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Urology - Surgery > LUTS > Flashcards

LUTS Flashcards

1
Q

What are lower urinary tract symptoms?

A

An array of symptoms affecting the control and quality of micturition in the lower urinary tract.

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2
Q

Who can be affected by LUTS?

A

ANYONE (Men & Women)

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3
Q

Who is most at risk to develop LUTS?

A
  • Men
  • Increasing age
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4
Q

What are the causes of LUTS in men & women?

A
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5
Q

What is the most common cause in men?

A

Benign prostatic enlargement (BPE) / benign prostatic hyperplasia (BPH)

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6
Q

What is the most common cause in women?

A

Lower UTI (in women over 40)

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7
Q

What can exacerbate / mimic LUTS?

A

Lifestyle factors, for example:

  • Drinking fluids late at night
  • Excess alcohol intake
  • Excess caffeine intake

Polyuria can exacerbate / mimic LUTS

  • Due to
    • Diabetes mellitus, excessive fluid intake or diuretics
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8
Q

What are the 3 broad categorisations of LUTS?

A
  • Storage symptoms
    • Occur when bladder should otherwise be storing urine
  • Voiding symptoms
    • Occur usually due to bladder outlet obstruction, making it more difficult to pass urine
  • Post-micturition symptoms
    • Occurs after voiding
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9
Q

Give 4 examples of different storage symptoms you may see

A
  • Increased urinary frequency
  • Nocturia
  • Increased urgency to urinate
  • Urge incontinence
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10
Q

List 5 examples of voiding symptoms you might see.

A
  • Hesitancy
  • Intermittent / poor flow (<10mL/s)
  • Straining
  • Incomplete emptying
  • Terminal dribbling
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11
Q

Give 2 examples of post-micturition symptoms.

A
  • Terminal dribble
  • Feeling of incomplete emptying
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12
Q

What specific things do you need to clarify from the patient when taking a history of LUTS?

A
  1. The exact nature of lower urinary tract symptoms present
  • Ask about all the different symptoms.
  • Establishing whether symptoms are mostly voiding / storage / post-micturition
  1. Ask about other associated symptoms
  • Visible haematuria
  • Suprapubic discomfort
  • Colicky pain
  1. Medication Hx
    * Some medications are known to cause LUTS (e.g. anticholinergics, antihistamines & bronchodilators)
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13
Q

What symptoms does overactive bladder typically present with?

A
  • Storage symptoms
    • Urgency
    • Increased frequency
    • Nocturia
    • Urge incontinence
  • Can also present with other types of incontincence (e.g. stress, mixed, functional)
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14
Q

What is bladder outlet obstruction (BOO)? & Who most commonly suffers from it?

A

When there is some impediment to the normal smooth, complete and rapid voiding of the bladder (encompassed within the term LUTS)

  • Most common in older men, often due to prostate problems
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15
Q

What symptoms do patients w/ bladder outlet obstruction typically present with?

A
  • Pain when urinating (dysuria)
  • Increase frequency
  • Voiding & Post-micturition symptoms
    • Incomplete empyting
    • Poor stream
    • Hesitancy
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16
Q

How would you like to examine a patient w/ LUTS?

A
  • DRE +/- examination of the external genitalia
    • Depending on presentation
17
Q

What is the International Prostate Symptom Score?

A

A useful tool for assessing and monitoring the impact of LUTS on quality of life in men

  • Both initially and throughout any treatment course
18
Q

What initial investigations are useful for a patient with LUTS?

A
  1. Urinalysis & culture
  • To look for evidence of UTI, haematuria or glycosuria
  • If infection likely, culture urine
  1. Routine bloods
  • FBC = anaemia/infection
  • U&Es = Kidney function
  • PSA (w/ likely prostate pathology)
    • After appropriate counselling
  1. Post-void bladder scanning and flow rate
    * To help distinguish between causes of LUTS & to quantify the severity of the condition in those presenting with voiding symptoms. A urinary frequency and volume chart is often useful in highlighting patterns of behaviour which may be contributing to symptoms.
19
Q

What specialist investigations might you want for a patient with LUTS?

