84. Urinary frequency/nocturia

Question 1

Index conditions.

Answer 1

1. UTI
2. Prostatic hypertrophy (benign, malignant)
3. Diabetes mellitus
4. Renal failure
5. Cardiac failure
6. Drug related (e.g. diuretics, caffeine, alcohol)

Uncommon:

• Diabetes insipidus
• Compulsive water drinking (may manifest in personality disorder)

Question 2

Two basic physiological causes of frequency

Answer 2

• Polyuria when too much urine is being produced.

- Instability of the detrusor /stretch mechanism.

Question 3

Aetiology.

a) Cystitis - types
b) Other urological
c) Non-urological conditions
d) Drugs

Answer 3

a) Bacterial , interstitial (no aetiology found), chemical (e.g. cyclophosphamide)
b) Urethritis, prostate enlargement, bladder/other malignancy, urolithiasis
c) Diabetes mellitus, vaginitis, cardiac failure, renal failure, diabetes insipidus, hypercalcaemia, Conn’s, pregnancy
d) Diuretics, alpha-blockers (bladder neck relaxation - may cause urge incontinence)

Question 4

Assessment and investigation.

a) Initial examination
b) Bloods
c) Orifices
d) XR/imaging
e) Special tests

Answer 4

a) Adbo. Women - PV may be appropriate; Men - DRE, maybe testicular
b) Glucose, renal, liver, calcium, FBC, UEs, osmolality,
?NT-proBNP, consider PSA blood test in men
c) Urine dip, pregnancy test
d) Bladder/ renal/ ureteric USS, CT / XR for stones
Bladder flow studies and cytometry. Cystoscopy
e) STI swabs?

Question 5

Overactive bladder (OAB)

a) One or more of the following 4 symptoms…
b) Management

Answer 5

a) Urgency
Frequency
Nocturia
Incontinence

b) Bladder re-training, anticholinergic drugs, intravesical botulinum toxin injections, intermittent self-catheterisation and sacral nerve stimulation

Question 6

Men with voiding LUTS: management

a) Conservative
b) Referral that might help manage symptoms
c) Drug choice if normal prostate size/ no signs of rapid progression
d) Drug choice if enlarged prostate/ evidence of rapid progression (e.g. poorer urine flow, higher symptom scores, chronic urinary retention, higher PSA)
e) Drugs if worrisome LUTS + enlarged prostate
f) If both voiding AND storage symptoms, - ?
g) If medications fail to control symptoms - referral to…? h) Secondary care - two main interventions

Answer 6

a) Active surveillance; treat any treatable causes; pelvic floor muscle training, bladder training, prudent fluid intake (and avoidance of alcohol/caffeine/fizzy drinks), containment products (pads, waterproof pants, external sheath, and catheters). Avoid/treat constipation. Healthy lifestyle (weight loss, exercise, no smoking)
b) Community continence team
c) alpha-blocker (tamsulosin, doxasozin)
d) 5-ARI (finasteride)
e) Alpha-blocker + 5-ARI
f) Alpha-blocker + antimuscarinic (e.g. oxybutynin)
g) Urology
h) Catheterisation (intermittent, indwelling urethral or intermittent suprapubic) or… surgery (e.g. TURP)