Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

UROLOGY > BLADDER OUTFLOW OBSTRUCTION > Flashcards

BLADDER OUTFLOW OBSTRUCTION Flashcards

1
Q

What percentage of men in their fifties have moderate to severe lower urinary tract symptoms consistent with bladder outflow obstruction?

A

30%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What percentage of men in their eighties have moderate to severe lower urinary tract symptoms consistent with bladder outflow obstruction?

A

50%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What’s the difference between BPE, BPH and BOO?

A

BPE - Benign Prostatic Enlargement - this is a clinical finding of which BPH is a leading cause

BPH - Benign Prostatic Hyperplasia - this is a histological diagnosis characterised by an increase in the number of cells

BOO - Bladder Outflow Obstruction - This is a clinical finding which does not take cause into account

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How do we divide up the male lower urinary tract symptoms (LUTS)?

A

Storage symptoms

Voiding symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the male lower urinary tract symptoms (LUTS) associated with storage problems?

A

Frequency

Nocturia

Urgency

Urgency incontinence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the male lower urinary tract symptoms (LUTS) associated with voiding problems?

A

Weak urinary stream

Prolonged voiding

Abdominal straining

Hesitancy

Intermittency

Incomplete bladder emptying

Terminal and post-void dribbling

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the different diagnosis for male lower urinary tract symptoms (LUTS)?

A

BPH

Bladder cancer

Prostate cancer

UTI

Overactive bladder syndrome (OAB)

Urethral strictures

Neurological disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What investigations would you do in a man who presents with LUTS?

A

Validated symptom score such as International Prostate Symptom Score (IPSS) - used to assess response to treatment

Urine analysis - blood, infection or diabetes

PSA when appropriate

Urodynamic studies

Detrusor pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Why do we perform a DRE (digital rectal examination) of men with LUTS?

A

To make a rough estimate of prostate size

To detect locally invasive prostate cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the normal upper limit of PSA for someone in their 40s above which we would worry about prostate cancer? 50s? 60s? 70s?

A

40s: Less than 2.5
50s: Less than 3.5
60s: Less than 4.5
70s: Less than 6.5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

In a urodynamic study, what is the normal maximum flow rate?

A

About 25 ml per second

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

In a urodynamic study, what would be considered a significantly reduced flow rate?

A

Less 10 ml per second

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How do we measure detrusor pressure in patients with LUTS? Why is this useful?

A

Measure intravesical pressure and rectal pressure

Detrusor pressure then calculated by subtracting rectal pressure from intravesical pressure.

Helps to distinguish between high-pressure low-flow obstructed systems, detrusor dysfunction or atonic bladder as the cause of LUTS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the indications for urological referral and intervention in someone presenting with LUTS?

A

Acute urinary retention

Obstructive nephropathy

Large post-void residual volume causing UTIs

Bladder stones

Failure of medical treatment to help with LUTS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the four categories of management options available for treatment of bladder outflow obstruction?

A

Conservative

Medical

Surgical

Catheter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the details of conservative management of bladder outflow obstruction?

A

Advice on fluid intake

Reduction in caffeine and alcohol ingestion

Bladder retraining

Continence products

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are the first line medical management options for bladder outflow obstruction?

A

Alpha blockers

5-alpha reductase inhibitors

18
Q

What are the two physiological elements involvement in bladder outflow obstruction due to BPE?

A

Static element - mechanical obstruction due to enlargement

Dynamic element - increased tone of prostate smooth muscle

19
Q

How do alpha blockers work to reduce LUTS caused by BPE?

A

Relax prostatic smooth muscle

20
Q

Name 5 alpha blockers used in the treatment of bladder outflow obstruction.

A

Terazosin

Doxazosin

Tamsulosin

Alfuzosin

Silodosin

21
Q

What are the side effects of alpha blockers used in the treatment of bladder outflow obstruction?

A

Postural hypotension

Lethargy

Gastrointestinal disturbance

Nasal congestion

Ejaculatory dysfunction

22
Q

How do 5-alpha reductase inhibitors work to reduce LUTS caused by BPE?

A

Reduce size by inhibiting conversion of testosterone into its active metabolite dihydrotestosterone.

23
Q

What is the minimum prostate size and PSA level beyond which 5-alpha reductase inhibitors are recommended as first line treatment for BPE even without moderate symptoms?

A

30 cc (about the size of a ping pong ball)

PSA more than 1.4 ng/ml

24
Q

Name 2 5-alpha reductase inhibitors used in the treatment of bladder outflow obstruction.

A

Finasteride

Dutasteride

25
Q

In which patients do we recommend combination therapy of an alpha blocker and a 5-alpha reductase inhibitor?

A

Severe symptoms

Risk factors for progression

26
Q

What are the risk factors for progressive BPH?

A

Age over 70 with LUTS

Moderate to severe symptoms ie IPSS of more than 7

PSA or more than 1.4 ng/ml

Prostate volume over 30 cc

Maximum flow rate of less than 12 ml/second

27
Q

What is the most popular and widely available herbal medication used in the treatment of symptomatic BPH?

A

Saw Palmetto, extracted from berries of the American dwarf palm

28
Q

In which patients with LUTS would we use anticholinergics as opposed to alpha blockers or 5-alpha reductase inhibitors?

A

Those with overactive bladder syndrome

29
Q

What are the surgical management options for bladder outflow obstruction?

A

Transurethral resection of the prostate (TURP)

Laser surgery

30
Q

What percentage of men will receive good symptomatic relief from transurethral resection of the prostate (TURP)?

A

90% - gold standard

31
Q

How is transurethral resection of the prostate (TURP) performed?

A

Electrocautery through endoscopic instruments introduced via the urethra. Tissue is resected in small chips until obstruction is removed.

32
Q

After transurethral resection of the prostate (TURP), how long must patients be catheterised for?

A

2-3 days

33
Q

What are the complications of transurethral resection of the prostate (TURP)?

A

UTI 2%

Blood transfusion 6%

Retrograde ejaculation 70%

TUR syndrome 2%

Impotence 8%

Incontinence 1%

Failure to void 5%

34
Q

What are the two types of laser surgery used in treatment of bladder outflow obstruction?

A

Holmium laser enucleation of the prostate

Laser ablation of the prostate

35
Q

What are the complications of acute urinary retention?

A

Hydronephrosis

Chronic retention

Obstructive nephropathy

Bladder stones

36
Q

What are the other non-malignant causes of bladder outflow obstruction?

A

Urethral strictures

Bladder neck dysfunction

37
Q

What is the classic sign of urethral stricture seen on investigation of LUTS?

A

Flow rate shows a plateau with a prolonged voiding cycle

38
Q

How do we treat short urethral strictures?

A

Endoscopic urethrotomy

39
Q

In which group of men is bladder neck dysfunction typically seen as the cause of LUTS?

A

Younger men

40
Q

How do we treat bladder neck dysfunction?

A

Alpha blockers

Surgical bladder neck incision

41
Q

What are the complications of surgical bladder neck incision?

A

Retrograde ejaculation so this will affect fertility

UROLOGY (5 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions