Review:
Bladder Outlet Obstruction (BOO)
| Diagnostic
Tools |
 |
Clinical
history, including the International Prostate Symtom Score
(see APPENDIX
A) or the AUA Symptom Score (see APPENDIX
B) |
|
Physical
exam, including a digital rectal exam |
|
Lab
testing, including PSA and urinalysis |
|
Additional
tools include flow rates, PVR, cystoscopy, and urodynamics |
| |
|
| BPH
(Benign Prostatic Hyperplasia) |
|
Progressive,
age-related condition of men; linked to testicular androgens
and aging |
|
BPH
leading to BOO is one potential etiology of LUTS (lower
urinary tract symptoms) |
|
Prostate
size correlates poorly with the degree of symptoms exhibited
by the individual patient |
|
Intrusion
of the prostate into the urethra and bladder neck leads
to an obstructive process whereby higher pressure must
be exerted by the detrusor (bladder muscle) to void. This
leads to detrusor hypertrophy and urinary problems, including
frequency, urgency, nocturia, and slowing of the urinary
stream. These symptoms are not exclusive to BOO, and can
also indicate diseases intrinsic to the bladder, neurogenic
bladder, or failure to relax while voiding. |
| |
|
| Symptom
Scores |
|
Help
to sort out symptoms and validate diagnosis of BOO |
|
Patients
with high symptom scores should complete a bother score
to assess how quality of life is affected |
|
Symptom
Scores may not correlate well with "Bother"
Scores |
|
Patients
with low bother scores may wish to defer treatment; however,
PVR should be assessed before making this decision |
| |
|
| Physical
Exam |
|
Refer
significant asymmetry, induration, or nodularity of the
prostate to a urologist |
|
Note
any rectal mass |
|
Test
PSA; refer to urologist if elevated |
|
Perform
urinalysis to detect hematuria, pyuria, bacteriuria |
| |
|
| Assessment
of PVR |
|
The
BladderScan™ instrument (Diagnostic Ultrasound Corporation)
provides a fast, easy, noninvasive way to determine PVR. |
|
The
BladderScan helps identify patients with high symptom
scores who have developed chronic urinary retention; if
these patients have low "bother" scores, they
may require intervention based on high PVR, even if they
aren't overly concerned about their symptoms. |
|
The
BladderScan also helps evaluate and manage patients with
neurogenic bladder. |
| |
|
| Treatment
for BOO |
|
Medical
therapy - Includes alpha-blockers and finasteride
(Proscar®, Avodart®) |
|
Minimally
Invasive Therapy - Thermal therapy (laser, microwave,
high frequency radio wave); appropriate for the patient
who cannot tolerate or fails to improve on medication,
or prefers to have definitive therapy on initial treatment.
Can be performed on an ambulatory or outpatient basis. |
|
Surgical
Therapy - TURP (transurethral resection of the
prostate) is the gold standard for treatment of BOO; it
provides the most lasting improvement in symptoms. Other
surgical treatments include TUIP (transurethral incision
of the prostate) and TUVP (transurethral vaporization
of the prostate). |
| |
|
| Conclusion:
Monitoring Changes in Bladder Volume |
|
Primary
care physicians should have the ability to evaluate LUTS
and recommend and monitor therapy for many common urinary
conditions. |
|
Symptom
Scores and noninvasive bladder volume monitoring with
the BladderScan are tools that will help primary care
practices achieve the highest quality care for urological
disease. |
| |
|
| |
|
BladderScan™
is a trademark of Diagnostic Ultrasound Corporation. All rights reserved.
|
