Please enable JavaScript.
Coggle requires JavaScript to display documents.
A 60 year old teacher comes in complaining of difficulty emptying his…
A 60 year old teacher comes in complaining of difficulty emptying his bladder. He has had to wait before the urinary stream starts, and also to strain to keep the stream going. He sometimes has the sensation of incomplete emptying, and this has interfered with his work in the classroom
Voiding (obstructive)
Hesitancy
Poor stream
Intermittent flow
Incomplete emptying (with associated frequency)
Postvoid dribbling Overflow incontinence
-
Complications
• acute or chronic urinary retention (patients in acute urinary retention
require catheter drainage and outpatient urological follow up)
• haematuria
• recurrent UTIs
• bladder stones
• urgency or over flow incontinence.
-
-
History
Co-morbidities
diuretics, diabetes, heart failure and sleep apnoea can all contribute to nocturia
-
Investigation
Ultrasound
hydronephrosis, bladder stones or
chronic urinary retention
Urinalysis & culture
UTI, presence of microscopic haematuria
-
Urine cytology
Urothelial Ca
risk factors: age >40 years, smoking history, chemical exposure
-
-
PE
palpable bladder, phimosis or meatal stenosis
-
Treatment
• watchful waiting (including reassurance and/or behavioural
modification)
• pharmacological therapy
• surgery.