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Genitourinary > Lower Urinary Tract Symptoms (LUTS) > Flashcards

Lower Urinary Tract Symptoms (LUTS) Flashcards

1
Q

What anatomical structures make up the lower urinary tract?

A

Bladder -> bladder neck -> prostate gland -> urethra and urethral sphincter.

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2
Q

Give 4 functions of the lower urinary tract.

A
  1. Storage of urine.
  2. Converts the continuous process of excretion to an intermittent, controlled and volitional process.
  3. Prevents leakage of stored urine.
  4. Allows rapid, low pressure voiding.
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3
Q

Is the detrusor muscle relaxed or contracted during storage?

A

Relaxed.

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4
Q

Is the detrusor muscle relaxed or contracted during voiding?

A

Contracted.

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5
Q

Is the urethral sphincter relaxed or contracted during storage?

A

Contracted.

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6
Q

Is the urethral sphincter relaxed or contracted during voiding?

A

Relaxed.

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7
Q

What is the role of the cortex in micturition?

A

It has roles in sensation and voluntary initiation of voiding.

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8
Q

What is the role of PMC/PAG in micturition?

A

Co-ordination and completion of voiding.

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9
Q

What type of epithelium lines the bladder?

A

Urothelium (transitional epithelium) - pseudo-stratified.

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10
Q

What brain centres are involved in the normal physiology of voiding?

A
  1. Cortex
    - Sensation of “full bladder”
    - Initiation of voiding
  2. Pontine micturition centre
    - Completion of voiding
    - Co-ordination
  3. Spinal reflexes
    - Reflex bladder contraction – Sacral micturition centre
    - Guarding reflex – Onuf’s nucleus
    - Receptive relaxation – Sympathetic pathway
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11
Q

Describe the physiology of micturition.

A

The bladder fills and stretch receptors are stimulated. Afferent impulses stimulate parasympathetic action of detrusor muscle; it contracts. The urethral sphincters relax; this is mediated by inhibition of the neurones to them. The PAG is stimulated.

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12
Q

What do the sympathetic, parasympathetic and somatic systems do during micturition?

A
  1. Parasympathetic cholinergic innervation
    - S3, S4 + S5
    - Detrusor contraction during voiding
    - Sphincter relaxation (smooth muscle)
  2. Sympathetic noradrenergic innervation
    - T10, L1, L2
    - Inhibition of detrusor contraction
    - Sphincter contraction (smooth muscle)
  3. Somatic innervation
    - Sphincter contraction/relaxation (striated muscle)
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13
Q

What are lower urinary tract symptoms (LUTS) in men > 50 likely to be due to?

A

Benign prostatic enlargement.

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14
Q

LUTS: give 3 symptoms of storage problems.

A
  1. Frequency.
  2. Urgency.
  3. Nocturia (>30% voided volume is at night).
  4. Incontinence.
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15
Q

LUTS: give 4 symptoms of voiding problems.

A
  1. Straining.
  2. Hesitancy.
  3. Incomplete emptying.
  4. Poor flow.
  5. Intermittency.
  6. Terminal dribbling.
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16
Q

LUTS: give 2 symptoms of post-micturition problems.

A
  1. Sensation of incomplete voiding.
  2. Post-micturition dribbling.
17
Q

What investigations might you do on someone who presents with LUTS?

A
  1. Urinary tests e.g. dipstick.
  2. Urinary flow: maximum flow rate and residual volume are important.
  3. Symptom assessment: international prostate scoring system.
  4. Blood tests e.g. PSA, U+E.
18
Q

Describe the treatment for someone who presents with mild LUTS.

A

Reassurance, watch and wait.

19
Q

Describe the treatment for someone who presents with moderate LUTS.

A
  1. Fluid management, avoid caffeine.
  2. Bladder drill / Bladder training.
    - A programme to re-train the bladder to become less overactive
20
Q

Give 2 pharmacological therapies used in the treatment of moderate to severe LUTS.

A
  1. Alpha-1-blockers e.g. tamulosin.
  2. 5-alpha-reductase-inhibitors.
21
Q

How do alpha-1-blockers work in the management of LUTS?

A

They cause vasodilation and so reduced resistance to bladder outflow.

22
Q

Give 2 potential side effects of tamulosin.

A

Tamulosin is an alpha-1-blocker used in the treatment of LUTS. 2 side effects include hypotension and retrograde ejaculation.

23
Q

How do 5-alpha-reductase-inhibitors work in the management of LUTS?

A

They inhibit the conversion of testosterone to dihydrotestosterone and so reduce prostate size.

24
Q

Give 5 potential consequences of untreated LUTS.

A
  1. Bladder calculi (stones).
  2. UTI.
  3. Urinary incontinence.
  4. Reduced QOL.
  5. Acute urinary retention.
25
Q

Give 3 symptoms of acute urinary retention.

A
  1. PAINFUL!
  2. Sudden onset.
  3. > 500ml of urine in bladder.
26
Q

What investigations might you do in someone with acute urinary retention?

A
  1. Clinical examination: palpable bladder?
  2. MRI / Renal ultrasound.
  3. Bloods - normal renal biochemistry; PSA test
  4. Neurological tests; could be a sign of spinal cord compression e.g. pain in back, loss of anal reflex, leg weakness.
27
Q

Name a rare but serious cause of acute urinary retention.

A

Spinal cord compression.

28
Q

Describe the treatment for someone with acute urinary retention.

A
  1. Reassurance
  2. Catheter relieves pain
  3. Alpha-1 blocker
    - E.g. TAMSULOSIN
    - Relaxes smooth muscle in bladder neck to aid voiding
  4. Prevent by giving 5-alpha-reductase inhibitor
    - E.g. FINASTERIDE
    - Reduces testosterones conversion to dihydrotestosterone and thus reduces prostate size
29
Q

What are the indications for surgery for LUTS?

A

RUSHES:
R - Retention
U - UTI’s
S - Stones
H - Haematuria
E - Elevated creatinine due to bladder outflow obstruction
S - Symptoms deterioration

30
Q

Name 3 types of incontinence.

A
  1. Stress - associated with coughing or sneezing.
  2. Urgency.
  3. Mixed - stress and urgency.
  4. Continuous - due to fistula.
31
Q

What is first line for urgency incontinence?

A

Oxybutynin - antimuscarinic
- Prevent parasympathetic contraction of detrusor

32
Q

Give a reason why incontinence in men is less common than it is women.

A

Men have a bladder neck mechanism and a strong urethral sphincter whereas women have only a weak urethral sphincter.

33
Q

What is the main cause of stress incontinence in women?

A

Stress incontinence is usually secondary to birth trauma.

34
Q

Describe the treatment for stress incontinence in females.

A
  1. Pelvic floor physio.
  2. Duloxetine (concerns over SE’s).
  3. Surgery.
35
Q

What is the main cause of stress incontinence in men?

A

Neurogenic or iatrogenic (prostatectomy).

36
Q

Describe the treatment for stress incontinence in males.

A
  1. Artificial sphincter.
  2. Sling.
37
Q

What is the treatment for stress incontinence?

A
  1. Bladder training.
  2. Duloxetine (SNRI)
38
Q

What are the symptoms of an overactive bladder?

A

Urgency and frequency in the absence of local pathology that would account for these symptoms.

39
Q

Describe the treatment for an overactive bladder.

A
  1. Behavioural e.g. limit caffeine and alcohol, bladder drill, hypnotherapy.
  2. Pelvic floor physio.
  3. Muscarinic antagonists.
  4. Beta 3 agonists.
  5. Botox.
  6. Cystoplasty.

Genitourinary (17 decks)

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