Common Urological Presentations - LUTS Symptoms

Question 1

Presenting complaint

-key questions

Answer 1

LUTS - anything that affects control and quality of peeing

Timeline and duration

Storage symptoms

• frequency
• urgency
• nocturia

Voiding symptoms

• weak stream
• intermittent
• straining
• emptying incomplete

Not made it in time to the bathroom?

Question 2

Systemic review

Answer 2

Systemic

• fever
• weight loss, night sweats, fatigue, appetite loss

Urology

• blood
• pain => SOCRATES
• back pain + N/V => pyelonephritis

Neuro
-back pain, bilateral sciatica, saddle anaesthesia, leg weakness => cauda equina?

Question 3

PMHx, DHx, FHx, allergies

Answer 3

Any medical conditions
-DM
-kidney disease - stones, CKD, pyelo, UTIs
Past hospital visits, urological procedures, surgeries

Medication, inhalers, OTC, herbal supplements, contraception?

Medication with urological impacts

• diuretics => nocturia, AKI?
• Ab (-zosin) => treat BPH
• ACEi, NSAIDs => nephrotoxics
• ABx - prophylaxis for recurrent UTIs

FHx - urological cancers?

Question 4

SHx

Answer 4

General

• house, flat => stairs, lifts?
• support network
• ADLs => self care, housework, food shopping
• carers

Smoking - BLADDER CANCER
Alcohol - MALIGNANCY RISK
Rec drugs

Fluids - dehydration => increased UTI, AKI risk

Work
-what does their job involve industrial dyes, textiles, rubber, plastics, leather => bladder cancer risk

Question 5

BPH

• risk factors
• core features
• investigations
• management

Answer 5

Risk factors

• male
• older age

LUTS

Patient
-Bladder diary - fluid intake, urine output, frequency and leakage
-IPSS
Bedside
-Abdo, ext genitalia exam
-DRE
-Urinedip - rule out DM, UTI
Bloods - U&E, PSA

Depends on severity of symptoms
Conservative
-reduce fluids, caffeine
-double voiding
-medication optimisation
Meds
-Ab - tamulosin
-anticholinergic
-5Areductase inh - finasteride
Surgery
-TURP
-prostatectomy

Question 6

Stress incontinence

• risk factors
• core features
• investigations
• management

Answer 6

Risk factors

• pregnancy, large body habitus
• increased age

Core features
Urine leaks on coughing, laughing

Investigations
Abdo, pelvic exam - ask patient to cough to see for leaks
Urinedip - UTI can present with freq
U&E - post renal AKI from obstruction

Management
Conservative
-weight loss, reduce caffeine
-pelvic floor exercise
Surgery

Question 7

Urge incontinence

• risk factors
• core features
• investigations
• management

Answer 7

Risk factors

Core features
Need to go to bathroom often immediately

Investigations
Abdo, pelvic exam - rule out stress
Urinedip - UTI can present with freq
U&E - post renal AKI from obstruction

Management
Conservative
-reduce fluid, caffeine
-bladder retraining
Medication - anticholinergics (oxybutinin, tolterodine)
Avoid in cog impairment

Question 8

UTI

• risk factors
• core features
• investigations
• management

Answer 8

Risk factors

• female
• DM, IC, sexually active
• past UTIs

Core features
Cloudy urine (blood)
Dysuria
LUTS

Investigations
Urinedip - leukocytes, nitrites, blood

Management
Wipe from front => back
Pee soon after sex
Fluids
3 days nitrofurantoin

Question 9

Prostate, bladder, testicular cancer 2ww

Answer 9

Prostate cancer => PSA, DRE abnormal

Bladder or renal cancer

• 45, VH no UTI
• 60 NVH + painful urination/high WCC

Testicular cancer => non painful enlargement/change in shape or texture