Bladder hypertrophy

It is well known that subvesical obstruction leads to bladder hypertrophy, reduced bladder compliance and capacity, high detrusor pressure during bladder filling and voiding, and unstable detrusor contractions. Based on this well-known pathophysiological mechanism, the speculative conclusion could... 

O The lower urinary tract symptoms and signs of benign prostatic hyperplasia are due to static, dynamic, or detrusor factors. The static factor refers to anatomic obstruction of the bladder neck caused by an enlarged prostate gland. The dynamic factor refers to excessive stimulation of a-adrenergic receptors in the smooth muscle of the prostate, urethra, and bladder neck. The detrusor factor refers to irritability of hypertrophied detrusor muscle as a result of long-standing bladder outlet obstruction. 

Prostatic hypertrophy, infection, cancer Improperly placed bladder catheter Anticholinergic medication Cancer with abdominal mass Retroperitoneal fibrosis Nephrolithiasis Nephrolithiasis Oxalate Indinavir Sulfonamides Acyclovir Uric acid... 

Special risk patients Use with caution in patients with narrow-angle glaucoma, prostatic hypertrophy, or bladder neck obstruction. 

First-generation antihistamines Flypersensitivity to specific or structurally related antihistamines newborns or premature infants nursing mothers monoamine oxidase (MAO) therapy pregnancy (hydroxyzine) angle-closure glaucoma, stenosing peptic ulcer, symptomatic prostatic hypertrophy, bladder neck obstruction, pyloroduodenal obstruction, elderly, debilitated patients (cyproheptadine). 

Use with caution in conditions which might be aggravated by anticholinergic therapy (eg, prostatic hypertrophy, stenosing peptic ulcer, pyloroduodenal obstruction, bladder neck obstruction, narrow angle glaucoma, bronchial asthma, cardiac arrhythmias). 

GU Obstructive uropathy (eg, bladder neck obstruction caused by prostatic hypertrophy) renal disease. 

Contraindications Bladder neck obstruction due to prostatic hypertrophy, cardiospasm, intestinal atony, myasthenia gravis in those not treated with neostigmine, narrow-angle glaucoma, obstructive disease of the GI tract, paralytic ileus, severe ulcerative colitis, tachycardia secondary to cardiac insufficiency or thyrotoxicosis, toxic megacolon, unstable cardiovascular status in acute hemorrhage... 

Benign prostate hypertrophy Alpha receptor blockers increase urinary flow rate and causing more complete emptying of urinary bladder in benign prostate hypertrophy patients. 

Chronic study (rat) Urinary bladder carcinoma (202 mg kg-1 per day) Liver hypertrophy, testicular atrophy, kidney degeneration (144mgkg I per day)... 

BM bone marrow bowel movement BMT bone marrow transplantation BOO bladder outlet obstruction BP blood pressure BPH benign prostatic hypertrophy bpm beats per minute BSA body surface area BUN blood urea nitrogen (measure of hydration and kidney function) BW body weight C constipation Ca/Ca2+ calcium CA cancer... 

Alpha-1 blockers can also be used to treat the symptoms of benign prostatic hypertrophy because they decrease sympathetic-mediated contraction of smooth muscle located in the prostate gland.34,91 Reduction of muscle tone in the prostate decreases constriction of the ureter, thereby improving urinary flow and the ability to empty the bladder.58,83... 

Lower tract infections include cystitis (bladder), urethritis (urethra), prostatitis (prostate gland), and epididymitis. Upper tract infections (such as pyelonephritis) involve the kidney and are referred to as pyelonephritis. Uncomplicated UTIs are not associated with structural or neurologic abnormalities that may interfere with the normal flow of urine or the voiding mechanism. Complicated UTIs are the result of a predisposing lesion of the urinary tract such as a congenital abnormality or distortion of the urinary tract, a stone, indwelling catheter, prostatic hypertrophy, obstruction, or neurologic deficit that interferes with the normal flow of urine and urinary tract defenses. 

Antihistamines that produce sedation should not be used with alcohol or any other sedating drug, such as opioid analgesics. Antihistamines with strong anticholinergic effects should be avoided in patients with peptic ulcer disease, prostatic hypertrophy, or bladder or pyloro-duodenal obstruction and in patients who have the potential for acute angle-closure glaucoma. 

Nonneoplastic forms Prostatic hypertrophy Renal tuberculosis Renal lithiasis Calculi of the bladder Cystic diseases Urethral stricture Hypospadias Neurogenic bladder Nephritis... 

Urinary tract. Any contraction of the ureters is probably clinically unimportant. Retention of urine may occur (particularly in prostatic hypertrophy) due to a mix of spasm of the bladder sphincter and to the central sedation causing the patient to ignore afferent messages from a full bladder. 

Cautions Narrow-angle glaucoma, prostatic hypertrophy, pyloroduodenal or bladder neck obstruction, asthma, chronic obstructive pulmonary disease (COPD), increased intraocular pressure, cardiovascular disease, hyperthyroidism, hypertension, seizure disorders... 

Postrenal renal failure Bladder outlet obstruction Prostatic hypertrophy... 

Drug therapy may also cause renal insufficiency due to lower urinary tract obstruction. Ureteral obstruction can be caused by calculi or retroperitoneal fibrosis. Bladder dysfunction with urinary outflow obstruction can result, particularly in males with prostatic hypertrophy, from anticholinergic drugs including tricyclic antidepressants and disopyramide. Bladder outlet and ureteral obstruction may result from bladder fibrosis following hemorrhagic cystitis with cyclophosphamide or ifosfamide therapy. Concurrent treatment with mesna can prevent cystitis and this complication. 

Urinary hesitancy and retention is reported with low-potency FGAs and with clozapine. Anticholinergic effects canse smooth mnscle slowing and paralyze the detrusor muscle of the bladder, requiring greater mine volume to evoke muscle contraction. Men with benign prostatic hypertrophy are especiaUy prone to this effect. ... 

Rarely, bladder ontlet obstmction may be caused by a functional obstmction at the level of the bladder neck. Hypertrophy of the smooth mnscle fibers at the level of the bladder neck in men and women may result in obstruction to the flow of nrine. In those patients who fail pharmacologic therapy with a-adrenergic receptor antagonists, endoscopic incision using the cy stoscope is highly effective in treating this very nncommon condition. 

In the elderly, the ratio of bacteriuria in women and men is dramatically altered and is approximately equal in persons over the age of 65. ° The overall incidence of UTI increases substantially in this population, with the majority of infections being asymptomatic. The rate of infection increases further for elderly persons who are residing in nursing homes, particularly those who are hospitalized frequently. The increase is probably the result of a number of factors, including obstruction from prostatic hypertrophy in males, poor bladder emptying as a result of prolapse in females, fecal incontinence in demented patients, neuromuscular disease, including strokes, and increased urinary instrumentation (catheterization). 

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