urinary outflow obstruction

Bladder outflow Bladder outflow obstructionobstruction

Harim MohsinHarim Mohsin

Case studyCase study A 62 year old man presented with moderate lower A 62 year old man presented with moderate lower

urinary tract symptoms (LUTS)-hesitancy, urgency, urinary tract symptoms (LUTS)-hesitancy, urgency, feeling of retention & decreased stream. feeling of retention & decreased stream.

ExaminationExamination: Small benign prostate : Small benign prostate InvestigationInvestigation: : PSAPSA of 1.7 and microscopic haematuria. of 1.7 and microscopic haematuria. (-(-

4.5)4.5)UroflowmetrUroflowmetry - flow rate of 5.4 ml/sec y - flow rate of 5.4 ml/sec (M-20-25, F-25-30)(M-20-25, F-25-30)

Post void residual of 328 cc suggestive of bladder outflow Post void residual of 328 cc suggestive of bladder outflow obstruction.obstruction.

CystoscopyCystoscopy and an and an ultrasound scanultrasound scan, showed no urethral , showed no urethral stricture but the bladder neck was occlusive by an stricture but the bladder neck was occlusive by an extrinsic mass The ultrasound scan, revealed mild right extrinsic mass The ultrasound scan, revealed mild right ureterohydronephrosis and a heterogeneous mass ureterohydronephrosis and a heterogeneous mass arising behind the bladder. arising behind the bladder.

CT CT was suggestive of bladder diverticulum arising from was suggestive of bladder diverticulum arising from the fundus. the fundus.

Diagnosis:Diagnosis: Neoplastic Neoplastic

mucocele of the mucocele of the appendix appendix

IntroductionIntroduction

Urinary outflow obstruction & stasis Urinary outflow obstruction & stasis is of immense importance in is of immense importance in urological disorders because of their urological disorders because of their effects on renal function; leading to effects on renal function; leading to hydronephrosis, infections or even hydronephrosis, infections or even failure. failure.

Approach to Approach to patientpatient

Clinical featuresClinical features Hesitancy in starting urinationHesitancy in starting urination Lessened force & streamLessened force & stream Terminal dribblingTerminal dribbling Urgency /incontinenceUrgency /incontinence Feeling of incomplete emptyingFeeling of incomplete emptying Acute urinary retentionAcute urinary retention Chronic urinary retentionChronic urinary retention Interruption of streamInterruption of stream Hematuria (partial-stricture, Hematuria (partial-stricture,

complete-tumor/prostatic obstruction)complete-tumor/prostatic obstruction) Cloudy urine (due to complicating infection)Cloudy urine (due to complicating infection)

ExaminationExamination

GPEGPE Abdominal examinationAbdominal examination

-Pelvic Mass-Pelvic Mass

-Palpation of bladder-Palpation of bladder

-DRE (prostate)-DRE (prostate)

Investigations Investigations Ultrasound to locate the blockage of urine is, Ultrasound to locate the blockage of urine is,

and find out completely the bladder is emptiedand find out completely the bladder is emptied IVP to locate the blockage isIVP to locate the blockage is Urinalysis to look for blood or infectionUrinalysis to look for blood or infection Urine culture to show an infectionUrine culture to show an infection Uroflowmetry-determine how fast the urine Uroflowmetry-determine how fast the urine

flows outflows out Urodynamic testing -- see how much urine Urodynamic testing -- see how much urine

flow is blocked and how well the bladder flow is blocked and how well the bladder contractscontracts

Cystoscopy and retrograde urethrogram (x-ray Cystoscopy and retrograde urethrogram (x-ray to look for urethral narrowing)to look for urethral narrowing)

Serum chemistries to reveal kidney damageSerum chemistries to reveal kidney damage

Copyright ©1996 BMJ Publishing Group Ltd.

Dawson, C. et al. BMJ 1996;312:767-770

Assessment procedure for patients with bladder outflow obstruction.

ClassificationClassification

CauseCause CongenitalCongenital AcquiredAcquired

DurationDuration AcuteAcute ChronicChronic

Degree Degree Partial Partial Complete Complete

Level Level Upper urinary Upper urinary

tracttract Lower urinary Lower urinary

tracttract

Anatomy Anatomy

EtiologyEtiology Urinary outflow obstruction is more Urinary outflow obstruction is more

common in males.common in males. The causes in males are generally The causes in males are generally

intrinsic while in women they are intrinsic while in women they are extrinsic. extrinsic.

