BLADDER OUTFLOW OBSTRCUTION
the pathology may be neuropathic due to the failure of the sphincters to relax in harmony with detrusor contraction or due to obstruction from bladder neck hypertrophy being prostate hyperplasia (BPH)urethral stricture urethral calculus meatal stenosis or a tight phimosis 1- urethral stricture once a urethral stricture always a urethral stricture this adage still holds good pharaohs even took dilators with them to their burial chambers for the after life the causes are numerous as 1- catheter urethral site penoscrotal mechanism by pressure necrosis and paraurethral gland sepsis 2- perineal injury urethral site bulbar mechanism by crush injury 3- pelvic fracture urethral site membranous mechanism by prostatic displacement shear injury 4- infection throughout urethra by gonorrhoea and chlamydia 5- BXO urethral site meatal mechanism by fibrosis 6- chemotherapy throughout the urethra by causing chemical urethritis 7- instruments throughout urethra either iatrogenic or masturbation 2- presentation depending on the degree and length of narrowing and
detrussor compensation the symptoms will vary the symptoms are indistinguishable from bladder outflow obstruction due to any other cause the finding may include thickening of the corpus spongiosum and a palpable bladder in patients who go into either chronic or acute on chronic retention 3-diagnosis in those who present with retention failure to catheterize urethrally may suggest the possibility .flow rate and abdominal ultrasound will indicate bladder outflow obstruction the diagnosis is confirmed on flexible |rigid cystoscopy or an ascending urethrogram 4- management the management depend on the site ,extent and the degree of narrowing 1- urethral dilatation this is te traditional way of opening up the stricture by using graded metallic or flexible dilators 2- internal urethrotomy using the optical urethrotome the stricture is incised open under vision this technique has replace urethral dilation and to keep the stricture open urethrotomy may need to be followed by regular dilatation preferably by the patient 3- urethroplasty when the above procedures fail then urethroplasty is undertaken using skin or buccal mucosa the skin may be used as a split or full thickness graft and may be free or on a pedicle
detrussor compensation the symptoms will vary the symptoms are indistinguishable from bladder outflow obstruction due to any other cause the finding may include thickening of the corpus spongiosum and a palpable bladder in patients who go into either chronic or acute on chronic retention 3-diagnosis in those who present with retention failure to catheterize urethrally may suggest the possibility .flow rate and abdominal ultrasound will indicate bladder outflow obstruction the diagnosis is confirmed on flexible |rigid cystoscopy or an ascending urethrogram 4- management the management depend on the site ,extent and the degree of narrowing 1- urethral dilatation this is te traditional way of opening up the stricture by using graded metallic or flexible dilators 2- internal urethrotomy using the optical urethrotome the stricture is incised open under vision this technique has replace urethral dilation and to keep the stricture open urethrotomy may need to be followed by regular dilatation preferably by the patient 3- urethroplasty when the above procedures fail then urethroplasty is undertaken using skin or buccal mucosa the skin may be used as a split or full thickness graft and may be free or on a pedicle
tags:outflow,bladder,obstruction
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