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What Is Bladder Outlet Obstruction?
Question: What is bladder outlet obstruction and how is it diagnosed? Please answer by urologist is needed.
Brief Answer:
obstructive urinary voiding symptons
Detailed Answer:
Hi,
When a patient gas symptoms of slow urunary flow, sense if incomplete evacuation of urine, with intermittent stream with straining to void urine, he is suspected if having bladder outlet obstruction which us fairly common in older makes due to prostate and due to a tight bladder neck in young men.
Common tests to diagnose this would be an ultrasound scan for KUB, I.e kidneys and bladder followed by a uroflowmetry and an estimate of post-boid residue urine. Quite a few patients would respond to medicines like Flomax while some might require surgery.
Some individuals could have similar symptoms due to a weak bladder muscle rather than an outlet obstruction and the net effect is the same, but these patients will not respond to drugs like Flomax and an ultrasound might not pick an enlarged prostate though there could be significant urine residue. Such patients are advised a urodynamic test which will correctly identify if the bladder outlet is indeed obstructed or if the muscle is weak.
Hope I have been able to answer your questions.
Regards
obstructive urinary voiding symptons
Detailed Answer:
Hi,
When a patient gas symptoms of slow urunary flow, sense if incomplete evacuation of urine, with intermittent stream with straining to void urine, he is suspected if having bladder outlet obstruction which us fairly common in older makes due to prostate and due to a tight bladder neck in young men.
Common tests to diagnose this would be an ultrasound scan for KUB, I.e kidneys and bladder followed by a uroflowmetry and an estimate of post-boid residue urine. Quite a few patients would respond to medicines like Flomax while some might require surgery.
Some individuals could have similar symptoms due to a weak bladder muscle rather than an outlet obstruction and the net effect is the same, but these patients will not respond to drugs like Flomax and an ultrasound might not pick an enlarged prostate though there could be significant urine residue. Such patients are advised a urodynamic test which will correctly identify if the bladder outlet is indeed obstructed or if the muscle is weak.
Hope I have been able to answer your questions.
Regards
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Aunt with over active bladder has advanced directive of DNR/DNI. She lives in an adult family home. She was put on Ditropan for a while but she gets dry mouth. She was referred to urologist. Cystoscopy was performed and renal ulsaound was done. From cystoscopy shows that aunt has no ability to hold bladder but no ability to empty bladder completely. Aunt has Trauamtic brain injury when she was 15 years old. The Ditropan was discontinued and started her on myrbetric for one month. The MD said in his note she failed two cholinergic drugs. Dr. said aunt can wear diaper to keep her dry because my aunt does not want to deal with side effect of dry mouth.
Aunt has forgetfulness and wants to go back and get the Ditropan again. Is it okay for her to have Ditropan if she wants too for her quality of life.
Aunt has forgetfulness and wants to go back and get the Ditropan again. Is it okay for her to have Ditropan if she wants too for her quality of life.
Brief Answer:
Quality of life issues important
Detailed Answer:
Hi,
I guess the MD who put your aunt on the drugs like DiTropan / Myrbetriq must have hoped for an improvement in the symptoms of your aunt, and if your aunt felt that there was no response with the medication, i.e. no reduction in urinary frequency, urgency or leak episodes, it would qualify as a failure.
However, even in the best of circumstances, these drugs are not effective fully, and therefore even a partial sense of control will help patients win back their self esteem, and a reduction of leak episodes will often cause them to accept minor side-effects which most of these drugs have such as dry mouth.
The other options available include an injection of botulinum Toxin via cystoscopy but you should realize this will give only a temporary relief, and a year from the day of injection, things could be back to square one.
Diapers are never a bad idea, and if there is an issue of restricted mobility, night time diapers might reduce chances of skin maceration. Also, elderly people have a tendency to slip and fall in their efforts to reach the toilet fast, and often land up with a broken hip which could be disastrous. So lifestyle changes could also help such as relocating her bed to be as close to the toilet as possible, and restricting fluids in the evenings, especially coffee, tea. Timed voiding, i.e going to the toilet at a particular time, irrespective of the urge to need to evacuate, and later gradually increasing the intervals between voids could also help regain control
Drugs are several in the market, and if one does not work, it does not mean that others will not. I guess she can experiment with several other brands available such as vesicare, and see which suites her the best and at what dosage.
Hope I have been of help.
Regards.
Quality of life issues important
Detailed Answer:
Hi,
I guess the MD who put your aunt on the drugs like DiTropan / Myrbetriq must have hoped for an improvement in the symptoms of your aunt, and if your aunt felt that there was no response with the medication, i.e. no reduction in urinary frequency, urgency or leak episodes, it would qualify as a failure.
However, even in the best of circumstances, these drugs are not effective fully, and therefore even a partial sense of control will help patients win back their self esteem, and a reduction of leak episodes will often cause them to accept minor side-effects which most of these drugs have such as dry mouth.