Congenital anomalies of the urinary tract Congenital anomalies of the urinary tract are generally obstructive. are generally obstructive.

In adults acquired obstruction can occur. In adults acquired obstruction can occur. The causes maybe different in children, The causes maybe different in children,

males & females.males & females.

EtiologyEtiologyIn In children children congenital anomalies are more congenital anomalies are more

common with the most common with the most usual sites of narrowing/obstruction :usual sites of narrowing/obstruction :

External meatus (meatal stenosis)External meatus (meatal stenosis) Distal urethra (stenosis)Distal urethra (stenosis) Posterior urethral valvesPosterior urethral valves Bladder neckBladder neck Ectopic uretersEctopic ureters UreterocelesUreteroceles Ureterovesical junction Ureterovesical junction Ureteropelvic junction Ureteropelvic junction Severe vesicouretric refluxSevere vesicouretric reflux

EtiologyEtiologyIn the adults the causes areIn the adults the causes are Acquired:Acquired:Maybe primary in the UT or secondary to Maybe primary in the UT or secondary to

retroperitoneal lesions invading or compressing the retroperitoneal lesions invading or compressing the urinary passages.urinary passages.

Urethral stricture following infection/injuryUrethral stricture following infection/injury Urolithiasis (stone formation) Inflammation such as ureteritis or urethritis. Vesical tumor involving neck or both ureteral Vesical tumor involving neck or both ureteral

orificesorifices Compression at the pelvic brim by metastatic lymph Compression at the pelvic brim by metastatic lymph

nodes from ca prostate or cervixnodes from ca prostate or cervix Pelvic massPelvic mass Sloughed papillae or blood clot. Neurogenic bladder

Etiology Etiology

Males:Males:

BPH or prostatic cancerBPH or prostatic cancer Inflammatory condition- prostatitis

EtiologyEtiology

Females:Females: Normal pregnancy. Uterine prolapse and cystocele. Local extension of cancer of cervixLocal extension of cancer of cervix

EmbryologyEmbryology

The The kidneykidney develops from 3 set of excretory organs: develops from 3 set of excretory organs: PronephrosPronephros Mesonephros Mesonephros MetanephrosMetanephrosUrinary bladder-Urinary bladder- during 4 during 4thth & 7 & 7thth week urorectal week urorectal

divides the cloaca into the anorectal canal & divides the cloaca into the anorectal canal & primitive urogenital sinus. primitive urogenital sinus.

The urogenital sinus is divided into 3 parts:The urogenital sinus is divided into 3 parts:Vesical part –forms larger part of urinary bladderVesical part –forms larger part of urinary bladderPelvic part –forms the prosthetic & membranous Pelvic part –forms the prosthetic & membranous

part of urethrapart of urethraPhallic part- form the genitals. Phallic part- form the genitals.


Urethra-Urethra- In males the prosthetic urethra is In males the prosthetic urethra is

formed from mesonephric duct & formed from mesonephric duct & urogenital sinus. urogenital sinus.

Penile urethra is formed from Penile urethra is formed from urogenital sinus & surface ectoderm. urogenital sinus & surface ectoderm.

In females the urethra is derived from In females the urethra is derived from the mesonephric duct & urogenital the mesonephric duct & urogenital sinus. sinus.

Urethral meatal stenosisUrethral meatal stenosisIt is narrowing (stenosis) of the opening of the It is narrowing (stenosis) of the opening of the

urethra at the external meatus.urethra at the external meatus.Males:Males: More common in circumscribed males. When the More common in circumscribed males. When the

meatus is not covered by the foreskin, it can rub meatus is not covered by the foreskin, it can rub against urine soaked diapers resulting in against urine soaked diapers resulting in inflammation and mechanical trauma= scarring.inflammation and mechanical trauma= scarring.

Damage to the frenular artery during circumcision.Damage to the frenular artery during circumcision. It may also be caused by lichen sclerosus.It may also be caused by lichen sclerosus.

FemalesFemales This condition is a congenital abnormality which This condition is a congenital abnormality which

can cause urinary tract infections and bed-wetting can cause urinary tract infections and bed-wetting (enuresis). (enuresis).

