Lower Urinary Tract Dysfunction Flashcards
2 categories of LUTS
Voiding
Storage
Voiding symptoms
Hesitance in micturition
Poor flow (<10mL/s)
Terminal dribble
Feeling of incomplete emptying
Storage
Inc urinary freq
Nocturia
Inc sense of urgency to urinate
Urge incontinence
Causes of LUTS in men
BPH UTI Urological malignancy Detrusor muscle weakness or instability Chronic prostatitis Urethral stricture External compression eg pelvic tumour, faecal impaction Neurological dx eg MS
Causes LUTS in female
UTI
Menopause
Gold standard investigation for LUT
Cystoscopy
Conservative management of LUTS
Treat underlying pathology
Regulate fluid intake eg dec caffeine
Pelvic floor exercise
Bladder training techniques
Pharmacological management of LUTS
Anticholinergics eg oxybutynin, tolterodine
Alpha blockers eg alfuzosin or tamsulosin
5-alpha reductase inhibitors eg finasteride
Urge incontinence
Strong desire to void which may not be controllable
Bladder= unstable with high detrusor muscle activity
Stress incontinence
Small amounts of urine are voided due to rises in intraabdominal pressure eg coughing.
Occurs due to weakened external sphincter, and is commoner in parous women and post-menopausal women w urethral atrophy
Urge incontinence management
Bladder training- inc time between voids
Duloxethine
Tolterodine OR oxybutynin
Stress incontinence management
Pelvic floor physio
Vaginal tampons
Oestrogen creams- for post-menopausal women
Surgery- to support urethra
Duloxethine MOA
Serotonin/NA uptake inhibitor
Decreases detrusor excitability/activity
Tolterodine or oxybutynin MOA
Anticholinergic agent
Decreases detrusor excitability/activity
Alfuzosin or tamsulosin MOA
alpha blockers