The other options available include an injection of botulinum Toxin via cystoscopy but you should realize this will give only a temporary relief, and a year from the day of injection, things could be back to square one.
Diapers are never a bad idea, and if there is an issue of restricted mobility, night time diapers might reduce chances of skin maceration. Also, elderly people have a tendency to slip and fall in their efforts to reach the toilet fast, and often land up with a broken hip which could be disastrous. So lifestyle changes could also help such as relocating her bed to be as close to the toilet as possible, and restricting fluids in the evenings, especially coffee, tea. Timed voiding, i.e going to the toilet at a particular time, irrespective of the urge to need to evacuate, and later gradually increasing the intervals between voids could also help regain control
Drugs are several in the market, and if one does not work, it does not mean that others will not. I guess she can experiment with several other brands available such as vesicare, and see which suites her the best and at what dosage.
Hope I have been of help.
Regards.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you for that enlightening question. A follow up question is this and I think this is the last one. When my aunt first went to her primary care provider ( a nurse practicioner), she was complaining of urinary frequency and it bothers her a lot. She wakes up many times at night. The nurse practicioner told her she will be on Ditropan to allow the bladder to hold more urine so she does not need to go as much. The nurse practicioner said it will also cause dry mouth. The dry mouth was being managed with sucking on hard candy and decreasing the water intake at night. The Ditropan seem to help and she only wakes up once at night but she has dry mouth and she always have urinary tract infection. She was referred to a urologist who changed the Ditropan to myrbertriq. The urologist note states the reason is to decrease urinary retention. My understanding is Ditropan is to make aunt hold more urine in her bladder and why is it that urologist is calling it a side effect. Is urinary retention same as saying to hold more urine in the bladder? It seems odd to me that for a nurse practicioner who knows my aunt it is a therapy but for a urologist he calls it a side effect. Please enlighten me again.Thanks.
Brief Answer:
Urinary retention likely if associated obstruction
Detailed Answer:
Hi,
Ditropan belongs to a class of drugs known as anti-cholinergics. One of the effects of the drug is to reduce the contractility of bladder. However, if a patient has a pre-existing bladder outlet obstruction, and the associated irritability has caused urinary urgency and frequency, placing them on Ditropan could cause an increase in the risk of urinary retention where patients will be unable to void urine despite the urge to do so. This is what your Urologist probably feared. Hence, one of the precautions we do take before placing patients on drugs like Ditropan would be to see if the urine flow rate is adequate,.i.e. comparable to people of that age for which standardized nomograms exist, and secondly check if there is significant post-void residue. If flow rate is adequate, and residual urine is not very high, there is no reason to withhold drugs like Ditropan which seem to have reduced the night time urge to toilet, while there might be increased urine staying back in the bladder after she voids, as long as it is not unacceptably high.
As I did mention earlier, Ditropan is a fairly old drug, and there have been newer molecules which have come in the market over the past 6-8 years like Vesicare which I did mention earlier or Darifenacin or Trospium which are probably more efficacious while not causing the kind of problems which can happen with Ditropan. Hard candy chewing is a perfectly acceptable solution for relief of the dry mouth rather than increase intake of fluids which can worsen the problem. Personally, I have never put my patients on Myrbetriq yet.
Hope i have been able to clarify your doubts.
Urinary retention likely if associated obstruction
Detailed Answer:
Hi,
Ditropan belongs to a class of drugs known as anti-cholinergics. One of the effects of the drug is to reduce the contractility of bladder. However, if a patient has a pre-existing bladder outlet obstruction, and the associated irritability has caused urinary urgency and frequency, placing them on Ditropan could cause an increase in the risk of urinary retention where patients will be unable to void urine despite the urge to do so. This is what your Urologist probably feared. Hence, one of the precautions we do take before placing patients on drugs like Ditropan would be to see if the urine flow rate is adequate,.i.e. comparable to people of that age for which standardized nomograms exist, and secondly check if there is significant post-void residue. If flow rate is adequate, and residual urine is not very high, there is no reason to withhold drugs like Ditropan which seem to have reduced the night time urge to toilet, while there might be increased urine staying back in the bladder after she voids, as long as it is not unacceptably high.
As I did mention earlier, Ditropan is a fairly old drug, and there have been newer molecules which have come in the market over the past 6-8 years like Vesicare which I did mention earlier or Darifenacin or Trospium which are probably more efficacious while not causing the kind of problems which can happen with Ditropan. Hard candy chewing is a perfectly acceptable solution for relief of the dry mouth rather than increase intake of fluids which can worsen the problem. Personally, I have never put my patients on Myrbetriq yet.
Hope i have been able to clarify your doubts.
Note: Consult a Urologist online for consultation about prostate and bladder problems, sexual dysfunction, kidney stones, prostate enlargement, urinary incontinence, impotence and erectile dysfunction - Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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