LUTS Flashcards
1
Q
Causes of LUTS
A
- BPH
- UTI
- Bladder/prostate cancer
2
Q
History for LUTS/urology in general
A
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
4
Q
LUTS classification
A
FUN WISE
Storage:
* Frequency
* Urgency
* Nocturia
Voiding:
* Weak stream
* Intermittency/hesitancy
* Straining
* Emptying - feeling of incomplete
5
Q
Associated symptoms to ask about when someone presents with LUTS
A
- Visible haematuria
- Suprapubic discomfort
- Colicky pain
6
Q
Drugs that exacerbate LUTS
A
- Anticholinergics
- Antihistamines
- Bronchodilators
7
Q
What scoring system can be used to assess and monitor LUTS in men?
A
International prostate symptom score
* Monitor impact and QOL
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
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
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
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
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)
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
14
Q
A