Symptoms of bladder outflow obstruction

Question 1

What can cause bladder outflow obstruction (BOO)?

Answer 1

Benign Prostatic Hyperplasia (BPH/BPE)
Urethral stricture
Prostate cancer
Bladder stones
Extrinsic 
Cystocele, pelvic non-urological cancers
Drugs such as antocholinergic and nasal decongestants

Question 2

What are the two main categories of symptoms seen in BOO/LURS?

Answer 2

Storage- Frequency, urgency, nocturia

Voiding- Hesitancy, poor/intermittent flow, sensation of incomplete emptying, dribbling

Question 3

What are some red flags associated with BOO?

Answer 3

Haematuria
Suprapubic pain.
Recurrent Urinary Tract Infections

Question 4

What is a good question to ask about frequency?

Answer 4

How often do you pass urine from the time you wake up in the morning until the time you go to sleep at night ?

Question 5

What is a good question to ask about nocturia?

Answer 5

How many times, on average are you woken from sleep because you need to pass urine ?

Question 6

What are some good questions to ask about urgency?

Answer 6

When you get the feeling of wanting to pass your water, can you hold on or do you have to go immediately ?
If you are watching your favourite TV Programme , and get the feeling of wanting to pass urine, can you delay until the programme is finished ?

Question 7

What is a good scoring test for BOO?

Answer 7

International Prostate Symptom Score (IPSS)

Question 8

How does the IPSS work?

Answer 8

7 question scored 0-5 and a single quality of life score

Question 9

What things are you looking for on the physical examination?

Answer 9

Palpable bladder.
Enlarged kidneys
Prostate
Anal tone
Renal failure
Fluid overload
Urea symptoms

Question 10

What three categories of urine flow rate result are there?

Answer 10

Qmax < 10 mls/s : 90 % probability of obstruction.
Qmax 10-15 : 60 %.
Qmax > 15 : 30%. ( Flow mantained by high pressure situation)