This document discusses bladder outlet obstruction (BOO), its causes such as benign prostatic hyperplasia (BPH) and treatments. BOO can cause lower urinary tract symptoms including poor urinary flow and retention. Long term effects include bladder decompensation and overactivity. BPH commonly causes BOO in men over 50 and treatment involves conservative measures, drugs or prostatectomy. Prostatectomy has risks including retrograde ejaculation, erectile dysfunction and incontinence that must be discussed.
6. BENIGN PROSTATE HYPERPLASIA
● Occure in men over 50 year of age,by age of 60 years,50%of men have
evidence of BPH
● Common cause of LUTS,most common cause of BOO in age >70 years
● ETIOLOGY
● HORMONES-LESS testosterone,increased oetrogenic effect
7. PATHOLOGY
● Typically affects submucous group of glands in transitional zone
● When BPH affects central zone,middle lobe projects into bladder within
internal sphincter
8. CONSEQUENCE OF BPH
● No symptoms no BOO
● No symptoms but urodynamic evidence of BOO
● LUTS,no evidence of BOO
● LUTS AND BOO
● Retention,hematuria,urinary infection,stone formation
9. ANATOMICAL EFFECTS
URETHRA-
● Prostatic urethra is lengthened,posterior curve may be exaggerated
● When only lateral lobe is enlarged,distortion of prostatic urethra occurs
BLADDER
● Bladder hypertrophy to overcome obstruction and appears trabeculated
● Increased blood flow at base of bladder are apt to cause hematuria.
10. LOWER URINARY TRACT SYMPTOMS
Idiopathic detrusor overactivity
Neuropathic bladder-
diabetes,stroke,Alzheimer disease,Parkinson disease
Can be described as-
Voiding hesitancy-if bladder is very full
Poor flow-unimproved by straining
11. Intermittent stream-stp and starts
Dribbling-after micturition
Sensation of poor bladder emptying
Episodes of near retention
20. LONG TERM EFFECT OF BOO
❖ Bladder may decompensate,detrusor becomes less efficient,residual urine
develops,leading to chronic retention
❖ Bladder may be more irritable,with decrease in functional capacity,caused by
detrusor overactivity,ageing or idiopathic.
21. COMPLICATIONS OF BOO
● Acute retention of urine
● Chronic retention
Residual volume >250ml,high pressure chronic retention,development of
bilateral hydronephrosis.
● Impaired bladder emptying-
Urinary infection and calculi are prone to develop.
● Hematuria
24. MANAGEMENT
Indications for prostatectomy-
● Acute retention in fit men with no other cause,drugs,constipation,recent
operation.
● Chronic retention and renal impairment-200ml
● Stone ,infection,diverticulum formation
● Haemorrhage
● Elective prostaectomy for severe symptoms
