Bladder Outflow Obstruction

Question 1

Give examples of processes which cause bladder outflow obstruction

Answer 1

Benign Prostatic Hyperplasia (BPH)
Urethral stricture
Prostate cancer
Bladder stones
Extrinsic compression

Question 2

What types of drugs can cause bladder outflow obstruction?

Answer 2

anticholinergic (against parasympathetics which usually make you pee)
nasal decongestants

Question 3

What are the two main groups of lower urinary tract symptoms?

Answer 3

Storage

Voiding

Question 4

What lower urinary tract symptoms are involved in the storage phase?

Answer 4

Frequency
Urgency
Nocturia

Question 5

What lower urinary tract symptoms are involved in the voiding phase?

Answer 5

• Hesitancy
• Poor flow
• Intermittent flow
• Incomplete emptying
• Post-micturition dribbling

Question 6

Why should you specifically ask about bed-wetting as a symptom?

Answer 6

High pressure chronic retention

Question 7

What are the red flag symptoms for bladder outflow obstruction?

Answer 7

Haematuria
Suprapubic pain.
Recurrent Urinary Tract Infections

Question 8

What should be asked about in the patients PMHx?

Answer 8

Urethral injury/ instrumentation.
Pelvic surgery
Neurological disorders. ( Parkinson’s, Stroke)

Question 9

What scoring systems can be used to analyse patients symptoms of outflow obstruction?

Answer 9

IPSS - International Prostate Symptom Score
AUA - American Urinary Assoc.
Bristol male LUTS

Question 10

Describe the scoring system of the IPSS?

Answer 10

7 questions each scored out of 5
1 qu. about quality of life

• Mild LUTS 0-7
• Moderate 8-19
• Severe 20-35
• QoL : 0-6.

Question 11

What specific features of examination would lead you to a possible bladder outflow obstruction?

Answer 11

• Palpable bladder
• ballotable kidneys
• Change in Prostate – size, consistency, nodules
• neuro abnormalities in younger pts

Question 12

What investigations can be used if you suspect a bladder outflow obstruction?

Answer 12

• Frequency- volume chart (if pt has polyuria/nocturnal polyuria)
• Urinalysis
• Serum Creatinine
• PSA ( after counselling)

Question 13

Below what level does the Qmax signify an obstruction?

Answer 13

if Qmax <10mls/s => 90% chance of obstruction

> 15mls/s suggests the flow is still maintained by a high pressure situation

Question 14

If lower urinary tract symptoms are found to be localised to the prostate, what treatments can be used?

Answer 14

Relax Prostate - alpha-blockers

Shrink Prostate - 5-alpha-reductase antagonists

Question 15

What does inhibiting 5-alpha reductase actually do to shrink the prostate?

Answer 15

Prevents Testosterone →Dishydrotestosterone

=> no growth signal to prostate