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Y3(S) - Urology > LUTS > Flashcards

LUTS Flashcards

1
Q

What are the 3 categories of LUTs?

A

Storage
Voiding
Post micturition

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2
Q

What are some storage LUTs?

A

Urge incontinence
Urgency
Frequency
Nocturia

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3
Q

What are some voiding LUTs?

A

Hesitancy
Poor flow
Incomplete emptying
Terminal dribble

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4
Q

What is a post micturition LUTS?

A

Post micturition dribble

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5
Q

What is considered nocturia?

A

Waking up more than once to urinate

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6
Q

What is nocturnal polyuria?

A

When you pass 1/3 or more of your urine output at night

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7
Q

Why may a patient have nocturnal polyuria and not have a urinary tract issue?

A

Conditions that causes peripheral oedema lead to more fluid circulating to the kidneys when lying down in the night

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8
Q

What is the most common cause of LUTS in men and why?

A

BPH

BPH eventually leads to bladder outlet obstruction

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9
Q

Which part of the prostate is typically affected by BPH?

A

Transitional zone

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10
Q

How is BPH diagnosed?

A

Histologically (needs biopsying)

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11
Q

Presentation:

60y/o man
LUTS:
-weak flow
-nocturia
-frequency
-incomplete emptying

What IX would you do?

A

Abdominal exam
FBC
U+Es
DRE
Urine dip
Freq-vol chart
PSA

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12
Q

What are the 3 categories you typically have in terms of treatment for any condition?

A

Conservative
Medical
Surgical

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13
Q

What is the conservative management approach to BPH?

A

Don’t drink 2hrs before bed
Switch to decaf
Stop alcohol
Toilet before bed
Elevate feet as much as possible in day to urinate as much before bed as possible

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14
Q

What is the first line drug for treating BPH?

A

Tamsulosin

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15
Q

What is the mechanism of action of tamsulosin in treating BPH?

A

Alpha 1 receptor antagonist, so leads to relaxation of internal urethral sphincter and other smooth muscle around the neck of the bladder making passing urine easier

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16
Q

What is an important side effect of tamsulosin?

A

Postural hypotension
(Blocks alpha 1 receptors in blood vessels preventing their smooth muscle. contraction)

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17
Q

What medication do you give alongside tamsulosin if it isn’t effective in treating BPH?

A

Finasteride

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18
Q

What is the mechanism of action of finasteride?

A

5a reductase inhibitor
Stops conversion of testosterone into its more potent androgen DHT (dihydrotestosterone) which leads to worsening of BPH

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19
Q

What are some side effects of finasteride?

A

Erectile dysfunction
Gynaecomastia

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20
Q

What is the surgical management of BPH?

A

TURP
Transurethral Resection of Prostate

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21
Q

What are some questions you should ask to investigate someone with LUTs?

A

What LUTS?
Duration
Fluid intake
Number of kids
PMH (prostate surgery)
Dye factory worker
Coffee or alcohol

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22
Q

What are the typical investigations when investigating LUTS?

A

Abdo exam
External genitalia exam
DRE
Urine dip
U+Es
FBC
PSA
Freq-vol chart

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23
Q

What are the RED FLAG questions/symptoms you should be asking someone with LUTS?

A

Haematuria
Weight loss
Recurrent UTIs

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24
Q

What is overactive bladder syndrome?

A

Urgency, frequency + or - urge incontinence often accompanied by nocturia

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25
Q

What is a common presentation of overactive bladder syndrome?

A

40 y/o woman
LUTS:
-Freq
-nocturia
-urge incontinence

26
Q

What investigations would you like to do for a woman with LUTS:
-freq
-nocturia
-urge incontinence

A

Urine dip
U+Es
FBC
Abdo exam
External genitalia
Freq-vol chart
(DRE and PSA if it was a man)

27
Q

What is the conservative management for overactive bladder syndrome?

A

Reduce fluid intake (drink when thirsty)
Don’t drink 2hrs before bed
Decaf
No alcohol
Pelvic floor exercises
Bladder training

28
Q

What is the first line medication give for overactive bladder syndrome?

A

Oxybutynin

29
Q

What is the mechanism of action of oxybutynin in treating overactive bladder syndrome?

A

Anticholinergic

Acts on the M3 receptors of the detrusor muscle of the bladder keeping it more relaxed allowing it to fill more before needed to Urinate

30
Q

What medications are used if oxybutynin doesn’t improve overactive bladder syndrome?

A

Always try 2 anticholingerics (so if oxybutynin doesn’t work try another)

Tolterodine
Solefenacin

31
Q

What are the side effects of anticholinergics like Oxybutynin?

