3.1.2 Men's Health Urology II Flashcards
What are some common causes of urinary retention?
- Prostatic enlargement, BPH or cancer
- Phimosis/urethral stricture/meatal stenosis
- Constipation
- UTI
- Drugs- anticholinergics
- Over-distension- too much fluids
- Following surgery
- Neurological
What are the different types of urinary retention?
Acute
Chronic
Acute on chronic
Features of acute urinary retention
Painful
Pain relieved by catheter
Residual volume < 1000mls
No kidney insult
Features of chronic urinary retention
Painless/less painful
May have some abdominal swelling
Residual volume >300mls (largest 5L)
May have kidney insult
Features of acute on chronic urinary retention
Painful
Residual volume >1000mls
Usually have kidney insult
How do you treat each type of urinary retention?
Acute- Trial without catheter, TWOC after treating exacerbating factor
Chronic - learn to self catherise
Acute on chronic - Long term catheter or surgical intervention (TWOC not usually successful as kidney insult)
What does nocturnal enuresis in older men suggest?
Chronic retention with overflow incontinence
How do you describe lower urinary tract symptoms?
Not disease specific, therefore do not say prostatism
What are the different types of LUTs (lower urinary tract symtpms)?
Voiding:
- Hesitancy
- Poor flow
- Post micturition dribble
Storage:
- Urgency
- Frequency
- Nocturia
What are some causes of storage LUTs?
Irritative eg bladder infection/inflammation, bladder stone, cancer
Overactive bladder - idiopathic or neuropathic (stroke, parkinsons, MS)
Low compliance of bladder (scarred) eg after TB, schistosomiasis, pelvic radiotherapy
Polyuria -
Global (eg from uncontrolled diabetes)
Nocturnal (venous stasis, sleep apnoea - leads to raised ANP levels)
What can cause voiding symptoms?
Bladder outflow obstruction:
- Uethra (phimosis, structure), prostate (BPH, cancer, bladder neck)
- Dynamic - prostate and bladder neck?
- Neurological - lack of coordination between bladder and sphincters - upper motor neurone problem?
Reduced contractility:
- Physical
- Neurological LMN lesion
What symptoms are suggestive of a stricture?
Urine spraying
Why can the prostate lead to bladder outflow obstructions?
Sympathetic smooth muscular tone
(mediated by a1 receptors)
What scoring system is used to assess LUTs?
IPSS, international postate symptom score
What are the 7 questions asked on IPSS?
Incomplete Emptying
Frequency
Intermittency
Urgency
Weak Stream
Straining
Nocturia
FUN WINS
F-requency
U-rgency
N-octuria
W-eak stream
I-ncomplete emptying
iN-termittency
S-training
If you were to spend the rest of your life with your urinary condition how would you feel?
How is IPSS scored?
Each 0-5
Mild - 0-7
Moderate - 8-19
Severe - 20-35
What examinations are used for LUTs?
DRE
Is the bladder palpable?
Neurological if suggestive history
What investigations are there for LUTs?
Dipstick, UTI, blood
Consider PSA (prostate specific antigen) - not a surrogat for DRE, if UTI treat first and if palpably benign prostate wait 4-6 weeks
What lifestyle changes should be made to manage BPH?
- Reduce caffeine intake
- Avoid fizzy drinks
- No need to drink more than 2.5L day
What can medication can be given for BPH?
Alpa blockers
5 alpha reductase inhibitors
How do alpha blockers relieve BPH symptoms?
Relaxing smooth muscle within prostate and bladder neck
Rapid symptom relief
Tamulosin
How do 5a Reductase Inhibitors work?
Prevents conversion of testosterone to DHT which is a more potent androgen
Shrinks the prostate, slower symptom relief than alpha blockers
Slows progression
Reduces risk of retention
Finasteride
What is the first thing to do when managing BPH in secondary care?
Flow rate before considering surgery
What are the indications for surgery for BPH?
Failed lifestyle and medical management
Urinary retention needing intervention
What is the standard surgery for BPH?
Transurethral resection of prostate (TURP)
Monopolar/laser/bipolar
