Bladder Outflow Obstruction and Prostate Adenoma and Prostate Cancer

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

• Hesitancy.

• 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

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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.

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Algorithm for medical management of Benign Prostatic Hypertrophy

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Prostate Adenoma

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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.

B. Finastride

3. Surgical Treatment:

A.Transurethral resection of Prostate (TURP).

Complications:

bleeding, stricture, retrograde ejaculation, impotence & incontinence.

B. Open surgery for large prostate.

 

Prostate Cancer

• 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

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Symptoms of Prostate Cancer

• Incidental.

• Prostatism as BPH.

 

Investigations  of Prostate Cancer

• PSA.

• Transrectal US + guided biopsies.

• CT scan.

• MRI.

• Bone scan.

Prostate Cancer : Staging

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Treatment of Prostate Cancer

1. Localized Ca prostate:

A. Radical prostatectomy.

B. External beam radiotherapy.

C. Brachytherapy.

2. Advanced Ca prostate:

A. Medical castration: Hormonal Therapy

B. Surgical castration: Bilat. Orchiectomy.

C. Palliative TURP

D. Radiotherapy for bone metastasis

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