Lower urinary tract symptoms

Question 1

What does LUTS stand for?

Answer 1

Lower urinary tract symptoms

Question 2

In older men, what is most likely to cause LUTS?

Answer 2

Benign prostatic hyperplasia

Question 3

In females what is the most common cause of LUTS?

Answer 3

Lower urinary tract infection

Question 4

What can cause LUTS?

Answer 4

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

Question 5

What things can exacerbate LUTS?

Answer 5

Drinking late at night, excess alcohol or caffeine intake

Question 6

What are storage symptoms?

Answer 6

Symptoms when the bladder should be storing urine e.g urgency, frequency, nocturia and urgency incontinence

Question 7

What are voiding symptoms?

Answer 7

Symptoms due to bladder outlet obstruction making it more difficult to pass urine e.g. hesitancy, intermittency, straining, terminal dribbling, incomplete emptying

Question 8

What are post micturition symptoms?

Answer 8

A term for the post micturition dribble and incomplete emptying

Question 9

What associated symptoms should you ask about along with LUTS?

Answer 9

Haematuria, suprapubic discomfort or colicky pain, medication history

Question 10

What medication can exacerbate LUTS?

Answer 10

Anticholinergics
Antihistamines
Bronchodilators

Question 11

What examinations should be done when LUTS is present?

Answer 11

DRE and external genitalia exam

Question 12

What score can be used to monitor the impact of LUTS on quality of life in men?

Answer 12

International prostate symptom score

Question 13

What are the initial investigations for someone with LUTS?

Answer 13

Post-void bladder scanning and flow rate
Urinalysis
Routine blood tests

Question 14

What does a post-void bladder scanning and flow rate show?

Answer 14

Will help distinguish between different causes of LUTS and quantify the severity
Can show this by a urinary frequency and volume chart

Question 15

What is urinalysis?

Answer 15

Assesses for signs of UTI and haematuria and glycosuria

Urine culture can be sent to investigate if infection is present

Question 16

What routine blood tests would you do?

Answer 16

FBC and U and E
for a baseline assessment especially if infection or renal impairment is suspected
PSA can also be done

Question 17

What specialist investigations would you do?

Answer 17

Urodynamic studies

Upper urinary tract imaging

Question 18

What does a urodynamic study do?

Answer 18

Assess flow rate, detrusor pressure and storage capacity.

Cystoscopy is the gold standard

Question 19

What does upper urinary tract imaging show?

Answer 19

Ultrasound or CT scanning is history of chronic retention, infections or haematuria

Question 20

What is the initial management for LUTS?

Answer 20

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

Question 21

What is the pharmacological management for overactive bladder?

Answer 21

anticholinergics help to relax the bladder muscle by opposing the parasympathetic cholinergic control of contraction
e.g. Mirabegron (B3 Adrenergic agonist)

Question 22

What is the pharmacological management for BPH?

Answer 22

Alpha blockers e.g. alfuzosin or Tamsulosin

5a- reductase inhibitors e.g. finasteride can reduce prostate size by relaxing the prostate muscle

Question 23

What is the pharmacological management for nocturia?

Answer 23

Loop diuretics eg. furosemide or bumetanide can be taken mid afternoon to prevent nocturia but this is unlicensed

Question 24

What are the complications of LUTS?

Answer 24

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