Bladder outflow obstruction.ppt
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The document discusses bladder outflow obstruction, which affects many older men. It outlines the various causes of obstruction including conditions like benign prostatic hyperplasia and neurological diseases. Symptoms include problems with urination like hesitancy, frequency, and incomplete emptying. Evaluation involves a prostate symptom score, exam, and tests like ultrasound. Treatment options range from lifestyle changes to medications, surgery, and minimally invasive procedures depending on the severity of symptoms and size of the prostate.
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This document discusses benign prostatic hyperplasia (BPH), a common condition in aging men that causes bladder outflow obstruction. It causes urinary symptoms and can lead to complications if left untreated. The document covers the causes, diagnosis, and treatment options for BPH including lifestyle changes, medications like alpha blockers, and surgical procedures if medications fail or complications occur. Treatment is aimed at relieving symptoms, improving urine flow, and preventing progression of kidney damage.
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Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
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mega ureter.ppt
A 6-year-old boy presented with a 2-year history of left flank pain that had increased in frequency and severity. Physical examination found pallor, clubbing, and koilonychia. Investigations revealed anemia and normal electrolytes and creatinine. He was diagnosed with congenital non-refluxing mega-ureter of the left side and underwent an operation to refashion and reimplant the left ureter, which found a grossly dilated and aperistaltic segment in the lower left ureter. His post-operative recovery was uneventful.
Haematuria.ppt
This document discusses haematuria, or the presence of red blood cells in urine. It notes there are medical and surgical causes of haematuria. The main difference is surgical causes present with dysmorphic red blood cells and renal casts, while medical causes present with proteinuria over 100mg/dl. The commonest causes of painful haematuria are urinary tract infections, urolithiasis, and enlarged prostate, while the commonest causes of painless haematuria are bladder tumors and renal masses. A series of questions and investigations are outlined to determine the cause and location of haematuria.
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1. Describe the organisation of respiratory center
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3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
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Bladder outflow obstruction.ppt
- 1. Brig HAROON SABIR KHAN FCPS(Surg), FCPS(Uro) FEBU(Eur), MHPE(RIU) Professor of Urology BLADDER OUTFLOW OBSTRUCTION
- 2. CAUSES OF BLADDER OUTFLOW OBSTRUCTION • CONGENITAL - URETHRAL VALVES & STRICTURES • STRUCTURAL: • Benign prostatic hyperplasia • Carcinoma of the prostate • Bladder neck stenosis • Urethral stricture • FUNCTIONAL: • Bladder neck dyssynergia • Neurological disease - spinal cord lesions, MS, diabetes • Drugs - anticholinergics, antidepressants
- 3. • INCIDENCE: • Affects 50% men older than 60 years • Affects 90% of men older than 90 years • ANATOMY OF THE PROSTATE: • Location • Normal weight and size • ETIOLOGY OF BPH: • Age relationship • Role of androgen vs estrogen / receptors • Family history • ? Role of diet
- 4. • PATHOPHYSIOLOGY OF BOO: • Size of prostate vis-a-vis BOO • Compensatory phase (detrusor hyperplasia) • Detrusor de-compensation ( PVRU) • SYMPTOMS OF BPH (LUTS - Voiding): • Obstructive • Hesitancy • Poor flow • Intermittency of stream • Terminal dribbling • Sense of incomplete evacuation of bladder • Retention of urine • Acute / chronic
- 7. • IRRITATIVE SYMPTOMS (LUTS - Storage) • Urgency • Frequency • Day time / Night time (nocturia) • Urge incontinence
- 8. • COMPLICATIONS OF BPH: • Bladder changes • Trabeculation • Saccules / diverticulae • Upper tract changes • Haematuria • Acute / chronic retention of urine • Vesical stones • `UTIs • Post obstructive renal failure (uraemia)
- 10. COMPLICATIONS OF BPH (cont) • Manifestations of prolonged straining (intra abdominal pressure) • Hernias • Haemorrhoids
- 11. EVALUATION OF THE BPE • Prostate symptom scoring • IPPS scoring (scoring chart) • Per abdominal examination and DRE • Ultrasound scan of KUB, prostate and PVRU
- 12. IPPS Urinary Symptoms (Symptom Score Criteria) Not at all Less than 1 time in 5 Less than half the time About half the time More than half the time Almost Always 1. Incomplete emptying Over the past month, how often have you had a sensation of not emptying your bladder completely after you finished urinating? 0 1 2 3 4 5 2. Frequency Over the past month, how often have you had to urinate again less than two hours after you finished urinating? 0 1 2 3 4 5 3. Intermittency Over the past month, how often have you found you stopped and started again several times when you urinate? 0 1 2 3 4 5 4. Urgency Over the past month, how often have you found it difficult to postpone urination? 0 1 2 3 4 5
- 13. IPPS Urinary Symptoms (Symptom Score Criteria) Not at all Less than 1 time in 5 Less than half the time About half the time More than half the time Almost Always 5. Weak Stream Over the past month, how often have you had a weak urinary stream? 0 1 2 3 4 5 6. Straining Over the past month, how often have you had to push or strain to begin urination? 0 1 2 3 4 5 None 1 time 2 times 3 times 4 times 5 or more times 7. Nocturia Over the past month, how many times did you most typically get up to urinate from the time you went to bed at night until the time you got in the morning? 0 1 2 3 4 5
- 14. IPPS QUALITY OF LIFE DUE TO URINARY PROBLEMS Delighted Pleased Mostly Satisfied Mixed-about equally satisfied and un-satisfied Mostly dis- satisfied Unhappy Terrible If you were to spend the rest of your life with your urinary condition just the way it is now, how would you feel about that? 0 1 2 3 4 5 6
- 15. UROFLOWMETRY
- 16. OTHER INVESTIGATIONS • Blood CP • Renal function profile • Urine DR • PSA
- 17. TREATMENT OF BPH: • Watchful waiting (Lifestyle changes) • Pharmacological treatment • Alpha adrenergic blockers • Prazosin • Terazosin • Doxazosin • Alfuzosin • Tamsulosin
- 18. • 5 α-reductase inhibitors • Finesteride (Proscar) • Dutasteride (Avodart) • Phytotherapy (plant extracts) • Saw palmetto (acti-pro) • β-sitosterols (pronals)
- 19. • SURGICAL MANAGEMENT: • Open prostatectomy > 80gm • RPP (Retropubic) • TVP (Trans-vesical) • TURP < 80gm
- 20. TURP
- 22. TUIP (BNI)
- 23. • OTHER MINIMALLY INVASIVE METHODS • Endoscopic laser ablation of prostate (ELAP) • Holmium laser enucleation of prostate (HoLEP) • Interstitial laser coagulation • Transurethral electroevaporation of the prostate (TUVP) • Transurethral microwave thermotherapy of the prostate (TUMT) • Transurethral radio frequency needle ablation of the prostate (TUNA)
- 24. • OTHER MINIMALLY INVASIVE METHODS • Water-induced thermotherapy (WIT) • High-intensity focused ultrasound (HIFU) • Prostatic stent (stenting) • Urolume • mamotherm
- 25. ?
- 26. THANK YOU