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Renal > LUTS and bladder outflow obstruction > Flashcards

LUTS and bladder outflow obstruction Flashcards

1
Q

what can cause bladder outflow obstruction

A 
bladder cancer
urethral cancer
anti cholinergics, nasal decongestants 
pelvic cancer 
spinal injuries causing sphincter abnormalities 
detrusor muscle dys-synergia 
men
BPH
urethral strictures
prostate cancer 
bladder stones (occur secondary to enlarged prostate- obstruct when they cluster at orifice)
penile cancer 
phimosis (foreskin)

women
cystocoele (prolapsed bladder)
urethral polyp
vaginal atrophy (distorts urethra), prolapse or cysts (extrinsic compression)

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2
Q

what spinal levels gives innervation to the bladder

A

S1,2,3

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3
Q

what is the role of the prostate

A

secretions contribute to semen

Produces PSA which keeps semen in liquid form

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4
Q

what happens to bladder when prostate is enlarged

A

becomes hypertrophic

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5
Q

what are LUTS

A

lower urinary tract symptoms
storage- frequency, urgency, nocturia
voiding- hesitancy, poor flow, intermittent flow, sensation of incomplete voiding, post micturition dribbling

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6
Q

what is bed wetting a sign of

A

high pressure chronic retention

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7
Q

what is the difference between acute and chronic urinary retention

A

acute- painful, sudden episode of urinary retention

chronic- patient is able to pass urine but is unaware they are holding 1-2 litres of urine

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8
Q

what are the complications of chronic urinary renetion

A

puts back pressure on the kidneys- hydronephrosis

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9
Q

what are the red flags of a urinary obstruction history

A

haematuria, subrapubic pain, recurrent UTIs (if present suspect bladder cancer)

back pain and neurological symptoms (sciatica, lower limb weakness, sensory symptoms)

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10
Q

is obstruction more common in males or females

A

males

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11
Q

is an overactive bladder (frequency and urgency) more common in males or females

A

females

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12
Q

what are the voiding symptoms (due to blockage affect)

A 
poor flow 
intermittent stream 
spraying of stream/ deviating stream 
hesitancy 
post micturition dribbling 
straining
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13
Q

what are the storage symptoms (due to the secondary effects of blockage)

A 
frequency of urination 
urgency 
urgency incontinence 
nocturia  
sense of incomplete emptying 
pain with bladder filling
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14
Q

what lifestyle factor can cause urgency

A

caffine

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15
Q

what PMH can cause urinary obstruction

A

urethral injury
instrumentation
pelvic surgery
neurological disorders (parkinsons, stroke, MS, spinal stenosis)

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16
Q

how do you asses the severity of prostate symptoms

A

international prostate system score: 0-7 mild, 8-19 mod, severe 20-35. QoL 0-6 (this score not used for diagnosis but more monitoring of treatment and severity of symptoms)

17
Q

what are you feeling for in the DRE

A

size, consistency, nodules of the prostate
anal tone and sensation
skin changes
blood and mucous on finger

18
Q

what other than a DRE should you do in urinary obstruction exam

A

external genitalia exam- meatus
neuro exam in younger patients

general features
-renal failure, fluid over load, uraemia signs

19
Q

what investigations into LUTS

A

frequency -volume chart (polyuria and nocturnal polyuria)

serum creatinine for renal function
PSA (after counselling) (if recent trauma, infect or instrumentation will be raised so do again in 4 weeks)

flow rate )Qmax <10 = 90% chance of obstruction

renal USS - if there is impaired renal function, loin pain, haematuria or a renal mass on exam

cystoscopy- previous urological surgery , haematuria, Hx of stricture, pain (shouldnt have pain in BPH and LUTS), recurrent UTIS (suggests bladder cancer)

transrectal USS if PSA elevated and prostate feels abnormal

20
Q

what can cause noctural polyuria

A

heart failure- exacerbated by lying down to go to sleep

21
Q

what is nocturnal polyuria

A

when more than 1/3rd of urine is produced at night

22
Q

how should you ask about frequency in a history

A

how often do you pass urine a day

23
Q

how should you ask about nocturia in a history

A

how often a night are you woken from sleep because you need to pee

24
Q

how should you ask about urgency in a history

A

when you get the feeling of wanting to pass urine, can you hold it or do you need to go immediately

if you are watching your favourite TV programme do you leave or wait till it finishes to go pee?

25
Q

what is the treatment for LUTS

A

watchful waiting
lifestyle modification (caffeine intake, fluid intake)
medical management
surgical treatment (transurethral resection of prostate, homium laser enucleation of prostate)

26
Q

what is the medical management for LUTS

A

prostate problem- to shrink 5- alpha reductase inhibitors
to relax prostate- alpha blockers

bladder muscle relaxants- anti cholinergics

27
Q

what do alpha blockers do

A

act on smooth muscle (tamsulosin)

28
Q

what do 5 alpha reductase inhibitors do

A

inhibits the conversion of testosterone to dihydrotestosterone

29
Q

what do anticholigergics do

A

inhibits bladder smooth muscle contraction

30
Q

what do beta agonists do

A

inhibits bladder smooth muscle contracts (by inhibiting para symp)

31
Q

what do you need to ask and do in gross haematuria

A 
clots? 
asses mild/mod/severe 
shape of clots 
painful or painless 
timing (initial, terminal or throughout)
check coagulation
32
Q

what do you need to do/ ask in micrscopic haematuria

A

(dipstick 3-5 TBS per HPF)
symptomatic?
check BP, proteinuria
exclude UTI

33
Q

what does a palpable roughness in penile body suggest

A

stricture

34
Q

what are the bladder complications of a bladder outlet obstruction

A

diverticulum/ saccules
trabeculation (low compliance/ high pressure in bladder)
atronic bladder (detrusor hypofunction)

35
Q

what are the renal complications of bladder outlet obstruction

A

high pressure in bladder cause back pressure effect on kidneys

  • hydonephrosis
  • abnormal renal function
36
Q

what other complications can arise from bladder outlet obstruction

A

recurrent UTIs

  • cystitis
  • prostatitis
  • epidymo-orchitis

haematuria

incontinence (overflow)

37
Q

Tx for urethral stricture

A

optical urethrotomy

anastomotic urethroplasty

38
Q

Tx for a phimos

A

circumcision

dorsal slit

39
Q

Tx for a meatal/ urethral stenosis

A

dilatation

Renal (27 decks)

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