Symptoms Suggesting Bladder Outflow Obstruction Flashcards
what are the 3 layers of the detrusor muscle?
inner longitudinal
circular
outer longitudinal
what can cause obstruction at the bladder neck in males?
bladder neck stenosis
stone at bladder neck
bladder tumour at bladder neck
what can cause obstruction at posterior urethra in males?
BPH posterior urethral stricture stone in posterior urethra posterior urethral tumour prostate cancer detrusor sphincter dys-synergia
what can cause obstruction at the anterior urethra in males?
urethral stricture
obstructing stone
urethral cancer
what can cause obstruction at the glans penis?
urethral meatus stenosis
penile cancer
what can cause obstruction at the foreskin (Prepuce)?
phimosis
what can cause obstruction at the bladder neck in females?
bladder neck stenosis
stone at bladder neck
bladder tumour at bladder neck
what can cause obstruction at the urethra in females
stenosis (synonymous with stricture in males as females have short urethra)
stone urethra
urethral tumour
detrusor sphincter dys-synergia (DSD)
what can cause obstruction at the urethral meatus in females?
stenosis
polyp/tumour
vaginal causes of obstruction?
vaginal atrophy (distorts urethra) vaginal prolapse vaginal cysts (extrinsic compression)
which urinary symptom is most common in males and females?
males = obstruction females = frequency and urgency
what voiding symptoms may occur due to effect of blockage?
poor flow intermittent stream spraying/deviated stream hesitancy post micturition dribbling straining
what storage symptoms may occur due to secondary effects of blockage?
increased frequency of urination urgency urgency incontinence nocturia sense of incomplete emptying pain with bladder filling
what is IPSS?
international prostate symptoms score
8 question written scoring tool for screening, diagnosis, track and suggest management for BPH
important features to ask about visible haematuria?
clots? mild/moderate/severe shape of clots painful/painless timing (initial, terminal or throughout) check coagulation
important fatures to ask about non-visible (microscopic) haematuria?
dipstick (microscopic = 3-5 RBCs per HPF)
symptomatic/asympatomatic
check BP, proteinuria
exclude UTI
examination of bladder symptoms in males?
is patient circumcised?
check urethral meatus
check glans penis
penile examination (palpable lumps, tumours, stones or roughness in body suggesting stricture)
abdominal exam (palpable bladder)
PR exam (anal tone, prostate, rectal tumour, blood on finger)
neuro examination (lower limb sensation, peri-anal sensation, back-meningeo-myelocoele/tuft of hair)
what does tuft of hair on the back suggest?
spina bifida oculta
examination of bladder symptoms in female?
urethral meatus (stenosis?) vaginal exam/PV (prolapse, cysts, tumours, atrophic and scarring) abdomen (palpable bladder) PR exam (anal tone, tumours, blood on finger) neuro exam (lower limb/peri anal sensation, tuft of hair on back)
lab investigations of urinary tract obstruction?
FBC
renal function tests (urea, creatinine, electrolytes)
urine dipstick/cultures
PSA
radiological investigations of urinary tract obstruction?
X ray KUB US KUB TRUS prostate + PVR (post-void residual urine) CT KUB (plain) CT urography
bladder complications of bladder outflow obstruction?
diverticulum/saccules
trabeculation
atonic bladder (detrusor hypofunction)
renal complications of bladder outflow obstruction?
back pressure on kidneys
- hydronephrosis
- abnormal RFTs
general urinary tract complications of outflow obstruction?
recurrent UTI (cystitis, prostatitis, epididymo-orchitis)
bladder stones
haematuria
incontinence
how is BPH managed?
alpha blockers
finasteride
TURP (trans-urethral resection of prostate)/laser (HoLEP - holium laser enucleation of prostate)
how is urethral stricture managed?
optical urethrotomy
anastomotic urethroplasty
how is phimosis managed?
circumcision
dorsal slit
how is meatus/urethral stenosis managed?
dilation
how are bladder stones managed?
cystolitholapexy (fragmentation of stones)
how are bladder tumours managed?
transurethral resection of bladder lesion (TURBT)
how are neurological causes of outflow obstruction managed?
treat neurological cause
intermittent catheterisation or long term suprapubic catheter
