management of bladder outflow obstruction

Question 1

zonal anatomy of the prostate

Answer 1

Question 2

bladdr outflo obstruction

Answer 2

• BPH
• Urethral stricture
• Carcinoma of the prostate
• Pelvic prolapse
• Urethral diverticulum
• Stress incontinence surgery
• Fowler’s Syndrome
• Pelvic/Ovarian Masses
• Neurological disease (MS,SB,SCI)
• Detrusor sphincter dysynergia

Question 3

luts

Answer 3

Question 4

bladder diseases

Answer 4

Question 5

obstructive symptoms

Answer 5

hesitancy

weak stream

straining to pass urine

prolonged mictruition

feeling of incomplete bladded emptying

acute urinary retention

nocturnal enuresis due to chronic retention

Question 6

irritative symptoms

Answer 6

frequency

urgency

nocturia

urge incontinence

Question 7

investigate bladdr outflow obstruction

Answer 7

• Urinary Flow rate
• Post void residual USS
• Pressure-flow studies (‘urodynamics’)
• Renal USS
• If elevated serum creatinine

Question 8

bph treatmet

Answer 8

Question 9

nerves controlling bladder and prostate

Answer 9

Question 10

treatmetn for BPH (PHARM)?

Answer 10

• Rationale
Dynamic obstruction from contraction of bladder neck,
prostatic fibromuscular stroma and capsule
• Sx & Qmax improvement in 70%
• Maximum improvement in Qmax 4-8hours!
• Tamsulocin 400mcg o.d

5 alpha reductase inhibit (finasteride):

inhibitis 5alpha reductase which inhibits DHT (D) and then AR and stops prolif

or you can combine them both for even more efficacy (MTOPS)

Question 11

surgical treatment for BPH?

Answer 11

TURP (Transurethral resection of the prostate)

millins open prostatectomy

Question 12

sgns of BPH - urinary retention

Answer 12

• Painful inability to void, relieved by
catheterisation
• Caution – lower abdominal pain and absent
urine output ≠AUR!
• relief of pain and large volume of urine on
catheterisation required for diagnosis

Question 13

how to treat urinary retention

Answer 13

• Management
• Immediate catheterisation
» Urethral vs. suprapubic
• Record volume drained
• Check (&record in notes!) serum U&E’s
• DRE!
• Monitor urine output
• If post obstructive diuresis (>200ml/hr)
replace losses with iv n.saline

• Subsequent management
• Alpha blocker (tamsulocin 400mcg o.d.)
• TWOC 24-48 hrs later
• If fails to void
» TURP
» Long term catheter
» Clean intermittent self catheterisation