A

Dry eyes
Dry mouth
Constipation
Urine retention

32
Q

Why is urine retention an important side effect of oxybutynin that patients should be aware of when treating overactive bladder syndrome?

A

May have to self catheterise

33
Q

If anticholinergics dont work in managing overactive bladder syndrome, what medication can be given?

A

Mirabegron

34
Q

What is the mechanism of action of mirabegron in treating overactive bladder syndrome?

A

B3 agonist

Leads to the detrusor muscle relaxing allowing it to fill more with urine

35
Q

What are the 3 surgical management options for overactive bladder syndrome?

A

Botulinum toxin injection

Sacral nerve stimulation

Ileocystoplasty

36
Q

What is a complication of botulinum toxin injection in treating overactive bladder syndrome?

A

May have to self catheterise due to bladder being too paralysed

37
Q

How does ileocystoplasty treat overactive bladder syndrome?

A

Put some ileum into the bladder preventing detrusor contraction

38
Q

What is a complication of ileocystoplasty?

A

May have to self catheterise

39
Q

What is stress incontinence?

A

Increase in Intra abdominal pressure leads to urinary leakage

40
Q

What is a medical treatment option for menopausal women with overactive bladder syndrome?

A

Topical oestrogen

41
Q

What is a major risk factor for stress incontinence?

A

Multiparous

42
Q

How is stress incontinence conservatively managed?

A

Weight loss
Supervised pelvic floor exercises by incontinence nurse
Smoking cessation (reduces coughing)

43
Q

What is the medical management of stress incontinence?

A

Nothing
Duloxetine not used due to arrhythmias

44
Q

What is the surgical management of stress incontinence?

A

Fascial sling
Artificial urinary sphincter

45
Q

What is a complication associated with a fascial sling?

A

Risk of retention may have to self catheterise

46
Q

What is classed as an acute urinary retention?

A

Painful inability to void with a residual volume 300-1500ml

47
Q

What is classed as a chronic urinary retention?

A

Painless retention of urine (may still be voiding)

RESIDUAL volume 300 - 4000ml

48
Q

What are some causes of urinary retention?

A

BPH
Prostate cancer
UTI
Constipation
Neurological dysfunction
Urethral strictures
Drugs
Pelvic mass
Recent surgery

49
Q

What is the approach to a patient with who you think has acute urinary retention?

A

Immediate catheterisation and record residual volume
Abdo and external genitalia exam
DRE
Post catheterisation/voiding scan
Urine dip
U+Es
CRP
FBC
Catheterised Specimen of Urine (to be checked for infection)

50
Q

If a man presents with acute urinary retention what medication should he be put on after catheterising?

A

Alpha blocker (tamsulosin)

51
Q

What should be tried 1-2 weeks after being put on tamsulosin following an acute urinary retention in a man?

A

TWOC
Trial. Without catheter (if low residual volume its a success)

52
Q

What management should be undertaken if a male has acute urinary retention and the TWOC fails after 1-2 weeks on alpha blocker?

A

TURP or long term catheterisation

53
Q

What volume collected after catheterisation would make you suspicious of chronic retention rather than acute?

A

> 1000mls

54
Q

What are. Some complications of acute on chronic retention?

A

AKI
Inc risk of UTIs and renal stones

55
Q

What is high pressure urinary retention?

A

Chronic urinary retention where the upper urinary tracts mechanisms of preventing reflux fail which can lead to hydroureter and hydronephrosis

56
Q

What is the approach to a patient with chronic urinary retention (over 1000mls drained)?

A

Catheterise and measure void volume and residual volume
Abdo exam
External genitalia
DREAM
Urine dip
U+Es

ULTRASOUND KUB TO ASSESS FOR HIGH PRESSURE URINARY RETENTION (HYDROURETER AND HYDRONEPHROSIS)

57
Q

What is a complication that is extremely important to monitor when offloading a patient with chronic urinary retention?

A

Post obstructive diuresis

58
Q

What is post obstructive diuresis?

A

When catheterising a patient with chronic retention leads to the loss of the medullary counter current gradient leading to excess water and electrolyte removal

59
Q

Can you TWOC a patient with high pressure chronic retention?

A

Never TWOC

60
Q

How is low pressure chronic urinary retention managed?

A

Intermittent self catheterisation
Long term catheter
Or TURP

61
Q

How does high pressure chronic retention present differently to low pressure retention?

A

HP = abnormal U+Es (hyperkalaemia), hydronephrosis

LP = normal renal function, no hydronephrosis

62
Q

What are the complications of chronic urinary retention?

A

UTIs
Bladder calculi
CKD

Y3(S) - Urology (5 decks)

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