Management of Non-Neurogenic Male Lower Urinary Tract symptoms (LUTS) Flashcards
How do you divide lower urinary tract symptoms?
Storage
Voiding
Post-micturition symptoms
Define acute retention of urine:
Painful, palpable or percussible bladder when the patient is unable to pass any urine
Define chronic retention of urine:
Non-painful bladder, wich remains palpable or percussible after the patient has passed urine.
The patient may also be incontinent
What characterises bladder outlet obstruction?
Increasing detrusor pressure and reduce urine flew rate
What is benign prostatic obstruction?
A form of BOO (bladder outlet obstruction) where the cause of outlet obstruction is known to be BPE (Benign prostatic enlargement)
What is Detrusor overactivity (DO)?
A urodynamic observation chareacterised by involuntary detrusor contratctions during the filling phase which may be spntaneous or provoked
IPSS: Asymptomatic?
0
IPSS: Mildly symptomatic?
1-7
IPSS: Moderately symptomatic?
8-19
IPSS: Severely symptomatic?
20-35
Give an example of a questionnaire that is suitable to evaluate nocturia and OAB?
ICIQ-MLUTS
The international consultation on Incontinence Questionnaire
When should Frequency volume charts and bladder diaries primarily be used?
Nocturia
For what period of time should the patient record their bladder diary?
At least 3 Days.
In male patients with LUTS what should the physical examination primarily focus on?
Suprapubic area, the external genitalia, the perineum and lower limbs.
Urethral discharge, meatal stenosis, phimosis and penile cancer must be excluded
How sensitive is DRE (digital rectal examination) when it comes to estimate prostate volume?
DRE can discriminate between volumes > or < 50 mL
If a patient has LUTS, should PSA be measured?
Yes If a diagnosis of prostatecancer will change management
or if it will assist in the treatment and/or decision making process
Is PSA useful in predicting prostate volume?
Yes, PSA > 1,5 predict a prostate volume of > 30 mL
What predictions can be made from baseline PSA value?
Risk of acute urinary retention (AUR) and BPE- related surgery
When evaluating a patient for LUTS, what labratory tests should be performed?
Krea and/or GFR
Urinalysis (dipstick or sediment)
What role in LUTS does measurements of PVR (post-void residual) have?
Monitoring Changes over time may allow for identification of patients at risk of AUR (acute urinary retention)
What volume is needed for diagnostic accuracy of uroflowmetry?
> 150 mL
When should uroflowmetry be used?
Prior to Medical or invasive treatment.
Not necessarily in the initial evaluation av LUTS.
What is measured with uroflowmetry?
Qmax and flow pattern
When should men with LUTS be examined with ultrasound?
Large PVR (post void residual)
haematuria
history of urolithiasis
