Male LUTS Flashcards
What are the types of LUTS?
Voiding:
- Hesitancy
- Poor flow
Storage:
- Frequency
- Urgency
- Incontinence
Post-micturition:
- Dribbling
What are voiding LUTS treated with?
Alpha blockers (Tamsulosin)
5 alpha reductase inhibitors (Finasteride)
What are storage LUTS treated with?
Anticholinergics
Beta agonists (Mirabegron)
How are post-micturition LUTS treated?
- Urethral milking
- Pelvic floor exercises
List the possible surgical treatments for male LUTS
- TURP
- Laser prostatectomy
- Urolift
- Rezum water vapour treatment
- Prostatic artery embolisation
Describe the TURP procedure
What are the risks?
Transurethral resection of the prostate
Risks:
- Bleeding
- Infection
- Fluid reabsorption
- Strictures
- Sexual dysfunction
Involves 2-3 day hospital stay, irrigation and large catheter
What are the risks and benefits of a laser prostatectomy?
Benefits:
- Shorter hospital stay
- Usually no irrigation
- Less bleeding
Side effects: same as TURP:
- Incontinence
- Scarring
- Sexual dysfunction
What are the benefits of a Urolift procedure?
- Day case
- Minimal side effects
- No catheter necessary
- Preserves sexual function
What is Rezum water vapour treatment?
Who is it suitable for?
- Superheated steam injected into the prostate to cause gradual shrinking
- Day case procedure
- Suitable for men with larger prostates
Define acute, chronic and acute-on-chronic urinary retention
What catheter is appropriate for each?
Acute:
- Painful with residual urine >600mls
- Indwelling catheter
Chronic:
- Painless with post-void residual urine
- High pressure (affects renal function) or low pressure
- Intermittent self-cathetersation
Acute on chronic:
- Painful with large residual urine
- Indwelling catheter
What questions should be asked when taking a history from a patient with LUTS?
- Onset and duration
- Degree of bother
- Incontinence/use of pads
- Constipation/IBS?
- Medical/surgical history: pelvic surgery, diabetes, CVA, other neurological disorders
- Medications- use of diuretics?
- FHx- prostate cancer?
What examinations and investigations should be carried out in a male patient with LUTS?
- Urinalysis/dipstick -?infection
- Neurological impairment
- Palpable bladder/DRE/urethral meatus
- U&Es and PSA
- Frequency volume chart
What are the red flags to look out for in a patient with LUTS?
- Haematuria
- Recent severe symptoms
- Pain
- Palpable bladder and nocturnal incontinence- high pressure chronic retention
- Abnormal DRE
- Abnormal U&Es and PSA
