Lower urinary tract symptoms Flashcards
What does LUTS stand for?
Lower urinary tract symptoms
In older men, what is most likely to cause LUTS?
Benign prostatic hyperplasia
In females what is the most common cause of LUTS?
Lower urinary tract infection
What can cause LUTS?
BPH or menopause, UTI, urological malignancy, detrusor muscle weakness or instability, chronic prostatitis, urethral stricture, external compression e.g. faecal impaction or pelvic tumour, neurological disease e.g MS, spinal cord injury
What things can exacerbate LUTS?
Drinking late at night, excess alcohol or caffeine intake
What are storage symptoms?
Symptoms when the bladder should be storing urine e.g urgency, frequency, nocturia and urgency incontinence
What are voiding symptoms?
Symptoms due to bladder outlet obstruction making it more difficult to pass urine e.g. hesitancy, intermittency, straining, terminal dribbling, incomplete emptying
What are post micturition symptoms?
A term for the post micturition dribble and incomplete emptying
What associated symptoms should you ask about along with LUTS?
Haematuria, suprapubic discomfort or colicky pain, medication history
What medication can exacerbate LUTS?
Anticholinergics
Antihistamines
Bronchodilators
What examinations should be done when LUTS is present?
DRE and external genitalia exam
What score can be used to monitor the impact of LUTS on quality of life in men?
International prostate symptom score
What are the initial investigations for someone with LUTS?
Post-void bladder scanning and flow rate
Urinalysis
Routine blood tests
What does a post-void bladder scanning and flow rate show?
Will help distinguish between different causes of LUTS and quantify the severity
Can show this by a urinary frequency and volume chart
What is urinalysis?
Assesses for signs of UTI and haematuria and glycosuria
Urine culture can be sent to investigate if infection is present
What routine blood tests would you do?
FBC and U and E
for a baseline assessment especially if infection or renal impairment is suspected
PSA can also be done
What specialist investigations would you do?
Urodynamic studies
Upper urinary tract imaging
What does a urodynamic study do?
Assess flow rate, detrusor pressure and storage capacity.
Cystoscopy is the gold standard
What does upper urinary tract imaging show?
Ultrasound or CT scanning is history of chronic retention, infections or haematuria
What is the initial management for LUTS?
Treat underlying pathology
Regulate fluid intake e.g. timing and volume of drinks, reduce caffeine and alcohol
If voiding symptoms then urethral milking techniques or double voiding, pelvic floor exercises and baller training techniques
What is the pharmacological management for overactive bladder?
anticholinergics help to relax the bladder muscle by opposing the parasympathetic cholinergic control of contraction
e.g. Mirabegron (B3 Adrenergic agonist)
What is the pharmacological management for BPH?
Alpha blockers e.g. alfuzosin or Tamsulosin
5a- reductase inhibitors e.g. finasteride can reduce prostate size by relaxing the prostate muscle
What is the pharmacological management for nocturia?
Loop diuretics eg. furosemide or bumetanide can be taken mid afternoon to prevent nocturia but this is unlicensed
What are the complications of LUTS?
increased risk of infection, calculi, choleric obstruction can cause bladder wall hypertrophy or distension which can lead t overflow incontinence, renal failure, bilateral hydronephrosis
Acute urinary retention in BPH