Meatal stenosisMeatal stenosisSigns & symptoms in malesSigns & symptoms in males Visible narrow opening Visible narrow opening

at the meatus in boysat the meatus in boys Abnormal strength and Abnormal strength and

direction of urinary streamdirection of urinary stream Discomfort with urination Discomfort with urination

(dysuria and frequency)(dysuria and frequency) Incontinence (day or Incontinence (day or

night)night) Hematuria at end of Hematuria at end of

urinationurination Urinary tract infectionsUrinary tract infections

DiagnosisDiagnosis: males- : males- history/examhistory/exam

Females -VCUG (voiding Females -VCUG (voiding cystourethrogram)cystourethrogram)

Distal urethral stenosisDistal urethral stenosis

It is present It is present congenitally & congenitally & could be due to could be due to fibrosis. fibrosis.

Girls present with Girls present with recurrent UTIs. recurrent UTIs.

Diagnosed by Diagnosed by VCUG. VCUG.

Distal urethral stenosisDistal urethral stenosis

Urolithiasis Urolithiasis Urolithiasis is calculus formation at any level in the

urnary collection system. The commonest types of stones present are calcium

oxalate, calcium phosphate, magnesium ammonium phosphate struvite, uric acid or cystine stones.

The cause maybe unknown or linked to specific problems like hypercalciuria linked or linked with hypercalcemia(due to hyperparathyroidism, vitamin D intoxication, sarcoidosis).

Magnesium ammonium phosphate (struvite) stones almost always occur in patients with a persistently alkaline urine, owing to urinary tract infections.

Gout and diseases involving rapid cell turnover,such as the leukemias, lead to high uric acid levels in the urine and the possibility of uric acid stones

UrolithiasisUrolithiasis

Stone formation is more common in males. Stone formation is more common in males. The major source of urethral stones is the The major source of urethral stones is the

bladder & lesser upper tract. The stones pass bladder & lesser upper tract. The stones pass through the urethra spontaneously. through the urethra spontaneously.

Urethral stones maybe formed secondary to Urethral stones maybe formed secondary to urinary stasis, urethral diverticulum, near urinary stasis, urethral diverticulum, near strictures or at a site of previous surgery. strictures or at a site of previous surgery.

Males also develop prostatic & seminal Males also develop prostatic & seminal vesical stones. vesical stones.

In females stones are rare but maybe present In females stones are rare but maybe present due to urethral diverticula. due to urethral diverticula.

Posterior urethral valvesPosterior urethral valves

During embryogenesis, the most caudal During embryogenesis, the most caudal end of the Wolffian duct is absorbed into end of the Wolffian duct is absorbed into the primitive cloaca at the site in the the primitive cloaca at the site in the posterior urethra. In healthy males, the posterior urethra. In healthy males, the remnants are the posterior urethral folds, remnants are the posterior urethral folds, called plicae colliculi. Posterior urethral called plicae colliculi. Posterior urethral valves occur when the primitive folds in valves occur when the primitive folds in the posterior urethra just distal to the the posterior urethra just distal to the verumontanum insert high and fuse, verumontanum insert high and fuse, resulting in bladder outlet obstruction. resulting in bladder outlet obstruction.

PUVPUV

Posterior urethral valves, which occur only in Posterior urethral valves, which occur only in males, consist of mucosal folds that can males, consist of mucosal folds that can obstruct the urethra and cause obstructive obstruct the urethra and cause obstructive uropathy. Dilatation of the urinary bladder and uropathy. Dilatation of the urinary bladder and proximal urethra are associated with a proximal urethra are associated with a characteristic "keyhole" deformity at the characteristic "keyhole" deformity at the bladder base and thickening of the bladder wall. bladder base and thickening of the bladder wall.

Urethral obstruction in females may be Urethral obstruction in females may be associated with caudal regression syndrome & associated with caudal regression syndrome & urethral atresia. urethral atresia.

Posterior urethral valvesPosterior urethral valves

Ureterocele Ureterocele It’s the sacculation of the terminal portion of It’s the sacculation of the terminal portion of

the ureter. It can be intravesical or ectopic. the ureter. It can be intravesical or ectopic. Most commonly associated with single Most commonly associated with single

ureters & ectopic ureters. ureters & ectopic ureters. Its because of late canalization of the Its because of late canalization of the

ureteral bud leading to a prenatal ureteral bud leading to a prenatal obstruction & expansion of the uretral bud obstruction & expansion of the uretral bud prior to its absorption into a urogenital prior to its absorption into a urogenital sinus. sinus.

Mostly associated with dysplastic upper pole Mostly associated with dysplastic upper pole of kidney that becomes prone to neoplasia. of kidney that becomes prone to neoplasia.

