Bladder outlet obstruction Flashcards
Causes of lower urinary tract symptoms
nocturnal polyuria
chronic pelvic pain syndrome
neurogenic bladder dysfunction
UTI
foreign body
urethral stricture
bladder tumour
distal ureteric stone
benign prostatic obstruction
detrusor under-activity
overactive bladder/detrusor overactivity
Bladder outlet obstruction definition
generic term for obstruction during voiding and is characterised by increasing detrusor pressure and reduced urine flow rate
How is bladder outlet obstruction usually diagnosed?
studying synchronous values of flow rate and detrusor pressure
urodynamics
high pressure + low flow = bladder outlet obstruction
What history questions need to be asked if suspecting bladder outlet obstruction?
number of voids per day/night
hesitancy (waiting for flow to start)
flow
post-void dribble (not normally associated with obstruction)
frequency
urgency/urge incontinence
visible haematuria
UTIs
‘Voiding’ bladder outlet obstruction symptoms
weak/intermittent urinary stream
straining
hesitancy
terminal dribbling
incomplete emptying
(nocturia)
‘Storage’ bladder outlet obstruction symptoms
urgency
frequency
incontinence
(nocturia)
What are the 2 categories of symptoms in bladder outlet obstruction?
voiding
storage
When should you be suspicious of bladder cancer with urinalysis?
+blood on >2 of 3 tests
What is PSA a surrogate marker of?
marker of prostatic volume
What PSA values would a small benign prostate and a bigger benign prostate have?
smaller = lower PSA
bigger = higher PSA
What PSA predicts a higher risk of progression to cancer?
> 1.4
What score can be used to assess prostate symptoms?
IPSS - international prostate symptom score
What is the formal name for a bladder diary?
frequency volume chart
Define nocturnal polyuria
> 30% of 24hr urine output at night
can be picked up with frequency volume chart
Causes of nocturnal polyuria
inappropriate fluid intake
ADH sensitivity/production issues
Management of nocturnal polyuria
lifestyle - fluid type/timing
diuretics late afternoon
vasopressin (beware in older patients)
Community investigations for bladder outlet obstruction
flow rate
post void ultrasound scan
What drugs can be used for bladder outlet obstruction due to enlarged prostate?
alpha blockers eg. tamsulosin
5-ARI eg. finasteride
How do alpha blockers work on the prostate?
relax the smooth muscle of the bladder neck reducing obstruction
work quickly
How do 5-alpha reductase inhibitors work on the prostate?
shrinks the prostate by blocking androgen conversion within the prostate
takes 6/12 to work
(once been on for 6/12 need to double PSA for corrected reading)
Which patients with bladder outlet obstruction should be referred to urology?
might need surgery:
- failure of medical treatment (2 visits to review sx and management)
- severe lower urinary tract symptoms (IPSS>20)
- urinary retention (palpable bladder)
- recurrent UTI
might have cancer:
- elevated age-specific PSA
- persistent non-visible or any visible haematuria
- abnormal DRE suggestive of prostate cancer
What surgical management is available for enlarged prostates causing bladder outlet obstruction?
TURP (gold standard)
HoLEP
REZUM
UROLIFT
TURP surgery complications
retrograde ejaculation
erectile dysfunction
HoLEP surgery complications
retrograde ejaculation
erectile dysfunction
What is a benefit of Rezum/Urolift surgeries over the other options?
no erectile dysfunction
What drug should be given if prostate is smaller but causing symptoms?
alpha blocker
What drug should be given if prostate is bigger and causing symptoms?
5 ARI/combo
