Bladder Problems Flashcards
causes of bladder obstruction
BPH urethral stricture cancer stones extrinsic drugs
drugs that cause bladder obstruction?
anticholinergics
nasal decongestants
presentation of bladder obstruction
frequency? hesitancy? poor flow incomplete emptying dribbling
diagnosis of bladder obstruction
IPSS (questionnaire to assess symptoms)
FVC
urinalysis
FVC result in obstruction
Qmax <10mls/s is likely to be an obstruction
normal is >15
management of bladder obstruction/ incontinence options
alpha blockers 5-alpha reductase inhibitors anticholinergics beta agonists transurethral resection of prostate holmium laser enucleation
alpha blockers in bladder obstruction
tamsulosin acts on smooth muscle
what do 5-alpha reductase inhibitors do?
inhibits testoterone to DHT (BPH)
what do anticholinergics and beta agonists do to the bladder?
inhibit contraction
what is acute urinary retention?
it is an emergency with inability to urinate causing increasing pain
most common cause of acute urinary retention?
complication of BPH
triggers of acute urinary retention
surgery
catheterisation
anaesthesia
medications
management of acute urinary retention
catheter or TWOC
alpha blockers before TWOC
when can a TWOC be used in acute urinary retention?
if <1L and normal electrolytes
complication of acute urinary retention
post-obstruction diuresis
what is bladder trauma often caused by?
pelvic fracture
presentation of bladder trauma
suprapubic/ abdominal pain
inability to void
bruising
reduced sounds
diagnosis of bladder trauma
CT cystography
retrograde urethrogram
management of bladder trauma
large bore catheter
antibiotics
immediate repair
risk in the urethra with pelvic fracture?
urethral injury especially in pubic rami fractures
presentation of urethral injury
blood at meatus
inability to urinate
full bladder
diagnosis of urethral injury
retrograde urethrogram
management of urethral injury
suprapubic catheter
delayed reconstruction
sub-types of cystitis
- parasitic
- aseptic
- reactive to catheters
cause of parasitic cystitis
schistosomiasis
risk in parasitic cystitis
persistent inflammation leads to squamous metaplasia and squamous cell carcinoma
what is aseptic cystitis
dysuria with persistent negative cultures and urinalysis
what happens in reactive to catheters cystitis?
persistent inflammation risk too
what is cystitis cystica?
infolding of bladder mucosa into cysts
