Jan16 M3-LUTS cases Flashcards
4 things to cover in a LUTS or BPH presentation
- family history (*cancers, ..)
- tests
- treatment options
- best option
how much is family history important in LUTS and BPH
not much. helps in management if early detection of prostate CA
pt with dyslipidemia, htn and enlarged prostate on DRE + mild LUTS: tests to do
PSA, UA and culture
pt with dyslipidemia, htn and enlarged prostate on DRE + mild LUTS: treatment options
mild symptoms so watch and wait. double voiding, time voiding. or (alpha blocker, 5 alpha reductase inhibitor, NOT anticholinergics)
why can’t give anticholinergics to anyone
if only mild obstruction could put you in retention by relaxing bladder too much
pt with 6 months history of LUTS worsening (frequency, dysuria, incontinence), overweight, diabetes, previous surgery, bulging anterior vagina: DDX
- UTI, vaginitis, salpingitis
- neuro: diabetic neuropathy, MS, CVA
- cancer
- anatomical
pt with worsening LUTS: tests
UA and culture, uroflow study, voiding scoring
urodynamic study more advanced
pt with worsening LUTS: if UA reveals microhematuria, is it related to her incontinence?
most likely not (but UTI could do that)
pt with worsening LUTS: tests to do now that hematuria found
ultrasound or CT (upper)
cystoscopy (lower)
pt with worsening LUTS for 1 yr and large prostate + diabetes: ddx
- prostate cancer
- UTI (chronic possible)
- overactive bladder from prolonged obstruction
- malignancies
- stones
pt with worsening LUTS for 1 yr and large prostate + diabetes: tests
UA (dipstick + microscopy), PSA, uroflow
pt with worsening LUTS for 1 yr and large prostate + diabetes: what to do if find blood in the urine
ultrasound and cystoscopy + transrectal ultrasound
pt with worsening LUTS for 1 yr and large prostate + diabetes: what to do if high PSA
ultrasound
pt with worsening LUTS for 1 yr and large prostate + diabetes: treatment options (he is already on alpha blockers)
- 5-alpha-reductase inhibitors
- anti-cholinergic
- self cath
- surgery to resect prostate
pt with worsening LUTS for 1 yr and large prostate + diabetes: alternative diagnosis that can mimic obstructive LUTS
urethral stricture (history of procedures)
