GP Student Handbook Urinary Common Presentations

Question 1

Lower urinary tract symptoms breakdown

Answer 1

Storage
Voiding
Post-micturition

Question 2

Common storage symptoms

Answer 2

Urgency
Nocturia
Daytime urinary frequency
Incontinence

Question 3

Common voiding symptoms

Answer 3

Hesitancy
Weak flow
Incomplete emptying
Terminal dribbling

Question 4

Post-micturition symptoms

Answer 4

Dribbling

Sensation of incomplete emptying

Question 5

Male urinary symptoms red flags

Answer 5

• Weight Loss >3kg.
• Haematuria.
• Hard/irregular prostate gland.
• Lower back pain.
• Bone pain.
• Raised prostate specific antigen (PSA).

Question 6

Differential diagnoses for males experiencing voiding symptoms?

Answer 6

1. BPH (Benign prostatic hypertrophy)
2. Prostate/ bladder cancer
   Anti-muscarininc side effect of medication e.g. tricyclic antidepressant, antihistamine
3. Diabetic autonomic neuropathy
4. Urethral stricture

Question 7

Differential diagnoses for males experiencing storage symptoms

Answer 7

1. Overactive bladder
2. Stress incontinence (leakage due to increase pressure on bladder)
3. Acute urinary retention

Question 8

Causes of an overactive bladder in males leading to storage symptoms?

Answer 8

1. BPH
2. Neurological conditions such as diabetic autonomic neuropathy, dementia, multiple sclerosis, Parkinson’s disease and stroke.
3. Lower urinary tract infection including prostatitis, urethritis and cystitis (see section on UTIs).
4. Bladder stones.
5. Bladder and prostate cancer.

Question 9

Causes of an stress incontinence in males leading to storage symptoms?

Answer 9

1. Pelvic surgery
2. Urethral injury
3. Drugs inc alcohol, caffeine, diuretics, alpha-blockers, sympathomimetics, anti-muscarinics and opioids
4. Neuro conditions e.g. MS

Question 10

What are the options for investigations urinary symptoms in males?

Answer 10

• Urinalysis – glucose, blood, protein, leucocytes and nitrites. If positive send MSSU. If microscopic haematuria – repeat to check that the blood is a persistent finding.
• Blood tests – renal function, full blood count to check for anaemia and PSA if concerns about prostate gland, such as enlarged prostate gland on examination. Be aware the PSA can rise with infections, post prostate examination and after intercourse.
• Urinary frequency volume chart
• International Prostate Symptom Score - IPSS

Question 11

Two key male urinary signs/symptoms that raise cancer suspicion of cancer?

Answer 11

• Raised PSA and enlarged prostate – refer to urology urgently
• Haematuria – visible - refer urgently – suspicion of cancer. Microscopic – repeat and if infection treat and re-check

Question 12

Drug therapy option for voiding symptoms

Answer 12

• Voiding symptoms – alpha-blocker such as tamsulosin

Question 13

Use of:

5-alpha reductase inhibitor – finasteride

Answer 13

Treats enlarged prostate - 5-alpha reductase inhibitor – finasteride

For drug therapy option for enlarged prostate symptoms

Question 14

Drug therapy options for voiding and stoage symptoms

Answer 14

• Mixed storage and voiding – alpha-blocker e.g. tamsulosin and anti-muscarinic - oxybutynin

Question 15

Action of tamsolusin

Answer 15

Drug therapy option for voiding symptoms

Voiding symptoms – alpha-blocker such as tamsulosin

Question 16

Common causative agents of UTI

Answer 16

E. coli (70-95% of infections)
Staphylococcus saprophyticus (5-10%)

Question 17

UTI risk factors

Answer 17

Sexual intercourse
Atrophic vaginitis 
Abnormal urinary tract 
Previous surgery
Immunocompromised 
Catherisation

Question 18

Which antibiotics are used in LOWER urinary tract symptoms if systemically well?

Answer 18

Women - nitrofurantoin/ trimethoprim used in Lothian (3 day course)

Men – nitrofurantoin/ trimethoprim (7 day course)

Question 19

When should a patient presenting with UPPER urinary tract symptoms be admitted?

Answer 19

If unwell, dehydrated, temp >38, signs of sepsis, pregnant, immunocompromised, diabetic or fail to improve after 24 hours of antibiotics

Question 20

When should a patient presenting with UPPER urinary tract symptoms be given antibiotics?

Answer 20

If apyrexial, or pyrexial but otherwise well and no risk factors for severe illness

–> treat with ciprofloaxacin or co-amoxiclav.