LUTS Flashcards

1
Q

Causes of LUTS

A
  • BPH
  • UTI
  • Bladder/prostate cancer
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2
Q

History for LUTS/urology in general

A
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3
Q

What can exacerbate LUTS apart of lifestyle?

A
  • Drinking fluids late at night
  • Excess alcohol
  • Excess caffeine
  • Polyuria eg due to diabetes or diuretic can exacerbate or mimic
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4
Q

LUTS classification

A

FUN WISE
Storage:
* Frequency
* Urgency
* Nocturia

Voiding:
* Weak stream
* Intermittency/hesitancy
* Straining
* Emptying - feeling of incomplete

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5
Q

Associated symptoms to ask about when someone presents with LUTS

A
  • Visible haematuria
  • Suprapubic discomfort
  • Colicky pain
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6
Q

Drugs that exacerbate LUTS

A
  • Anticholinergics
  • Antihistamines
  • Bronchodilators
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7
Q

What scoring system can be used to assess and monitor LUTS in men?

A

International prostate symptom score
* Monitor impact and QOL

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8
Q

Initial investigations for LUTS

A
  • Post void bladder scan - eg if OAB will be low, if BPH will be high –> distinguishes cause
  • Flow rate - urinate into machine
  • Bladder diary - patterns?
  • Urinalysis + culture
  • Bloods - FBC, U&E, PSA
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9
Q

Specialist investigations for LUTS

A
  • Urodynamic studies - assess flow rate, detrusor pressure and storage capacity (abdo (eg vagina/rectum), bladder, detrusor pressure)
  • Cystoscopy - GOLD standard for lower urinary tract
  • Upper urinary tract imaging - US or CT
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10
Q

When are urodynamic studies done (for women specifically)?

A
  • Failed medical treatment for OAB or stress urinary incontinence
  • Being considered for more invasive options
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11
Q

Management of LUTS - conservative

A
  • Regulate fluid intake - reduce caffeine and alcohol in evenings
  • Urethral milking techniques if voiding symptoms - manually emptying bulbar urethra
  • Double voiding - pass and then remain before passing again
  • Pelvic floor exercises - stress incont or post mic dribble
  • Bladder training - OAB
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12
Q

Medical management LUTS

A
  • Anticholinergics - eg oxybutynin or tolterodine for OAB
  • Mirabegron (B3 adrenergic agonist) can also help with OAB
  • Alpha blockers eg Tamsulosin or 5a reductase inhibitors eg Finasteride for BPH
  • Loop diuretics mid afternoon to prevent nocturia - unlicensed use (Desmopressin also shown to help this)
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13
Q

Complications LUTS

A
  • Increased risk infection, renal and bladder calculi - if retain post mic (stasis)
  • Chronic –> bladder wall muscle hypertrophy or distension –> overflow incontinence
  • Renal failure/hydronephrosis
  • Acute retention
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14
Q
A
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