LUTS Flashcards
Most common cause of LUTS in older men
BPE most commonly due to BPH
Most common in females
Lower UTI
Causes of luts in men and women
Lifestyle factors that can cause LUTS
Drinking fluids late at night
Excess alcohol intake
Excess caffeine intake
Voiding symptoms
Hesitancy
Poor flow
Intermittency
Straining
Terminal dribbling
Incomplete emptying
Storage symptoms
Increased freq
Nocturia
Sense of urgency
Urge incontinence
History and Examination
Determine whether storage or voiding
Ask about haematuria, suprpubic discomfort, colicky pain
DH of anticholinergics, antihistamines, bronchodilator (all known to exacerbate LUTS)
DRE and ex of external genitalia might be helpfull
International Prostate Symptom score might be done
Initial investigations
Post-void bladder scanning and flow rate to distinguish between causes
Urinary frequency and volume chart can also be done
Urinalysis
Urine culture
Routine blood tests with FBC and U&Es
PSA might be done
Specialist investigations
Urodynamic studies to assess flow rate, detrusor pressure and storage capacity
Cytoscopy is gold standard for assessing the lower urinary tract.
Upper urinary tract imaging by ultrasound or CT scanning
Conserative management
Treat underlying pathology
Regulating fluid intake + reducing caffeinated and alcoholic drinks
Urethral milking techniques for voiding
Double voiding (passing urine then remaining for a short time before passing again)
Pelvic floor exercises
Bladder training techniques
Indications for pharmacological management
When conservative measures are insufficient or inappropriate
Pharmacological management
Anticholinergics like oxybutynin and tolterodine for overactive bladder to help relax bladder muscle by opposing parasympathetic cholinergic control of contractino. Mirabegro can also be used
Alpha blockers like alfuzosin or tamsulosin +/- 5a-reductase inhibitors like finasteride for BPH
Loop diuretics like furosemide and bumetanide can be used as well.
Complications
Increased risk of infection
FOrmation of renal and bladder calculi
Chronic obstruction may lead to bladder wall muscle hypertrophy or distention which can lead to overflow incontinence
Renal failure and bilateral hydronephrisis
Acute urinary retention in BPH
