LUTS

Question 1

LUTS symptoms

Answer 1

Voiding systems: (Obstructive)
- Weak of intermittent urinary flow
- Straining
- Hesitancy
- Terminal dribbling
- Incomplete emptying
Storage symptoms (irritative)
- urgency
- frequency
- urinary incontinence
- nocturia
- intermittency
Post micturition
- dribbling

Question 2

Questions to ask

Answer 2

How often do you go during the day? FREQUENCY
Do yo have to rush to the toilet? URGENCY
How often do you get up at night to pass urine? NOCTURIA
Do you ever leak urine, and if so when, how much and how often? INCONTINENCE
When you want to go can you go straight away or do you have to wait? HESITANCY
Do you feel you empty your bladder completely? INCOMPLETE EMPTYING

Question 3

Investigations

Answer 3

FIRST LINE = DRE: shows smooth but enlarged prostate with maintained central sulcus
PSA: high due to more prostate cells
Urinary frequency volume chart: Diary of freq + volume of voiding = minimum 3 days
Urine dipstick: infection, haematuria (bladder cancer)
U+E: if chronic retention

Question 4

How to fill bladder diary

Answer 4

Record Input
- eat + volume
- drink + volume
Record output
- How many times
- Length of time of stream
- Leakage
- Strong urgency’s = what activity doing at time of urgency

Normal voiding =
- 2 1/2 - 4 hours (5-9 times at day)
- Non at night or only once

Question 5

Pros of PSA testing

Answer 5

• help pick up prostate cancer before symptoms
• help pick up fast growing cancer at early stage
• individuals at higher risk of prostate cancer = cancer can be picked up before

Question 6

Cons of PSA testing

Answer 6

• Your PSA level might be raised, even if you don’t have prostate cancer.
  The PSA test can miss prostate cancer - 1 in 7 men with a normal PSA level may have prostate cancer, and 1 in 50 men with a normal PSA level may have a fast-growing cancer.
  If your PSA level is raised you may need a biopsy. This can cause side effects, such as pain, infection and bleeding. But in most hospitals, men now have an MRI scan first, and only have a biopsy if the scan finds anything unusual.
  Being diagnosed with a slow-growing prostate cancer that is unlikely to cause any problems or shorten your life may still make you worry, and may lead you to have treatment that you don’t need. But most men with low-risk, localised prostate cancer now have their cancer carefully monitored instead, and only have treatment if the cancer starts to grow.

Question 7

BPHIL treatment

Answer 7

FIRST LINE = TAMSULOSIN, alfuzosin = alpha-1 antagonist
- decrease smooth muscle tone of the prostate + bladder
- first line if IPSS > 8
- side effects = dizziness, POSTURAL HYPOTENSION, dry mouth, depression
SECOND LINE = FINASTERIDE = 5-alpha reductase inhibitors
- blocks conversion of testosterone to dihydrotestosterone = reduction in prostate volume may slow disease progression
- can take 6 months for symptoms to improve
- side effects: erectile dysfunction, reduced libido, ejaculation problems, gynaecomastia
THIRD LINE = Tamsulosin + Finasteride