Excretory urography will show a filling Excretory urography will show a filling defect in the bladder or cystic dilatation. It defect in the bladder or cystic dilatation. It may also show hydronephrosis of kidney. may also show hydronephrosis of kidney.

Ureterocele Ureterocele

UretroceleUretrocele

Bladder diverticulumBladder diverticulum

Outpouching of the bladder mucosa Outpouching of the bladder mucosa into the muscle layer. into the muscle layer.

Maybe congenital or acquired Maybe congenital or acquired (infection or inflammation)(infection or inflammation)

Features: recurrent UTI, VUR, Features: recurrent UTI, VUR, retention. retention.

Treatment :surgical. Treatment :surgical.

Bladder diverticulumBladder diverticulum

Ureteropelvic junction Ureteropelvic junction obstructionobstruction

Commonly the ureterovesical or ureteropelvic junction Commonly the ureterovesical or ureteropelvic junction is obstructed, the latter is the most common is obstructed, the latter is the most common congenital. congenital.

Its more common in boys than girls. Its more common in boys than girls. Exact cause is unknown but uretral valves & polyps Exact cause is unknown but uretral valves & polyps

have been reported. There is nearly always the have been reported. There is nearly always the presence of kinking & angulation at the junction of presence of kinking & angulation at the junction of the renal pelvis & ureter which maybe the primary or the renal pelvis & ureter which maybe the primary or secondary cause.secondary cause.

True stenosis rare but a thin walled hypoplastic ureter True stenosis rare but a thin walled hypoplastic ureter is frequently observed leading to abnormal peristalsis. is frequently observed leading to abnormal peristalsis.

2 other findings maybe found during operation. 1-high 2 other findings maybe found during operation. 1-high origin of ureter from renal pelvis & 2-abnormal origin of ureter from renal pelvis & 2-abnormal relationship of proximal ureter with lower pole renal relationship of proximal ureter with lower pole renal artery causing it to become entrapped & leading to artery causing it to become entrapped & leading to obstruction. obstruction.

Diagnosis is made on ultrasound. Diagnosis is made on ultrasound.

Ureteropelvic junction Ureteropelvic junction obstructionobstruction

Pelvic junction Pelvic junction obstruction obstruction

Ectopic uretersEctopic ureters Mostly associated with ureterocele or Mostly associated with ureterocele or

duplication of ureters but singly effected duplication of ureters but singly effected ureters present. ureters present.

Caused by delay or failure of separation of the Caused by delay or failure of separation of the ureteric bud from the mesonephric duct ureteric bud from the mesonephric duct during embryologic development. Primarily during embryologic development. Primarily because of the abnormally located ureteral because of the abnormally located ureteral bud. bud.

The ureters may open in the vas deferens or The ureters may open in the vas deferens or seminal vesical. In girls it may open into the seminal vesical. In girls it may open into the urethra, vagina or perinieum. urethra, vagina or perinieum.

Clinical features vary with the gender & Clinical features vary with the gender & position of ureteral opening. position of ureteral opening.

Ultrasound & voiding cystourethrography help Ultrasound & voiding cystourethrography help delineate the problem. delineate the problem.

Ectopic ureterEctopic ureter

Vesicoureteral Vesicoureteral reflux(VUR)reflux(VUR)

Incompetence of the ureterovesical junction causing Incompetence of the ureterovesical junction causing backflow of urine leading to hydronephrosis & backflow of urine leading to hydronephrosis & pyelonephritis.pyelonephritis.

Most commonly affected is the intravesical ureter. Most commonly affected is the intravesical ureter. It may not be long enough to enable the ureter to close It may not be long enough to enable the ureter to close

sufficiently to prevent urine reflux.(rare)sufficiently to prevent urine reflux.(rare) Most common cause is trigone weakness related to the Most common cause is trigone weakness related to the

uretric bud on the mesonephric duct. The deficiency in uretric bud on the mesonephric duct. The deficiency in the trigone’s occulsive power leads the orifice to retract the trigone’s occulsive power leads the orifice to retract back into the uretral hiatus. back into the uretral hiatus.

Uretral abnormalities like duplication, ectopic urethral Uretral abnormalities like duplication, ectopic urethral orifice (shape/position) & ureterocele are the other orifice (shape/position) & ureterocele are the other common causes. common causes.

Common presentation maybe UTI or obstruction in Common presentation maybe UTI or obstruction in severe cases. severe cases.

Diagnosed on cystogram and a voiding Diagnosed on cystogram and a voiding cystourethrogram (VCUG). U/s will show cystourethrogram (VCUG). U/s will show hydronephrosis. hydronephrosis.

