Lower Urinary Tract Dysfunction (2)

Question 1

Retention:
What are its acute causes?
→ How is this managed?

What are its chronic causes?
→ How is this managed?

Answer 1

➊ BPH, Urethral stricture (recent trauma/catheterisation), or UTI
→ Catheterisation and a-blocker (e.g. tamsulosin)

➋ BPH, Prostatitis, Tumour
→ U&Es and Urology referral

Question 2

Incontinence:
What occurs in Urge type?
→ Why is social hx so important here?

What occurs in Stress type?

What occurs in Overflow type?
→ What is it due to?

Answer 2

➊ Detrusor overactivity, causing symptoms of urgency
→ Can be very embarrassing for pts; can have a significant impact on their quality of life

➋ Weakness of pelvic floor and sphincter muscles, allowing urine to leak when there’s increased intra-abdominal pressure e.g. laughing, coughing, sneezing, exercise

➌ Small leaks of urine w/o warning – This occurs when pressure in the bladder overcomes the pressures of the outlet
→ • Detrusor underactivity e.g. Anticholinergics, MS, DM, Tumours
• High urinary outlet pressures e.g. BPH, prostatism, constipation