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Intravesical obstruction

Benign prostatic hyperplasia (BPH)​

Clinical classification of BPH​

(by location)

  • Sub-cystic
  • Intra-cystic
  • Retrotrigonal

Etiology​

  • Hormones

Pathogenesis​

5-alpha reductase activity -> converts androgens to estrogen and DHT -> prostate hyperplasia

Symptoms and clinic​

  • Lower urinary tract symptoms (LUTS):
    • Storage symptoms
    • Voiding symptoms
  • Bladder outlet obstruction

Stages:​

  1. Compensated
  2. Sub-compensated
  3. Decompensated

Diagnosis​

  • Anamnesis (history of LUTS)
  • Digital rectal exam
  • Urinalysis, blood count, + PSA (prostate specific antigen)
  • Ultrasound
  • Uroflowmetry
  • X-ray with contrast (for dif. diagnosis)

Differential d.​

Bladder cancer, UTI, urethral stricture, chronic prostatitis, neurogenic bladder

Treatment​

Medication​

  • Alpha-1-adreno-blockers (suffix -ozine)
  • 5-alpha-reductase inhibitors (finasteride, etc.)

Surgery​

  • Open:
    • Transvesical
    • Transurethral resection of the prostate
    • Transurethral incision of the prostate
    • Prostatectomy
  • Less invasive:
    • Laser ablation
    • Laser enucleation
    • Vaporization

Prophylaxis​

  • On time treatment of prostatitis
  • Diet
  • Healthy lifestyle

Urethral stricture​

A urethral stricture is a narrowing of the urethra

Classification (and etiology)​

  1. Traumatic
  2. Inflammatory
  3. Congenital

Signs and symptoms​

  • Weak urinary stream
  • Urinary frequency, urgency

Diagnosis​

  • Cystoscopy
  • Urethrography

Treatment​

  • Endoscopic urethral dilation
  • Urethroplasty
  • Urethral stent

Neurogenic bladder disfunction​

Neurogenic bladder disfunction - urinary bladder problems due to disease or injury of the central nervous system or peripheral nerves involved in the control of urination.

Classification​

  1. Hyperactive / Hypoactive bladder
  2. By cause:
  • Uninhibited
  • Spastic
  • Flaccid
  • Mixed

Symptoms​

  • Urinary urgency
  • Urinary incontinence
  • Urinary retention
  • UTI

Diagnosis​

  • Anamnesis (history, examintaion)
  • Blood test (serum creatinine)
  • Imaging
  • Ultrasound
  • Urodynamics (measurement of the pressure-volume relationship in the bladder)
  • Cystometry
  • Uroflowmetry

Treatment​

  • Catherization
  • Medical:
    • Anti-cholinergic drugs
  • Surgery
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