VURVUR

Urethral strictureUrethral stricture Urethral stricture is fibrotic narrowing of the urethra.Urethral stricture is fibrotic narrowing of the urethra. Urethral stricture may be caused by inflammation or Urethral stricture may be caused by inflammation or

scar tissue from surgery, disease, or injury. It may scar tissue from surgery, disease, or injury. It may also be rarely caused by external pressure from an also be rarely caused by external pressure from an enlarging tumor near the urethra.enlarging tumor near the urethra.

Increased risk is associated with men who have a Increased risk is associated with men who have a history of sexually transmitted disease (STD), history of sexually transmitted disease (STD), repeated episodes of urethritis, or benign prostatic repeated episodes of urethritis, or benign prostatic hyperplasia (BPH). There is also increased risk of hyperplasia (BPH). There is also increased risk of urethral stricture after an injury or trauma to the urethral stricture after an injury or trauma to the pelvic region. Any instrument inserted into the pelvic region. Any instrument inserted into the urethra (such as a catheter or cystoscope). urethra (such as a catheter or cystoscope).

Diagnosed by urine flowmetry, Post-void residual Diagnosed by urine flowmetry, Post-void residual (PVR) & x-ray. (PVR) & x-ray.

Urethral strictureUrethral stricture

Contracture of bladder Contracture of bladder neckneck

It’s the congenital narrowing of the It’s the congenital narrowing of the bladder neck & the cause is bladder neck & the cause is debatable, proposed causes maybe debatable, proposed causes maybe presence of VUR, vesicular presence of VUR, vesicular diverticula, bladder of large capacity diverticula, bladder of large capacity & irritable bladder. & irritable bladder.

Diagnosis: VCUGDiagnosis: VCUG

Contracture of bladder Contracture of bladder neckneck

Neurogenic bladderNeurogenic bladder Neurogenic bladder is the loss of normal bladder Neurogenic bladder is the loss of normal bladder

function caused by damage to part of the nervous function caused by damage to part of the nervous system. system.

Risk factors for neurogenic bladder include Risk factors for neurogenic bladder include Birth defects affecting the spinal cord and function of Birth defects affecting the spinal cord and function of

the bladder, including spina bifida. the bladder, including spina bifida. Tumors within the spinal cord or pelvis may also Tumors within the spinal cord or pelvis may also

disrupt normal nervous tissue function and place an disrupt normal nervous tissue function and place an individual at risk. individual at risk.

Traumatic spinal cord injury is also a major risk factor Traumatic spinal cord injury is also a major risk factor for development of neurogenic bladder. for development of neurogenic bladder.

Diagnosis: CT of the skull and spineDiagnosis: CT of the skull and spineUrodynamic studies: cystometry, uroflowmetery, EMG Urodynamic studies: cystometry, uroflowmetery, EMG

(electromyography)(electromyography)

Benign prostatic Benign prostatic hyperplasia hyperplasia

It’s the most common cause of obstruction in It’s the most common cause of obstruction in males. males.

BPH may occur because the higher amount of BPH may occur because the higher amount of estrogen within the gland increases the estrogen within the gland increases the activity of substances that promote cell activity of substances that promote cell growth.growth.

Dihydrotestosterone (DHT), which is derived Dihydrotestosterone (DHT), which is derived from testosterone in the prostate, may help from testosterone in the prostate, may help control its growth. Older men continue to control its growth. Older men continue to produce and accumulate high levels of DHT produce and accumulate high levels of DHT in the prostate. This accumulation of DHT in the prostate. This accumulation of DHT may encourage the growth of cellsmay encourage the growth of cells

BPHBPH

Digital Rectal Examination (DRE)Digital Rectal Examination (DRE) Prostate-Specific Antigen (PSA)Prostate-Specific Antigen (PSA) Urine Flow StudyUrine Flow Study Rectal Ultrasound and Prostate Rectal Ultrasound and Prostate

BiopsyBiopsy CystoscopyCystoscopy

Benign prostatic Benign prostatic hyperplasiahyperplasia

Benign prostatic Benign prostatic hyperplasiahyperplasia

Treatment OptionsTreatment Options

Medical Medical Watchful waiting Watchful waiting Drugs ( alpha blockers-terazosin, doxazosin, finasteride) Drugs ( alpha blockers-terazosin, doxazosin, finasteride) Prostatic stents Prostatic stents