A
  1. Urodynamic studies
    * To assess flow rate, detrusor pressure, and storage capacity if indicated
  2. Cystoscopy (Gold standard investigation for assessing the lower urinary tract)
    * If clinically indicated, such as a history of recurrent infection or the presence of haematuria.
  3. Upper urinary tract imaging (USS / CT)
    * If there is a history of chronic retention, recurrent infection, or the presence of haematuria.
20
Q

How would you describe urodynamic studies to a patient?

A

Different types of tests that look at how well your bladder, urethra (the tube that passes urine from your bladder) & sphincters are functioning /storing and releasing urine.

We usually use them to show us the bladder’s ability to hold urine & empty it steadily and completely. But sometimes we use them to show us whether the bladder is having involuntary contractions that cause urine leakage.

21
Q

What is uroflowmetry?

A

A non-invasive test (urodynamic study) that measures:

  • Volume of urine released from the body
  • Speed at which it is released
  • How long the release takes.

To assess bladder and sphincter function

22
Q

How would you explain uroflowmetry to a patient?

A

You’ll need to urinate into a funnel-shaped device. As you do so, an electric device connected to the funnel measures the:

  • Speed of flow
  • Quantity of urine prod
  • Length of time it takes to empty bladder completely

It draws this information on a chart. Normally, the initial urine stream begins slowly, speeds up, and then finally slows down again. Any differences from the norm will be recorded and used to form your diagnosis.

23
Q

What is the conservative management of patients with mostly storage symptoms?

A
  1. Regulating fluid intake
  • Timing and volume of drinks consumed
  • Reducing caffeinated & alcoholic beverages in evenings
  1. Techniques to assist voiding
  • Urethral milking techniques
    • Manually emptying the bulbar urethra of residual urine
  • Double voiding
    • Passing urine and then waiting shortly before passing urine again
  1. Pelvic floor exercises

For patients with stress incontinence or post-micturition dribble.

  • To strengthen the pelvic floor
    4. Bladder training techniques

For patients with overactive bladder

  • To increase the duration between the urge to void and micturition
24
Q

How is LUTS managed pharmalogically, when conservative methods are insufficienct / inappropriate?

A

For overactive bladder:

  • Anticholinergics (e.g. oxybutynin, tolterodine)
    • Helps to relax bladder muscle by opposing parasympathetic cholinergic control of contraction
  • Mirabegron
    • A β3 adrenergic agonist

For BPH

  • Alpha blockers (e.g. alfuzosin, tamsulosin)
  • 5α-reductase inhibitors (e.g. finasteride)

Both work to reduce prostate size by relaxing prostatic muscle

For nocturia:

  • Mid-afternoon loop diuretics (e.g. furosemide, bumetanide)
  • Desmopressin

Both treatments are unlicensed

25
Q

What are the complications of untreated LUTS?

A
  • Infection
  • Formation of renal & bladder calculi
    • Due to stagnation of urine.

Chronic obstruction may lead to :

  • Bladder wall muscle hypertrophy
  • Bladder distention
  • Overflow incontinence.
  • Renal failure
  • Bilateral hydronephrosis.
  • Acute urinary retention (in progressive BPH)
26
Q

What is nocturnal polyuria?

A

Excessive urine production overnight

27
Q

What is the aetiology & management of nocturnal polyuria?

A

Aetiology

  • Associated with
    • Sleep apnoea
    • Swollen ankles
    • HF

Management

Fluid restriction

+/- diuretics & vasopressin / oral desmopressin

28
Q

What are some causes of bladder outlet obstruction?

A
  • Urethral polyps / strictures
  • BPH
  • Bladder neck stenosis
  • Prostatic carcinoma
  • Faecal impaction
  • Pelvic tumour
29
Q

What is the management of BOO?

A
  1. Catheter insertion
    * To relieve he blockage and drain bladder
  2. Drugs to treat causes
    * e.g alpha blockers / 5-alpha-reductase inhibitors for BPH
  3. Surgery
    * TURP = Transurethral resection of Prostate

Urology - Surgery (12 decks)

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