LUTS

Question 1

What is a risk factor for LUTS?

Answer 1

Diabetes, cardiovascular disease, obesity, sedentary lifestyle, and erectile dysfunction

Question 2

LUTS are categorized as symptoms related to

Answer 2

storage, voiding, or postmicturition

Question 3

What are storage symptoms?

Answer 3

Urgency
Daytime frequency
Nocturia
Incontinence
Abnormal bladder sensation

Question 4

What are voiding symptoms?

Answer 4

Slow stream
Intermittent stream
Hesitancy
Straining to void
Terminal dribble - prolongation of final part of micturition when the flow has slowed to a trickle/dribble
Dysuria

Question 5

What are postmicturition symptoms?

Answer 5

A sensation of incomplete emptying after passing urine
Postmicturition dribble (post-void) Involuntary loss of urine shortly following urination usually after leaving the toilet

Question 6

What causes LUTS in males primarily?

Answer 6

BPH, bladder outlet obstruction and OAB

Question 7

What is OAB?

Answer 7

Syndrome of urinary urgency, with or without urgency incontinence, usually accompanied by increased frequency during both daytime and nighttime nocturia

Question 8

What questions do you ask for LUTS?

Answer 8

Onset of s/s
Duration
Severity of symptoms
On antidepressants, diuretics, bronchodilators, and antihistamines
Initially perform UA

Question 9

Initial management for LUTS includes

Answer 9

lifestyle and behavioral interventions including:
Limiting fluid intake before bedtime or prior to travel
Limiting intake of mild diuretics
Limiting intake of bladder irritants (highly seasoned or spicy foods)
Avoiding constipation
Increasing activity
Weight control
Timed voiding regimens
Double-voiding techniques
Pelvic floor muscle training

Question 10

Alpha blockers improve the symptoms of

Answer 10

BPH, and can also improve some bladder irritability symptoms (exception is patients with significant nocturia)

Question 11

For patients with isolated OAB and persistent symptoms despite lifestyle modification, a

Answer 11

beta-3 agonist (Mirabegron and Vibegron) is recommended as antimuscarinic agents are associated with more side effects including risk of dementia

Question 12

A post void residual that is between 300-400 should have upper tract imaging such as

Answer 12

Renal US to assess for hydronephrosis

Question 13

If there is concern for OAB, a _____ should be check

Answer 13

Urodynamic study

Question 14

What are two indications for cystoscopy?

Answer 14

Microscopic hematuria and recurrent UTIs

Question 15

Urinary hesitancy and weak stream could indicate

Answer 15

obstruction; would need cystoscopy to evaluate