Obstruction Flashcards
outline the layers of the bladder
epithelium
lamina propria
detrusor muscle
what is contained in the lamina propria of the bladder?
nerve receptors
collagen
CT
blood vessels
how is muscle arranged in the detrusor muscle?
inner longitudinal layer
circular layer
outer longitudinal layer
causes of bladder neck obstruction in men?
bladder neck stenosis
stone
tumour
causes of posterior urethral obstruction in men?
BPH
stricture
stone
tumour
causes of anterior urethral obstruction in men
stricture
stone
cancer
causes of glans penis obstruction?
urethral orifice stenosis
penile cancer
vaginal causes of obstruction?
vaginal atrophy
prolapse
cyst
urethral causes of obstruction in women?
stone
stenosis
tumour
obstruction is more common in what gender?
men
overactive bladder is more common in what gender?
women
voiding symptoms are due to what pathology?
obstruction
symptoms of poor voiding?
poor flow intermittent stream deviated stream hesistancy dribbling post micturition
storage symptoms are due to what pathology?
secondary effects of obstruction
symptoms of storage problems?
frequency urgency (incontinence?) nocturia incomplete emptying pain with bladder filling
what level of RBCs indicates microscopic haematuria?
3-5 RBCs per HPF on dipstick
what should be asked in a patient with gross haematuria?
painful - infection/stone? painless? clots (ask about shape) timing coagulation test
what investigations should be done in the GP in microscopic haematuria?
BP
urinalysis - look for blood and protein
a palpable roughness in the penile body indicates…
a stricture
what is hypospadias?
urethral meatus on the ventral aspect of the penis
blood on finger would indicate…
a tumour in the rectum
most common cause of obstruction of the urethral meatus in post menopausal women?
stenosis
non imaging Ix into urinary obstruction?
FBC U+Es creatinine urinalysis urine cultures
imaging Ix into urinary obstruction?
KUB x ray
USS KUB
transrectal USS biopsy of prostate
CTU if stone or suspected cancer
complications of obstruction?
retention atonic bladder from detrusor hypofunction renal failure from urine backup recurrent UTI incontinence
BPH treatment?
tamsulosin (alpha blocker)
TURP or laser if not working
Tx of urethral sphincter?
optical urethrotomy
anastomotic urethroplasty
Tx of phimosis (tightened foreskin)?
circumcision
dorsal slit
Tx of bladder stone?
cystolitholaplexy (to break up stone)
what is a TURP?
transurethral resection of prostate
