Bladder Outflow Obstruction Flashcards
What factors are related to storage of urine?
Frequency
Urgency
Nocturia/bedwetting
What factors are related to voiding of urine?
Hesitancy
Poor/intermittent flow
Sensation of incomplete emptying
Post-micturition dribbling
State the red flags for outflow obstruction
Haematuria Suprapubic pain Recurrent UTIs Back pain Neurological symptoms
What is important to include in a bladder outflow obstruction history?
Drugs Urethral injury Instrumentation Pelvic Surgery Neurological disorders
Name the scoring system used to diagnose outflow obstruction
International Prostate Symptom Score
Describe the IPSS
Mild 0-7
Moderate 8-19
Severe 20-35
Quality of life graded 1-6
What will examination of obstruction entail?
Palpate bladder and kidneys (enlarged)
PR Exam - anal tone, prostate, external features
Neurological exam in younger patients
State the investigations carried out in a patient with bladder outflow obstruction
Frequency - volume chart
Urinalysis
Creatinine
PSA
Describe the frequency-volume chart and its relation to chance of obstruction
Qmax <10ml 90% chance
10-15mls 60%
>15ml 30%
When is renal USS indicated?
Creatinine >130
Loin Pain
Haematuria
Palpable renal mass
When is cystoscopy indicated?
Haematuria Profound symptoms Recurrent UTIs Pain Previous surgery
When is transrectal ultrasound indicated?
Elevated PSA and abnormal DRE
>100mls - significant volume
Describe the treatment pathway if the pathology is thought to be prostate related
Relax prostate using alpha blockers which act on smooth muscle rapidly e.g Tamulosin
Shrink prostate using 5 alpha reductase inhibitors which inhibit testosterone conversion to dihydrotestosterone e.g Finesteride
What drugs act to relax the bladder?
Anti-cholinergic
Beta agonists
Inhibit bladder smooth muscle contraction
What surgery can be performed in obstruction?
Transurethral resection of prostate gland
Holmium laser enucleation of prostate
