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Renal > Symptoms Suggesting Bladder Outflow Obstruction > Flashcards

Symptoms Suggesting Bladder Outflow Obstruction Flashcards

1
Q

what are the 3 layers of the detrusor muscle?

A

inner longitudinal
circular
outer longitudinal

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2
Q

what can cause obstruction at the bladder neck in males?

A

bladder neck stenosis
stone at bladder neck
bladder tumour at bladder neck

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3
Q

what can cause obstruction at posterior urethra in males?

A 
BPH
posterior urethral stricture
stone in posterior urethra
posterior urethral tumour
prostate cancer
detrusor sphincter dys-synergia
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4
Q

what can cause obstruction at the anterior urethra in males?

A

urethral stricture
obstructing stone
urethral cancer

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5
Q

what can cause obstruction at the glans penis?

A

urethral meatus stenosis

penile cancer

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6
Q

what can cause obstruction at the foreskin (Prepuce)?

A

phimosis

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7
Q

what can cause obstruction at the bladder neck in females?

A

bladder neck stenosis
stone at bladder neck
bladder tumour at bladder neck

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8
Q

what can cause obstruction at the urethra in females

A

stenosis (synonymous with stricture in males as females have short urethra)
stone urethra
urethral tumour
detrusor sphincter dys-synergia (DSD)

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9
Q

what can cause obstruction at the urethral meatus in females?

A

stenosis

polyp/tumour

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10
Q

vaginal causes of obstruction?

A 
vaginal atrophy (distorts urethra)
vaginal prolapse
vaginal cysts (extrinsic compression)
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11
Q

which urinary symptom is most common in males and females?

A 
males = obstruction
females = frequency and urgency
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12
Q

what voiding symptoms may occur due to effect of blockage?

A 
poor flow
intermittent stream
spraying/deviated stream
hesitancy
post micturition dribbling
straining
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13
Q

what storage symptoms may occur due to secondary effects of blockage?

A 
increased frequency of urination
urgency
urgency incontinence
nocturia
sense of incomplete emptying
pain with bladder filling
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14
Q

what is IPSS?

A

international prostate symptoms score

8 question written scoring tool for screening, diagnosis, track and suggest management for BPH

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15
Q

important features to ask about visible haematuria?

A 
clots?
mild/moderate/severe
shape of clots
painful/painless
timing (initial, terminal or throughout)
check coagulation
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16
Q

important fatures to ask about non-visible (microscopic) haematuria?

A

dipstick (microscopic = 3-5 RBCs per HPF)
symptomatic/asympatomatic
check BP, proteinuria
exclude UTI

17
Q

examination of bladder symptoms in males?

A

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)

18
Q

what does tuft of hair on the back suggest?

A

spina bifida oculta

19
Q

examination of bladder symptoms in female?

A 
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)
20
Q

lab investigations of urinary tract obstruction?

A

FBC
renal function tests (urea, creatinine, electrolytes)
urine dipstick/cultures
PSA

21
Q

radiological investigations of urinary tract obstruction?

A 
X ray KUB
US KUB
TRUS prostate + PVR (post-void residual urine)
CT KUB (plain)
CT urography
22
Q

bladder complications of bladder outflow obstruction?

A

diverticulum/saccules
trabeculation
atonic bladder (detrusor hypofunction)

23
Q

renal complications of bladder outflow obstruction?

A

back pressure on kidneys

  • hydronephrosis
  • abnormal RFTs
24
Q

general urinary tract complications of outflow obstruction?

A

recurrent UTI (cystitis, prostatitis, epididymo-orchitis)
bladder stones
haematuria
incontinence

25
Q

how is BPH managed?

A

alpha blockers
finasteride
TURP (trans-urethral resection of prostate)/laser (HoLEP - holium laser enucleation of prostate)

26
Q

how is urethral stricture managed?

A

optical urethrotomy

anastomotic urethroplasty

27
Q

how is phimosis managed?

A

circumcision

dorsal slit

28
Q

how is meatus/urethral stenosis managed?

A

dilation

29
Q

how are bladder stones managed?

A

cystolitholapexy (fragmentation of stones)

30
Q

how are bladder tumours managed?

A

transurethral resection of bladder lesion (TURBT)

31
Q

how are neurological causes of outflow obstruction managed?

A

treat neurological cause

intermittent catheterisation or long term suprapubic catheter

Renal (34 decks)

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