Lower Urinary Tract Symptoms

Question 1

Sympathetic vs Parasympathetic
- Retention and Urination

Answer 1

Sympathetic = Retention
- Flight or Flight

Parasympathetic = Urination
- Relaxation

Question 2

LUTS
- Categories of Symptoms

Answer 2

Storage
Voiding
Post Micturition

Question 3

LUTS
- Storage Symptoms

Answer 3

Urgency
Incontinence
Frequency
Nocturia

Question 4

LUTS
- Voiding Symptoms

Answer 4

Slow Stream
Splitting/Spraying
Intermittent Stream
Hesitancy
Straining
Terminal Dribble

Question 5

LUTS
- Post Micturition Symptoms

Answer 5

Feeling of incomplete emptying
Post Micturition dribble

Question 6

LUTS
- Other

Answer 6

Leakage during intercourse
Genital Pain

Question 7

Overactive Bladder Syndrome

Answer 7

Urgency
- With or without incontinence
- Frequent urinations and nocturia

Question 8

Bladder Outlet Obstruction

Answer 8

Voiding symptoms in men

Question 9

LUTS and Prevelance

Answer 9

Common in older adults, however, many do not seek consultation with a professional

Question 10

Benign Prostatic Hyperplasia

Answer 10

Prostate enlarges due to testosterone exposure
- Compresses on urethra leading to urinary tract symptoms

Question 11

Requirements for Continence

Answer 11

Cognitive Ability

Mobility

Manual Dexterity

Balance and Coordination

Motivation to stay dry

Question 12

Risk factor for LUTS

Answer 12

D: Delirium, Dementia
I: Infection
P: Pharmaceuticals
P: Psychological
E: Excessive Urine Output, Endocrine
R: Restricted Mobility
S: Stool Impaction, Stroke, Spinal Cord Injury

Question 13

LUTS
- Drugs that decrease awareness

Answer 13

• Ethanol
• Psychotropic Medications
• Muscle Relaxants
• Opioids

Question 14

LUTS
- Drugs that cause retention

Answer 14

• Alpha Agonists (Phenylephrine)
• Anticholinergics (Scopolamine)
• Calcium Channel Blockers (Diltiazem)

Question 15

LUTS
- Drugs that cause urine loss

Answer 15

• Alpha Antagonists (Terazosin)
• Cholinergic Agonists (Cholinesterase Inhibitors)
• Diuretics (Furosemide)
• Glucocorticoids (Prednisone)
• Sympatholytics (Clonidine)
• Bladder Irritants (Ketamine)

Question 16

Urgency/Overactive Bladder
- Description

Answer 16

Urge to void precedes incontinence by only a few seconds
- Periodic voiding of moderate to large amounts
- Common nocturnal incontinence
- Low PVR (Little urine remains)

Question 17

Urgency/Overactive Bladder
- Mechanism

Answer 17

• Detrusor overactivity (Involuntary contraction of bladder)
• Damage to inhibitory centre
• Local irritation
• Bladder stimulants (Cholinergic Drugs)

Question 18

Stress Incontinence
- Description

Answer 18

Incontinence that occurs during an increase of intraabdominal pressure
- Incontinence of small to moderate amounts
- Infrequent nocturnal incontinence

More common in women

Question 19

Stress Incontinence
- Mechanism

Answer 19

• Outlet incompetence (Decreased outlet resistance)
• Pelvic floor laxity (Childbirth trauma)
• Prostate or pelvic surgery
• Intrinsic sphincter deficiency

Question 20

Overflow Incontinence
- Description

Answer 20

Weight of urine exceeds outlet resistance
- Incontinence of frequent but small amounts
- Constant dribbling during night and day
- Incomplete emptying of bladder(High PVR)

More common in men

Question 21

Overflow Incontinence
- Mechanism

Answer 21

Outlet Obstruction
- Mass (Enlarged Prostate or Prolapse)
- Fecal Impaction
- Urethral Stricture

Detrusor Underactivity (Underactive bladder, does not empty completely)
- Atonic Neurogenic
- Atonic Myogenic

Question 22

Mixed Incontinence
- Description

Answer 22

Mixture of incontences
- usually urgency + stress
- Can be other combos

Question 23

Functional Incontinence
- Description

Answer 23

Urinary leakage caused by inability to reach toilet
- Factors outside urinary tract

Question 24

Functional Incontinence
- Mechanism

Answer 24

• Patient impaired cognitively and physically
• Psychological unwillingness
• Environmental barriers

Question 25

Nocturia
- Description

Answer 25

Getting up during main sleep period to pass urine

Question 26

Nocturia
- Mechanism

Answer 26

OAB or BPH

Often due to Nocturnal Polyuria which stems from multiple causes including comorbid conditions