MEDI7111 Lecture Notes - Lecture 8: Prostatectomy, Orthostatic Hypotension, Prostatic Urethra
Common conditions of the Kidney and Urinary Tract
Bladder Outlet Obstruction (BOO)
Bladder outlet obstruction has many potential causes which differ between males and females.
Male causes include:
Benign prostatic hyperplasia (BPH)
Prostate cancer
Urethral stricture
Bladder stones
Female causes include:
Pelvic prolapse
Urethral stricture
Uterine/vaginal cancers
There are neurological causes of BOO such as spinal cord injury, spina bifida and MS which need
to be considered in the differential diagnosis.
Clinical Features
Generalised lower urinary tract symptoms (LUTS)
Storage/Irritation symptoms
oFrequency
oUrgency
oNocturia
Voiding/Obstructive symptoms
oWeak stream
oIntermittency
oTerminal dribbling
oStraining
oIncomplete emptying
Haematuria
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Overflow incontinence
Diagnostic Testing
International Prostate Survey Score (IPSS)
oUsed to determine the severity of the
symptoms
oIncludes quality of life indicators as well
Uroflowmetry
oRate and volume of urine produced during a void
KUB ultrasound
oScanned on full bladder and again post voiding to measure residual volume
Serum PSA
oSignificant elevation vs gradual increase
Urine MCS
Urine electrolytes
oCreatinine and eGFR are most important
Management
The level of urinary impairment will determine the management of the patient. With very mild
impairment simply monitoring the symptoms and test results is sufficient. The underlying
condition causing the BOO will determine the management.
Acute and Chronic Urinary Retention
Acute and chronic urinary retention are both problems related to BOO however they have quite
different clinical presentations and outcomes.
Acute Urinary Retention
Acute urinary retention is usually a presentation to emergency with severe abdominal pain and
anuria. Physiologically it precipitates from either a physical blockage to the urethral opening, a
drug interaction or a neurological condition/injury that prevents functioning of the micturition
reflex. The drug interactions usually cause a complete obstruction of an already partially
occluded urethra (mainly in BPH).
Physical obstruction:
Bladder stones
Prostatitis
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Document Summary
Common conditions of the kidney and urinary tract. Bladder outlet obstruction has many potential causes which differ between males and females. There are neurological causes of boo such as spinal cord injury, spina bifida and ms which need to be considered in the differential diagnosis. Voiding/obstructive symptoms: weak stream, intermittency, terminal dribbling, straining, incomplete emptying. International prostate survey score (ipss: used to determine the severity of the symptoms, includes quality of life indicators as well. Uroflowmetry: rate and volume of urine produced during a void. Kub ultrasound: scanned on full bladder and again post voiding to measure residual volume. Serum psa: significant elevation vs gradual increase. Urine electrolytes: creatinine and egfr are most important. The level of urinary impairment will determine the management of the patient. With very mild impairment simply monitoring the symptoms and test results is sufficient. The underlying condition causing the boo will determine the management.
