Lower urinary tract symptoms

Question 1

Causes of LUTS

Answer 1

• UTI
• Urological malignancy
• Detrusor muscle weakness or instability
• Urethral stricture
• External compression e.g. pelvic tumour, faecal impaction
  tumour, faecal impaction
• Neurological disease e.g. multiple sclerosis, spinal cord injury

Question 2

Male specific causes of LUTS

Answer 2

BPH

Chronic prostatitis

Question 3

Female specific causes of LUTS

Answer 3

Menopause

Question 4

Risk factors for LUTS

Answer 4

Drinking fluid late at night
Excess alcohol
Excessive caffeine

Polyuria due to:

• DM
• Diuretics
• Excessive fluid intake

Question 5

Storage symptoms

Answer 5

Urgency
Frequency
Nocturia
Urgency incontinence

Question 6

Voiding symptoms

Answer 6

Hesitancy
Intermittency
Straining and spraying
Terminal dribbling
Incomplete emptying

Question 7

Associated symptoms

Answer 7

Haematuria
Suprapubic discomfort
Colicky pain
Medication history

Question 8

Medication that can exacerbate LUTS

Answer 8

Anticholinergics

Antihistamines Bronchodilators

Question 9

Investigations

Answer 9

DRE

Examination of external genitalia

Bladder diary

Urinalysis and culture

Routine bloods + PSA

Post void bladder scanning

Urodynamic studies

Cystoscopy - gold standard

Question 10

Urodynamic studies use

Answer 10

Assess flow rate
Detrusor pressure
Storage capacity

Question 11

Upper urinary tract imaging indication and modality

Answer 11

USS
CT

Used in chronic retention, history of recurrent infection or haematuria

Question 12

Conservative Management

Answer 12

Don’t drink late at night
Reduce caffeine and alcohol intake

Bladder training

Stress incontinence:
- Pelvic floor exercises

Voiding:

• urethral milking
• double voiding

Question 13

Overactive bladder management (urge)

Answer 13

Anticholinergics (e.g. oxybutynin, tolterodine)

Mirabegron - β3 adrenergic agonist

Question 14

BPH management

Answer 14

Alpha blockers (e.g. alfuzosin, tamsulosin) +/- 5α-reductase inhibitors - finasteride

Question 15

Stress incontinence management

Answer 15

Pelvic floor exercises

Question 16

Complications of LUTS

Answer 16

Infection

Renal or bladder calculi - due to stagnated urine

Question 17

Investigations for haematuria

Answer 17

Abdominal exam 
Routine bloods 
PSA
DRE
Urinalysis + MC+S
Albumin: creatinine ratio
Flexible cystoscopy (+ biopsy) - gold standard 
Imaging

Question 18

Haematuria imaging

Answer 18

US KUB imaging - non visible

CT Urogram - visible haematuria, sensitive for upper tract tumours

Question 19

Medical cause of haematuria

Answer 19

Rifampicin
Cyclophosphamide
Naproxen
Nitrofurantoin

Question 20

Terminal haematuria cause

Answer 20

Severe bladder irritation e.g. stone

Question 21

Causes of haematuria

Answer 21

Renal:
• Infarct
• Trauma: inc. Renal calculi
• pyelonephritis
• Neoplasm
• Glomerulonephritis
• Polycystic kidneys

Ureter:
• Stone
• urothelial carcinoma

Bladder:
• Cystitis
• Stones
• Tumour
• Exercise
• Radiation cystitis
• Parasitic - schistosomiasis

Prostate:
• BPH
• Prostatitis
• prostate adenocarcinoma

Urethra:
• Infection
• Stones
• Trauma
• Tumour

Question 22

Clinical features of haematuria

Answer 22

• Timing:
- Beginning of stream: urethral
- Throughout stream: renal / systemic, bladder
- End of stream (terminal): bladder stone, schistosomiasis
• Painful or painless?
• Obstructive symptoms?
• Systemic symptoms: wt. loss, appetite