symptoms suggesting blader outelt obstruction Flashcards
aetiology of bladder outlet obstruction in males is divided into
- bladder neck
- posterior urethra (prostatic and membranous)
- anterior urethra (penile and bulbar)
- glans penis
- prepuce
bladder neck aetiology
bladder neck stenosis, tumour or stone obstructing the bladder neck
posterior urethra
benign prostatic hyperplasia, prostate cancer, posterior urethral stricture, stones obstructing the posterior urethra, detrusor sphincter dysnergia
anterior urethra
anterior urethral stricture, obstructing stone, urethral cancer
glans penis
urethral metal stenosis and penile cancer
prepuce
phimosis
aetiology in females is divided into
bladder neck, urethra, urethral meatus vagina
bladder neck causes in females
bladder neck stenosis, bladder tumours and stones
urethra causes in female
urethral stenosis (same as a stricture in males), stones, tumours, detrusor sphincto dysnergia
urethral meatus causes
metal stenosis and tumours
vaginal causes
vaginal atrophy, vaginal prolapse vaginal cysts
symptoms of bladder outlet obstruction are the same or different in males or females?
the same
the symptoms of ablaze outlet obstruction are divided into
voiding symptoms due to the blockage affect and storage symptoms (due to irritative secondary affects)
voiding symptoms
poor flow intermittent stream, sparing of stream, hesitancy, post micturition dribbling
storage symptoms
frequency of urination, urgency, urge incontinence, incomplete emptying pain with bladder emptying
bladder outflow obstruction is more common in
males
overactive blader is more common in
females
overactive bladder is identified from
frequency and urgency
examination in males
- is the patient circumcised
- location of the urethra (hypospadias is a congenital condition where the urethra is underside of penis)
- penile exmaination= palpable mass suggests a tumour whereas palpable roughness suggests a stricture
- abdomen= palpate and percuss the bladder
- PR exam; assess anal tone and feel the size of the prostate, blood on your hand suggests a rectal
- focused neurological examination
examination in females
- vaginal examination
- abdominal examination
- PR exam= anal tone and rectla tumours
- focussed neurological examination
investigations in someone presenting with a bladder outlet obstruction
creatinine, us and es, urinalysis, PSA in males
- XRAY KUB, TRUS OF PROSTATE IN MALES, PLANE CT KUB
Complications of bladder outlet obstruction
- acute or chronic urinary retention
- diverticulum formation in the bladder
- atonic bladder
- renal failure caused by hydronephrosis
- overflow incontinenve
management of bladder outlet obstruction depends on
underlying cause
management of BPH
first line is lifestyle the tamsulsin and last line is TURP
management of urethral stricture
optical urethrotomy
management of phimosis
manual decompression if unsuccessful dorsal slit
management of bladder stone
cystolitholaplexy
