Lecture 1 Flashcards
What are the 2 kinds of Lower Urinary Symtoms ?
LUTS
Voiding symptoms
Storage symtoms
What are voiding symptoms?
WISH
Hesitancy( struggling to start in public toilets takes time to start)
Intermittency
**Straining **
Weak stream
Incomplete emptying
Storage symtoms are?
They cannot store, they have to go !
Frequency
Urgency
Nocturia (need to pee at night)
What are the things pt might complain of?
Wake up at night & tired
Frequency and urgency are the worst, affect their shopping & going out
What are the risks of LUTS?
Bladder Blockage
What happens if you have abdo strain everytime ?
Prolapse
Inguinal Hernia
so we need more investigation
How do you asses LUTS?
International Prostate Symptom Score (which involve 7 LUTS symptoms) depends on the number is the answer. This is the only guidelines for LUTS.
How do you investigate LUTS?
rectal examination ( to check for enlarged prostate, haemorrhoids, prostate ca
loss of sphincter tone - Cauda quina
abdo examination
IPSS - expect to see storage symtoms & prolapse and hernia
Urine dipstick ( if sign of infection) send for urine culture
Bladder frequency - volume chart( get the urine in the jug in 50 millilitres and check for 3 days)
what are the signs of bladder tendorness?
Suprapubic mass
Dull on suprapubic
What scan can you do for LUTS?
Uroflowmetry ( urology outpatient dpt only) check the flow and if the flow is good
post-void bladder scan
Ultrasound Bladder scan
What bloods do you do for LUTS?
PSA
(Serum Creatinine) -
Why do we check for PSA?
Can show the englarement of prostate ca
How do you diagnose for Prostate cancer without any other investigation
DIgital Rectal Examination
If pt has chronic bladder blocakge /RETENTION
they can develop blockage and affect kidney function
Do abdominal examination
What is the treatment of Benign prostatic hyperplasia BPH
Medical treatment
-Alpha blockers (Tamsulosin 400ug) OD
- Alfuzosin 10mg OD
What helps with weak pelvic floor weakness?
Pelvic floor exercise will improve the storage symtoms
In diabetes, how does it affect?
Polyuria
Diabetic Neuropathy
if later stage, DN lead to detrusor hyperactivity
If they have LUTS found BPH on a man? What is the management plan ?
- Be systematic( do nothing) at first
- Alpha blockers such as Tamsulosin 400ug OD & Alfuzosin 10 mg OD
-5 alpha reductase inhibitor: **finasteride 5mg **
What is the 4th treatment(surgical) for Benign Prostatic Hyperplasia BPH?
TURP - Transurethral resection of the prostate /endoscopic resection
Laser : enucleation, vaporization
How long does it take for the Tamsulosin for work ?
after 2-3 days
How long can you see the effect of 5-alpha reductase inhibitor :
finasteride 5 mg ?
3-6 months
This medication can reduce the LUTS symptoms
Nocturia/Nocturnal Polyuria?
important stuff
Nocturia >2
The more the frquency is called Nocturnal Polyuria : >1/3 24h urine output
- Excessive fluid intake late in a day
- Swelling of legs
- Sleep apnea syndrome (SAS) can cause nocturia symotms
- Elderly pts
-Bladder frwuency - volume chart
Why sleep apnoea causes nocturia symptoms?
This is because sleep apnea affects a hormone in the body known as atrial natriuretic peptide (ANP), which causes the body to produce more urine while sleeping.
A man at 65 complaining of urinary frequency and has nocturia
SD of tamsulosin?
Postrual hypotension
Risk of fall
What are Incontinence?
Incontinence refers to any accidental or involuntary loss of urine from the bladder12. It can also refer to the loss of bowel motion, feces, or wind from the bowel2. Urinary incontinence can affect both men and women of all ages
What is stress urinary incontinence ?
Pelvic floor exercises
What is the surgical treatment for stress urinary incontinence?
Suburethral slings
What is Urge urinary incontinence?
Anticholinergic
- oxybutynin
- Solifenacin(Vesicare)
- Tolterodine (Detrusitol)
- BOTOX intra-detrusor injections
What is Overflow incontinence?
Bladder retension
How do you rule out overflow incontinence?
Bladder scan
When do you leak?
Cough, sneeze, heavy lifting or when they couldn’t reach to the toilet on time ?
Urge incontinence
Gu infections
UTI
Non-parenchymal infection
Parenchymal infection
What is Non-parenchymal infection?
Cystitis
-LUTS
What is Parenchymal Infection?
- Pyelonephritis
- Prostatitis, orchi-epididymitis
- Fever, generally unwell
What is the treatment for UTI?
Cystitis
-Nitrofurantoin for 3 days
Trimethroprim for 3 days
What is the treatment of pyelonephritis ?
What is the treatment for Male urethritis ?
Chlamydial urethritis
-Doxycycline 100 mg BD for 7 days
Gonococcal urethritis
- Ceftriaxone 500mg intramuscular injection
Where would you refer a male urethritis?
Refer to genito-urinary medicine (GUM) clinic or local specialist sexual health service
- screen for STIs
- Perform contact tracing
What is risk classification of prostate carcinoma?
1) PSA
4-10-20-50
2) Grade Gleason score
6-7-8/9/10
3) Stage
Imaging for prostate
-MRI of prostate
-abdomen and pelvis CT scan
Bone Scan
What is the main risk of Prostate Carcinoma?
