Approach to lower urinary tract symptoms

Question 1

what 3 buckets of symptoms encompass LUTS?

Answer 1

• voiding problems
• storage problems
• post-micturation problems

Question 2

what are 4 examples of LUTS voiding s/s?

Answer 2

• weak stream
• incomplete voiding/emptying
• hesitancy
• straining
• terminal dribbling

Question 3

what are 4 examples of LUTS storage s/s?

Answer 3

• urgency
• frequency
• urinary incontinence
• nocturia

Question 4

what is an example of post-micturation s/s?

Answer 4

post-void dribbling

Question 5

what are some ddx for LUTS?

Answer 5

• UTI: cystitis, prostatitis, urethritis
• reduced anatomical bladder capacity: bladder or prostate ca, radiation cystitis, TB, bladder surgery, pregnancy
• reduced functional bladder capacity: BPN, prostate cancer, pelvic floor insufficiency, foreign body in urethra/bladder, stones, neurogenic
• pharmacological: diuretics, caffeine, beta-blockers
• psychological: stress, anxiety, after sexual trauma

Question 6

what’s the difference between BPN and prostate cancer?

Answer 6

BPN is the hyperplasia of prostate cells resulting in the enlargement of the prostate as a whole

vs

prostate cancer is the uncontrolled cell division of a group of cells within the prostate

Question 7

when performing a DRE, what zone of the prostate are you mostly palpating?

Answer 7

typically palpating the peripheral zone

zones of prostate:
- central zone (surrounds the ejaculatory ducts)
- transitional zone (surrounds the urethra)
- peripheral zone (posteriorly)