3. Lower Urinary tract symptoms Flashcards
What causes LUTs in men?
- BPH (most common)
- chronic prostatitis
- UTI
- urethral stricture
- urological malignancies
- external compression.g. pelvic tumour, faecal impaction
- destrusor weakness/ overactive bladder
- neurogenic disease e.g MS, spinal cord injury
- ureteric calculi
What causes LUTs in women?
- menopause
- UTI (most common)
- urethral stricture
- urological malignancies
- external compression
- destrusor weakness/overactive bladder
- neurogenic disease e.g MS, spinal cord injury
What can exacerbate LUTs?
drinking fluids late at night, excess alcohol intake, and excess caffeine intake
What are storage symtoms?
- frequency
- urgency
- nocturia
- urge incontinence
What are voiding symptoms?
Typically due to bladder outflow obstruction
- hesitancy
- post micturition dribble
- weak flow
- feeling of incomplete emptying
- intermittency
- straining
questions to ask if someone presents with LUT
Have you found that you need to urinate more often?
are you able to hold your urine?
have you had any accidents?
how would you describe the flow of your urine?
do you find that you have to wait before you start?
do you find that you have to start and stop?
do you have to strain to urinate?
are you having to wake up at night to urinate?
do you feel like you haven’t emptied your bladder fully?
what other symptoms should be enquired about?
visible haematuria, suprapubic discomfort, or colicky pain, and their medication history
which medication can exacerbate LUT?
anticholinergics, antihistamines and bronchodilators
what examination must be performed?
A digital rectal examination and / or examination of the external genitalia may be helpful, depending on the presentation
what score should be used?
International Prostate Symptom Score
Initial investigations?
- Urinalysis (and culture)
- post voiding bladder scan and flow rate
- urinary frequency and volume chart
- routine blood tests
- PSA
what should be checked for in urinalysis?
signs of UTI predominantly, however also haematuria (e.g. bladder stones) or glycosuria (e.g. diabetes mellitus)
Specialist investigations?
- Urodynamic studies (flow rate, detrusor pressure, bladder volume)
- Cystoscopy
- Upper urinary tract imaging (ultrasound or CT)
when will upper urinary tract imaging be done?
if there is a history of chronic retention, history of recurrent infection, or the presence of haematuria.
Conservative management?
- treatment of underlying pathology
- fluid intake limit
- urethral milking and double voiding
- pelvic floor exercises
- bladder training
Pharmacological managament?
- anticholinergics for overactive bladder e.g. oxybutynin
- alpha blockers or 5α-reductase inhibitors for BPH e.g. tamsulosin, finasteride
- loop diuretics (unlicensed) mid afternoon to prevent nocturia
Complications?
- UTI and calculi developmetn due to stagnation
- chronic obstruction can lead to hypertrophy or distention which can casue overflow incontinence
- renal failure and bilateral hyronephrosis
