LUTS + BPH Flashcards
What is the common cause of LUTS in older men?
Bengin prostatic enlargement (BPE) most commonly due to the histological diagnosis of BPH.
What is the most common aetiology of LUTS in women?
Over 40 years old and commonly associated with lower urinary tract infection.
What is LUTS?
Term used to describe array of symptoms affecting control and quality of micturition
What are the casues for LUTS in men?
BPH UTI Urological malignancy Detrusor muscle weakness or instability Chronic prostatitis Urethral stricture External compression e.g. pelvic tumor, faecal impaction Neurological disease e.g. MS, spinal cord injury
What are the causes of LUTS in females?
UTI
Menopause
Urological malignancy
Detrusor muscle weakness or instability
Urethral stricture
External compression e.g. pelvic tumor, faecal impaction
Neurological disease e.g. MS, spinal cord injury
What lifestyle factors can excerbate LUTS?
Drinking fluids late at night
Excess alcohol intake
Excess caffeine intake
DM and diuretics can both mimic LUTS
What are voiding symptoms?
Hesitancy Poor flow Terminal dribble Feeling of incomplete emptying Intermittency Straining
What are storage symptoms?
Urgency
Frequency
Nocturia
Urgency incontinence
What assoicated symptoms should be asked about in a history of LUTS?
Visible haematuria
Suprapubic discomfort
Colicky pain
Medication history - anticholinergics, antihistamines and bronchodilators
What scoring system may be used for LUTS in men?
International prostate symptom score - IPSS
What examinations may be carried out in LUTS?
DRE
External genitalia
What initial investigations should be done for LUTS?
Post-void bladder scanning and flow rate
Urinary frequency and volume chart
Urinalysis +/- urine culture
Routine bloods
PSA?
What specialist investigations may be ordered for LUTS?
Urodynamic studies
Cystoscopy - GOLD standard for lower urinary tract
Upper urinary tract - ultrasound and CT
What does urodynamic studies involve?
Flow rate
Detrusor pressure
Storage capacity
Used in neurogenic bladder dysfunctions suspected
When is cystocopy indicated?
Recurrent infection
Presence of haemturia
When is ultrasound and CT indicated in LUTs?
Chronic retention
Reccurent infection
Presence of haematuria
What is the conservative management of all LUTS other then treating underlying cause?
Regulating fluid intake - timing and volume of drinks consumed and reducing caffine and alcoholic drinks
What is the conservative management for voiding symptoms in LUTS?
Voiding symptoms - urethral milking techniques (manually emptying the bulbar urethra of residual volume) or double voiding (passing urine and then remaining for a short time before passing urine again)
What is the conservative management for stress incontinence and post-micturition dribble?
Pelvic floor exercises
What is the conservative management for overactive bladder?
Bladder training technique
What is the pharmacological managment of overactive bladder?
Anticholinergics - oxybutynin and tolterodine - first line
Mirabegron - B3 adrenergic agonist
What is the pharmacological managment for BPH?
Alpha blocker - tamsulosin
5 alpha reductase inhibitors - finasteride
What is the pharmacological managment of nocturia?
Loop diuretics - taken mid afternoon - unlicensed
Desmopression - unlicensed
What are the complications of LUTS in left untreated?
Infection
Renal and bladder calculi
Chronic obstruction leading to overflow incontince
Renal failure and bilateral hydronephrosis
Acute urinary retention in BPH
What are the side effects of alpha blockers?
Reterograde ejactulation
Postural Hypotension
What are the side effects of 5-alpha redcutase?
ED
Decreased libido
Rash
What is TURP syndrome?
Dilutional hyponataremia due to TURP procedure using glycine. This is due to hypoosmolar irrigation during TURP and leads to fluid overload.
Presents as confusion, nausea, agitation or visual changes
Quite rare due to the use of bipolor energy which uses isotonic irrigation fluid
What are the differntial diagnosis for BPH?
Prostate cancer
UTI
Overactive bladder
Bladder cancer
What investigations should be requested for in BPH?
Urinary freq and volume chart
Urinalysis
Post-void bladder scan - chronic urinary retention
PSA
Ultrasound + urodynamic studies
What is the management of BPH?
Symptom diary
Medication review an sutible lifestyle advice
Alpha-blockers - first line unless contraindicated
5 alpha reductase - decrease prostatic volume - can take upto 6 months to achieve symptomatic benefits
What is the surgical management of BPH and when is it offered?
Not responding to medical management or develop significant sequlae of bengin prostatic hyperplasia (e.g. high pressure retention)
Transurethral resection of the prostate (TURP)
What are the complications of TURP?
Haemorrhage
Sexual dysfunction
Reterograde ejaculation
Urethral stricture
What are other techniques other then TURP in BPH management?
Holmium laser enucleation of the prostate (HoLEP)
Less commonly prostatectomy - pts with large prostates
What is the main complications of BPH?
High-pressure retention
Reccurent UTIS or significant haematuria
