2: Male Incontinence Flashcards
What two types of incontinence occur in males
Urge
Overflow
What is urge incontinence
Over-active bladder results in contraction. This increases pressure leading to rise in intra-vesical pressure and subsequent leakage of urine
What is overflow incontinence
Complication of chronic retention. Where there is damage to sacral plexus resulting in loss sensation. As the bladder fills, it becomes grossly distended leading to dribbling
What cause overflow incontinence most commonly
BPH
In which gender is incontinence more common
Males (3:1)
What are the two types of LUTS
Storage and Voiding
What is a mnemonic to remember storage symptoms
FUNI
What are the storage LUTS
Frequency
Urgency
Nocturia
Incontinence
What is a mnemonic to remember voiding symptoms
UR HITS
What are the voiding symptoms
Urinary Retention
Hesitancy
Incomplete emptying
Terminal dribbling
Stream poor
what investigations are ordered in men with LUTS
- Urinalysis
- DRE
- PSA
- Bladder Diary
- Urodynamic studies
- Internal prostate symptom score
in males how are voiding symptoms managed conservatively
Bladder training
what first-line medication is indicated for voiding symptoms
A-blocker
what second line medication is used for voiding symptoms
Finasteride
if missed storage and voiding what is indicated
Add anti-muscarinic if not managed by above
If over-active bladder, what conservative measures are taken
bladder training
what medication is offered for over-active bladder
anti-muscarinic
if patient is bothered by nocturia, what is offered
moderate fluid intake at night
what medication is offered in nocturia
40mg furosemide in later afternoon or desmopressin
what are the two main causes of bladder outlet obstruction in males
BPH
TCC
Urethral stricture
how is urethral stricture investigated
retrograde urethrogram or anterograde cystogram
how is urethral stricture managed
internal urethrotomy
what does bladder outlet obstruction cause
acute or chronic urinary retention
what are complications of acute urinary retention
- AKI
- Obstructive nephropathy
what are complications of chronic urinary retention
- UTI
- Urolithiasis
- Overflow incontinence
what is obstructive uropathy
obstruction urine flow at any level causing back-flow of pressure and hydronephrosis. If untreated hydronephrosis is untreated it can compress blood vessels decreasing perfusion and causing atrophy
what are the two types of chronic urinary retention
- Low-pressure
- High-pressure
what is low pressure chronic retention
- Normal creatinine
- No hydronephrosis
what is high pressure chronic retention
- Raised creatinine
- Normal pressure hydronephrosis
how are patients with high pressure chronic retention managed
intermittent self-catheterisation
