Lower urinary tract

Question 1

Storage symptoms (FUN)

Answer 1

1. Frequency - high frequency of voiding during waking hours
2. Urgency - difficulty to defer desire to pass urine
3. Nocturia - need to awaken to void urine
   • Daytime freq w/o nocturia = anxiety
   • Nocturia alone - heart failure/obstructive sleep apnea

Question 2

Voiding symptoms

Answer 2

1. Hesitancy - difficulty initiating micturition
2. Straining - muscular effort required to initiate/maintain urinary stream
3. Slow/Weak stream
4. Intermittent stream - urine flow stops and starts during micturition
5. Dribbling - terminal release of urine at the end of micturition
6. Incomplete emptying

Question 3

Incontinence symptoms

Answer 3

1. Stress continence - involuntary loss of urine on physical exertion
2. Urge incontinence - involuntary leakage of urine on urgency
3. Continous incontinence - constant loss of urine

Question 4

Benign prostatic hyperplasia

Answer 4

Enlarged prostate which pushes against the bladder and urethra

Question 5

Clinical features of BPH

Answer 5

• FUN symptoms
• HITS ( hesitancy, intermittency and stream reduction)
• Acute urinary retention
• Chronic retention and bladder neck obstruction can lead to renal impairment

Question 6

Investigations of BPH

Answer 6

• DRS
• Prostate specific antigen
• Urinalysis
• Flow rates

Question 7

Acute urinary retention

Answer 7

Sudden inability to pass urine and is a emergency
• Urge to pass urine but is unable to do so, bladder continues to get distended
• Bladder is palpable and dull to percuss
• Catheter must be inserted as soon as possible

Question 8

Overactive bladder

Answer 8

Characterised by sudden urge to urinate that cannot be controlled
(FUN)
No ovbious pathology