Minimally invasive treatments (thermotherapy) Minimally invasive treatments (thermotherapy) Laser (e.g., non-contact, contact, interstitial types) Laser (e.g., non-contact, contact, interstitial types) Microwave (e.g., TUMT) Microwave (e.g., TUMT) Other thermotherapies (e.g., Prostiva™ RF therapy [previously known Other thermotherapies (e.g., Prostiva™ RF therapy [previously known

as TUNA]) as TUNA])

Surgical treatments Surgical treatments Transurethral resection of the prostate (TURP) Transurethral resection of the prostate (TURP) Holmium laser enucleation of the prostate (HoLEP) Holmium laser enucleation of the prostate (HoLEP) Prostatectomy Prostatectomy Transurethral incision of the prostate (TUIP) Transurethral incision of the prostate (TUIP) Transurethral ultrasound-guided laser incision of the prostate (TULIP) Transurethral ultrasound-guided laser incision of the prostate (TULIP)

Bladder carcinomaBladder carcinoma Most are transitional cell carcinomas Most are transitional cell carcinomas Of all bladder carcinomas: Of all bladder carcinomas: 90% are transitional cell carcinomas 90% are transitional cell carcinomas 5% are squamous carcinoma 5% are squamous carcinoma 2% are adenocarcinomas 2% are adenocarcinomas

Aetiological factorsAetiological factors Occupational exposure Occupational exposure Chemical implicated - aniline dyes, chlorinated Chemical implicated - aniline dyes, chlorinated

hydrocarbons hydrocarbons Cigarette smoking Cigarette smoking Analgesic abuse e.g. phenacitin Analgesic abuse e.g. phenacitin Pelvic irradiation - for carcinoma of the cervix Pelvic irradiation - for carcinoma of the cervix

Commonest presentationCommonest presentation: frank hematuria or : frank hematuria or microscopic hematuria. microscopic hematuria.

Bladder carcinomaBladder carcinoma

O-epitheliumO-epithelium A-lamina A-lamina

propriapropria B1-muscleB1-muscle B2-deep muscleB2-deep muscle C-peritoneumC-peritoneum D-pelvic wall D-pelvic wall

/uterus/prostate/uterus/prostate..

Bladder carcinomaBladder carcinoma

Treatment optionsTreatment options

Depending on the staging:Depending on the staging: Transurethral resection Transurethral resection Chemotherapy Chemotherapy Immunotherapy Immunotherapy BCG BCG Radical cystectomy Radical cystectomy Radiotherapy Radiotherapy

Cystocele Cystocele A A cystocelecystocele occurs when the tough fibrous wall occurs when the tough fibrous wall

between a woman's bladder and vagina (the between a woman's bladder and vagina (the pubocervical fascia) is torn by childbirth, allowing pubocervical fascia) is torn by childbirth, allowing the bladder to herniate into the vagina. the bladder to herniate into the vagina.

Presenting features maybe incontinence or urinary Presenting features maybe incontinence or urinary retention. retention.

Grade Grade 1-when the bladder droops only a short way 1-when the bladder droops only a short way into the vagina into the vagina

Grade Grade 2-cystocele, the bladder sinks far enough to 2-cystocele, the bladder sinks far enough to reach the opening of the vagina. reach the opening of the vagina.

GradeGrade 3-bladder bulges out through the opening of 3-bladder bulges out through the opening of the vagina the vagina

CystoceleCystocele

Other causesOther causes

They may directly or indirectly effect the They may directly or indirectly effect the urinary tract & lead to obstruction. urinary tract & lead to obstruction.

Other tumors arising from prostate, Other tumors arising from prostate, seminal vesicle, urethra,cervix or seminal vesicle, urethra,cervix or vagina. vagina.

Urethral spasmUrethral spasm Foreign bodyForeign body Pregnancy Pregnancy Inflammation-urethritisInflammation-urethritis

Complications of BOOComplications of BOO

Renal failure Renal failure Recurrent urinary tract infection Recurrent urinary tract infection Urinary incontinence Urinary incontinence Urinary retention Urinary retention Bladder and renal calculi Bladder and renal calculi

Management Management

Depends on the cause of the Depends on the cause of the obstruction:obstruction:

Relief of obstruction:Relief of obstruction:

Temporary: cathertisation Temporary: cathertisation (foley’s/suprapubic)(foley’s/suprapubic)

Permanent: surgical repairPermanent: surgical repair

Eradication of infectionEradication of infection

The EndThe End

urinary outflow obstruction

Health & Medicine