Causes of Bladder Outflow Obstruction
1- Neuropathic: failure of sphincters to relax in harmony with contraction of detrusor muscle (diabetes mellitus, neurological diseases).
2- Enlarged prostate: blocking bladder outlet (hypertrophy or tumors)
3- Urethral strictures: congenital or acquired.
Bladder Response to Obstruction
1- Compensatory hypertrophy: bladder responds to obstruction by Ý size & strength of smooth muscle fibers to overcome outflow obstruction.
2- Detrusor failure: if resistance is high the detrusor muscle will eventually give upÞ gradual incomplete emptying of bladder with gradual Ý volume of residual urine.
Common Urinary Symptoms
• Frequency: Ý number of micturation.
• Nocturia: awoken from sleep .
• Urgency: strong desire to void
• If not fulfilled Þ Urge incontinance.
• Weak urine flow.
• Interrupted stream.
• Post micturition dribbling.
• Retention of urine
Benign Prostatic Hypertrophy
• All men > 40 yrs have nodular hyperplasia, 10% only develop obstruction that need treatment.
• If neglected lead to changes in detrusor muscle, residual urine & obstructive uropathy.
• Abdominal exam. : bladder detected
• DRE: enlarged prostate.
Algorithm for medical management of Benign Prostatic Hypertrophy
Investigations of Prostate Adenoma
• Uroflowmetry: urine flow rate (<10ml/s).
• Lab. Workup: MSU, RFT, CBC, PSA.
• U/S: Of KUB & residual urine.
• Transrectal ultrasound (TRUS) to check for size & lesions.
Treatment of Prostate Adenoma
1. Wait & see,
2. Medical Treatment:
A. alfa-blockers: For small prostate.
3. Surgical Treatment:
A.Transurethral resection of Prostate (TURP).
bleeding, stricture, retrograde ejaculation, impotence & incontinence.
B. Open surgery for large prostate.
• More common in Africa than Asia.
• Usually arise from outer zone.
• Graded according to cellular differentiation
• Tumor markers: prostatic-specific antigen (PSA) only secreted by prostate, acid phosphatase.
• Staging: TNM.
Prostate Cancer : Origin
Symptoms of Prostate Cancer
• Prostatism as BPH.
Investigations of Prostate Cancer
• Transrectal US + guided biopsies.
• CT scan.
• Bone scan.
Prostate Cancer : Staging
Treatment of Prostate Cancer
1. Localized Ca prostate:
A. Radical prostatectomy.
B. External beam radiotherapy.
2. Advanced Ca prostate:
A. Medical castration: Hormonal Therapy
B. Surgical castration: Bilat. Orchiectomy.
C. Palliative TURP
D. Radiotherapy for bone metastasis