dictates Rx:
- 0-7=mild
- 8-19=moderate
- 20-35=severe
conservative Mx for BOO (4)
if mild:
- advice on fluid intake
- reduce caffeine and alcohol
- continence products
- bladder retraining
Medical Mx of BOO+mechanisms, SEs and when to review (8)
dynamic problem-contraction of smooth muscle in prostate/bladder neck:
- alpha blocker e.g. tamsulosin, alfuzosin, doxazosin
- relax smooth muscle in bladder neck
- SEs: post-hypo, RETROGRADE EJACULATION, lethargy, GI disturbance, nasal congestion
- review at 4-6wks
static problem-prostatic enlargement:
- 5-ARIs: finesteride, dutasteride
- inhibit conversion of testosterone>DHT
- takes 3mo to start working.
- indicated if prostate>30cc or high risk of progression
- SEs: decreased libido, erectile dysfunction, increased scalp hair.
- excreted into semen so warn to use condoms
- review at 3-6 mo
Surgical Mx of BOO (3)
TURP:
- peripheral zone still left
- post-op: no driving or sex for 2wks, may have some haematuria
- SEs: incontinence, retrograde ejaculation, impotence, UTIs, failure to void
- TUR syndrome: de-ionised fluid used in irrigation enters circulation>hyponatraemia+seizures+fluid overload
TUVaporisationP:
- electrical current ablates prostate
- lower cost, can be used w. anticoagulants, fewer SEs, shorter recovery time
Laser surgery
LT Mx of AUR (4)
start alpha blocker
trial w/o catheter
if this fails:
- long term catheter
- prostatic surgery
LT Mx of CUR (3)
Prostate surgery
LT catheter
monitor electrolytes imbalances esp. hyponatraemia
