Basics of BOO for students and interns

1. Bladder Outlet (Out-flow)
Obstruction (BOO)
IBNOUF M MA
MB.BS, MRCSEd, MHPE, MD
Urology Reg ULHG

2. Case Scenario
• 68 year old male presented to the casualty
with frequency of urination, red urine,
burning micturition, drops of urine in the
underwear just before sitting to the bath in
spite of waiting and straining to urinate, urine
flow is weaker and not continuous and also,
the urine again drops in his cloths after he
finishs voiding and stands up. for the last
three months and getting worst. The smell of
urine annoys him.

3. Case Scenario
• He is hypertensive on lisinopril 10mg.
• Physical examination revealed nothing but a
suprapubic mass and enlarged prostate with a
patent median sulcus and smooth rectal
mucosae on DRE.
• Hb is 11 grams, urinalysis uncountable pus
cells and RBCs, urea 80 crea 1.9. PSA 12ng/l.
• U/S abd: prostate 140g, PVRU 600/150ml.
• Cystoscopy: enlarged median lobe, biopsied.

4. LUTS

5. BOO Symptomatology
Obstructive:
• Weak stream
• Hesitency
• Intermittent stream (intermitancy)
• Dribbling
• Straining (stranguary)

6. BOO Symptomatology
Irritative:
• Frequency
• Nocturia
• Urgency
• Urge incontinence

8. Presentation of BPH
• 68 year old male presented to the casualty
with increase number of urination with red
urine, burning micturition, drops of urine in
the underwear just before sitting to the bath
in spite of straining to urinate, urine flow is
weaker and not continuous and also, the urine
again drops in his cloths after he finish viding
and stands up for the last three months and
getting worst. It annoys him that burden Salat.

9. BPH Presentation cont…
• Physical examination revealed nothing but an
enlarged prostate with a patent median
sulcus and smooth rectal mucosae on DRE.

10. Diagnosis

13. WORK-UP
• IPSS
• Investigation
• Treatment options
• Follow-up
• Screening for cancer

14. • Hb is 11 grams, urinalysis uncountable pus
cells and RBCs, urea 80 crea 1.9. PSA 12ng/l.
• U/S abd: prostate 40g, PVRU 600/150ml.
• Cystoscopy: enlarged median lobe, biopsied.

16. Carcinoma Prostate

17. Modes of presentation of CA Prostate

19. Complications

20. Further presentation
• Other complications
• Options of management
• Indications for surgery
• Types of surgeries
• Other options, patient QoL
• How to prepare a patient for TURP
• Post TURP care, M&M

21. Forward and forward