LUTS

Question 1

Storage symptoms

Answer 1

Urgency
incontinence
frequency
nocturia

Question 2

Voiding symptoms

Answer 2

slow stream
hesitancy
straining
splitting/spraying

Question 3

Post micturition symptoms

Answer 3

Feeling of incomplete emptying
post micturition dribble

Question 4

Causes of LUTS (5)

Answer 4

cognitive and motivation
mobilty
dexterity
balance and coordination
aging

Question 5

aging effects

Answer 5

reduced bladder contraction and sensation
weaker urethral closing after menopause
BPH
sphincter tone decline

Question 6

LUTS risk factor

Answer 6

Physical status
genetic
neuropsychiatric
pelvic floor damage
IBD, menopause, constipation

Question 7

Retention drugs (3)

Answer 7

Alpha agonists
anticholinergic
Ca+ channel blockers

Question 8

Voiding drugs

Answer 8

alpha antagonists
cholinergic agonists
diuretics
glucocorticoids
Clonidine
Ketamine (irritant)

Question 9

DIPPERS

Answer 9

Delirium/dementia
infection
pharmaceuticals
psychological
excessive urine output
restricted mobile
stoke, spinal injury

Question 10

Urgency/OAB

Answer 10

Urge and void are very close (frequent large voids). from detrusor overactivity (CNS, irritation, cholinergic agonist)

Question 11

Anticholinergics

Answer 11

inhibits detrusor contraction
4 weeks for effects with 12 weeks for max decrease of 1-2V/day
————-
-Over active bladder (urgency)
-Stress LUTS
————-
-oxybutynin (bad)
-solifenacin (selective)
-fesoterodine (safest)
————-
-Anticholinergic (dry, drowsy, blurred vision)
QT prolongation

Question 12

Beta 3 agonists

Answer 12

/
Relax SM in bladder
———
-Over active bladder (urgency)
———-
-Mirabegron
-tricyclic antidepressants (dicyclomine, flavoxate)
————–
-tachycardia
-headache
-prolonged QT

Question 13

Stress incontinence

Answer 13

Increased intra abdominal pressure causes dribble, no problem holding urine
from lax pelvic floor or sphincter, post TURPS

Question 14

Alpha agonists

Answer 14

/
Can increase sphincter tone but evidence is minimal
———
-Stress LUTS
used as self treatment
———-
-terbutaline, pseudoped
————
-tachy

Question 15

Hormone therapy (women)

Answer 15

/
Can reduce sphincter atrophy and increase alpha receptor sensitivity
——-
-stress LUTS
———
-estrogen (vagifem)
———-
-

Question 16

Duloxetine

Answer 16

/
Can increase sphincter contractility via alpha agonist and good for depression comorbid
———
-stress incontinence
———–
-TCA
———–
-

Question 17

Bladder suspension

Answer 17

help sphincter and reduce pressure on it. for stress incontinence

Question 18

bulking agents

Answer 18

Used to close urethra channel to prevent stress LUTS, autologous fat, silicone

Question 19

Overflow incontinence

Answer 19

Trouble emptying the bladder so it dribbles when overpressured
from outlet obstruction, fecal impaction, urethral stricture or detrusor weakness

Question 20

Nocturia

Answer 20

too much production at night
Use anticholinergic to help urge and desmopressin to prevent urine production

Question 21

5-alpha reductase inhibitors

Answer 21

-BPH
——–
-dutasteride (better)
-finasteride
———
-impotence
-decrease libido
-infertility

Question 22

Alpha antagonists

Answer 22

/
Decrease SM tone in prostate within 1 week
——–
-BPH
———
-tamsulosin
-terazosin
———-
-Dizziness (QHS preferred) but watch for night fall risk

Question 23

PDE5i

Answer 23

/
relaxes smooth muscle in bladder (similar to anticholinergic)
———–
-BPH with ED
———
-sildenafil
-tadalafil
———-
-headache
-non-arteritic ischemic optic neuropathy priapism

Question 24

Cholinergic agonists

Answer 24

/
Contract bladder muscles
——-
-overflow LUTS
———
-bethanechol (duvoid)
-cholinesterase inhibitors
———
-Parasympatheic effects