LUTS

Question 1

Divide lower urinary tract symptoms into 3 main categories

Answer 1

Storage, voiding, postmictural symptoms

Question 2

Classify the LUTS which are considered symptoms of storage dysfunction

Answer 2

Incontinence (stress, urge, mixed)
Increased daytime frequency
Nocturia
Urgency
Overactive bladder

Question 3

Define incontinence

Answer 3

Involuntary leakage of urine

Question 4

Define stress incontinence

Answer 4

involuntary leakage of urine secondary to exertion or increased intrabdominal pressure (exercise/coughing/sneezing)

Question 5

Define urge incontinence

Answer 5

Involuntary leakage of urine associated with the symptom of urgency

Question 6

Define urgency

Answer 6

Sudden strong desire to pass urine which is difficult to defer

Question 7

What are the symptoms of overactive bladder

Answer 7

Urgency, usually associated with frequency and nocturia. Can be wet (with urge incontinence) or dry (no incontinence). In the absence of underlying pathology or UTI

Question 8

What concentration of bacteria is considered significant to be classified as bacteruria?

Answer 8

> 105 organisms/ml

Question 9

Which organisms are considered “fastidious” in recurrent uti?

Answer 9

Mycoplasma homini
Ureaplasma urelyticum
Chlamydia trachomatis

Question 10

Which LUTS are classified as voiding symptoms?

Answer 10

Hesitancy, straining, slow stream, terminal dribble

Question 11

Which LUTS are classified as postmictural symptoms?

Answer 11

sensation of incomplete bladder empyting, postmictural leak

Question 12

What is the most common type of incontinence in women?

Answer 12

Stress

Question 13

How common a lower urinary tract symptoms?

Answer 13

Lowest reported incidence is 39%

Upper estimate is 67%

Question 14

What is the aetiology of stress incontinence?

Answer 14

Poor suburethral support (urethral hypermobility) or intrinsic urethral incontinence, or a combination of the two

Question 15

What is the most common group of LUTS symptoms?

Answer 15

Storage symptoms

Question 16

What is the prevalence of OAB?

Answer 16

13-16%

Question 17

What proportion of women with OAB have urge leakage?

Answer 17

1/3

Question 18

Which type of urinary incontinence is most prevalent in the elderly?

Answer 18

Mixed and urge incotinence

Question 19

Describe the anatomical parts of the urethra which contribute to its resting closure pressure

Answer 19

1) Outer circular striated muscle supplied by the pudendal nerve - voluntary control
2) middle smooth muscle supplied by sympathetic (alpha adrenergic contract) and parasympathetic (nitric oxide relax)
3) inner mucosa and submucosa
All 3 layers contribute a third of the tone each

Question 20

Describe parasympathetic innervation of urinary control

Answer 20

Sacral nerves 2-4 supply muscarinic M3 receptors in the bladder (contraction for voiding) and nitric oxide receptors of the smooth muscle middle layer of the urethra (relaxation for voiding)

Question 21

Describe sympathetic innervation of urinary control

Answer 21

T10-L2 via the hypogastric nerve and pelvic nerves supply alpha adrenergic receptors in the bladder( contraction of bladder neck smooth muscle and inhibition of parasympathetic supply to the detrusor muscle) and supply the inner smooth muscle layer of the urethra causing contraction

Question 22

Incidence of LUTs and pelvic organ prolapse

Answer 22

38%

Question 23

Incidence of LUTs and faecal incontinence

Answer 23

31%

Question 24

What volume of a post void residual is considered abnormal?

Answer 24

Any volume greater than 100ml

Question 25

What is a normal volume of water to drink in a day?

Answer 25

1.5-2litres

Question 26

What is a normal amount of times to pass urine in the day and at night?

Answer 26

<8 in the day, once at night