LUTS Flashcards
Storage symptoms
Urgency
incontinence
frequency
nocturia
Voiding symptoms
slow stream
hesitancy
straining
splitting/spraying
Post micturition symptoms
Feeling of incomplete emptying
post micturition dribble
Causes of LUTS (5)
cognitive and motivation
mobilty
dexterity
balance and coordination
aging
aging effects
reduced bladder contraction and sensation
weaker urethral closing after menopause
BPH
sphincter tone decline
LUTS risk factor
Physical status
genetic
neuropsychiatric
pelvic floor damage
IBD, menopause, constipation
Retention drugs (3)
Alpha agonists
anticholinergic
Ca+ channel blockers
Voiding drugs
alpha antagonists
cholinergic agonists
diuretics
glucocorticoids
Clonidine
Ketamine (irritant)
DIPPERS
Delirium/dementia
infection
pharmaceuticals
psychological
excessive urine output
restricted mobile
stoke, spinal injury
Urgency/OAB
Urge and void are very close (frequent large voids). from detrusor overactivity (CNS, irritation, cholinergic agonist)
Anticholinergics
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
Beta 3 agonists
/
Relax SM in bladder
———
-Over active bladder (urgency)
———-
-Mirabegron
-tricyclic antidepressants (dicyclomine, flavoxate)
————–
-tachycardia
-headache
-prolonged QT
Stress incontinence
Increased intra abdominal pressure causes dribble, no problem holding urine
from lax pelvic floor or sphincter, post TURPS
Alpha agonists
/
Can increase sphincter tone but evidence is minimal
———
-Stress LUTS
used as self treatment
———-
-terbutaline, pseudoped
————
-tachy
Hormone therapy (women)
/
Can reduce sphincter atrophy and increase alpha receptor sensitivity
——-
-stress LUTS
———
-estrogen (vagifem)
———-
-
Duloxetine
/
Can increase sphincter contractility via alpha agonist and good for depression comorbid
———
-stress incontinence
———–
-TCA
———–
-
Bladder suspension
help sphincter and reduce pressure on it. for stress incontinence
bulking agents
Used to close urethra channel to prevent stress LUTS, autologous fat, silicone
Overflow incontinence
Trouble emptying the bladder so it dribbles when overpressured
from outlet obstruction, fecal impaction, urethral stricture or detrusor weakness
Nocturia
too much production at night
Use anticholinergic to help urge and desmopressin to prevent urine production
5-alpha reductase inhibitors
-BPH
——–
-dutasteride (better)
-finasteride
———
-impotence
-decrease libido
-infertility
Alpha antagonists
/
Decrease SM tone in prostate within 1 week
——–
-BPH
———
-tamsulosin
-terazosin
———-
-Dizziness (QHS preferred) but watch for night fall risk
PDE5i
/
relaxes smooth muscle in bladder (similar to anticholinergic)
———–
-BPH with ED
———
-sildenafil
-tadalafil
———-
-headache
-non-arteritic ischemic optic neuropathy priapism
Cholinergic agonists
/
Contract bladder muscles
——-
-overflow LUTS
———
-bethanechol (duvoid)
-cholinesterase inhibitors
———
-Parasympatheic effects
