LUTS Flashcards
1
Q
What is urinary incontinence?
A
- Involuntary loss of urine
- A symptom, not a diagnosis
- Bladder wall is formed from detrusor muscle (smooth) + is compliant, stretching to allow urine to fill the bladder
2
Q
What are the common types of urinary incontinence in women?
A
- Stress
- Urgency
- Mixed (stress + urge)
- Chronic retention/overflow
3
Q
What is stress incontinence?
A
- Involuntary loss of urine when the pressure inside the bladder is greater than the urethral closing pressure
- Sudden increase in abdo pressure (sneezing, coughing) raises the bladder pressure
- Causes a small amount of urine to be lost
- Common in middle-aged multiparous women and is caused by pelvic floor weakness
4
Q
Which investigations for stress incontinence?
A
- Exam → incontinence occurs when pt coughs; there may be a cystocele
- Bladder diary → records frequency + volumes
- Urodynamics → shows flow of urine when pt coughs
5
Q
What is the management for stress incontinence?
A
- Conservative → pelvic floor strengthening exercises are required for at least 6 months, plus weight loss + fluid advice
- Surgery → vaginal slings or Burch Colposuspension
6
Q
What is urge incontinence?
A
- Is involuntary bladder contractions during the filling phase
- The underlying abnormality is an overactive detrusor muscle, usually idiopathic
- Sudden urge to pass urine, which often results in incontinence
- Common in middle-aged women
- Urodynamics performed to confirm diagnosis, showing regular contractions of the detrusor while the bladder is filing
7
Q
What is the management of urge incontinence?
A
- Conservative → bladder retraining attempts to teach bladder to hold urine, thus reducing frequency and urgency
- Medical → mainstay of treatment with anti-cholinergic medications (eg. oxybutynin, tolterodine) that prevent detrusor overactivity; SE: blurred vision, dry mouth, constipation
- Surgery → Botulinum toxin A has been used v successfully; injected into bladder via cystoscopy
8
Q
What is overflow incontinence?
A
- When bladder cannot fully empty, there is ‘overflow’ of urine, leading to frequency of small amounts of urine + constant dribbling; this often occurs during the day + night
- Cystometry confirms diagnosis, showing an overfull bladder with weak contraction + weak detrusor activity
9
Q
What is the treatment for overflow incontinence?
A
- Relieving the obstruction
- Eg. TURP
- Or intermittent self-catheterisation
10
Q
LUTS can be divided into storage, voiding and post-micturition symptoms.
What are storage symptoms?
A
- Frequency
- Urgency
- Nocturia
- Incontinence
11
Q
What are the voiding symptoms?
A
- Slow stream
- Splitting or spraying
- Intermittency
- Hesitancy
- Straining
- Terminal dribble
12
Q
What are post-micturition symptoms?
A
- Post-mic dribble
- Feeling of incomplete emptying
13
Q
For male LUTS, what is involved in a basic evaluation?
A
- History + assessment of symptoms and bother
- Digital rectal examination
- Urinanalysis
- Serum PSA
- Frequency - vol chart (voiding diary)
14
Q
What is involved in a specialised evaluation for LUTS?
A
- Detailed quantification of symptoms by standardised questionnaires
- Flow rate recording
- Residual urine
- Pressure flow studies
15
Q
What is acute urinary retention?
A
- Sudden inability to pass urine and is a urological emergency
- Common in older men
- May be acute presentation of BPH
- May follow any operation (particularly pelvic surgery) or anaesthetic (spinal)
- Bladder is palpable + dull to percussion, may be enlarged to umbilicus
