Presenting complaints Flashcards
Haematuria DDx - groups (5)
- Transient
- Infection / inflammatory
- Renal disease
- Obstructive
- Malignancy
Overactive bladder syndrome - symptoms
Clinical dx of exclusion
- Urinary urgency +/- incontinence
- Urinary frequency
- Nocturia
Overactive bladder - risk factors
Older age
Obesity
Vaginal deliveries
Chronic constipation
Overactive bladder syndrome - history
-Symptoms
To exclude other dx.
- Other symptoms
- > Polydispia, haematuria, dysuria
- > Constipation
- > Sexual dyfunction in men
- PMHx - UTIs, renal . bladder conditions or surgery
- Medications - diuretics
Impact on patient
Overactive bladder syndrome - examination
- BMI
- Abdominal exam - ?masses
- Spec exam + bimanual exam - ?prolapse, vaginal atrophy, masses
- DRE - ?prostate abnormality
Overactive bladder syndrome - investigations
All
- Urineanlaysis -?infection, ?haematuria, ?glucosuria
- U/S KUB -?post void residual - at risk of retention
- Bladder diary - voiding frequency, volume, nocturia, incontinence frequency
Consider
- Cytology x3 days - ?bladder cancer
- Urodynamics - establish the type of incontinence
- Cystoscope
- PSA
Overactive bladder syndrome - management (7 options)
- Lifestyle intervention
- - Hydration spaced out through the day, not too much before bed. 1.5-2L in total, 2/3 should be water.
- -Avoid bladder irritants - caffeine, alcohol, carbonated drinks
- -Smoking cessation
- -Weight reduction if BMI elevated
- -Managed bowels to prevent constipation. - Pelvic floor exercises
- Refer to pelvic floor physio
- Try for at least three months - Bladder training
- Reduce voiding frequency - have a voiding schedule
- Increase bladder capacity (holding for longer periods of time - at least 1min after urge onset)
- Use of urge suppression techniques (distraction and relaxation techniques - Anticholinergic
- NOT suitable if closed angle glucoma
- SE dry mouth +++, blurred vision, dizziness, drowsiness.
- Oxybutynin 5 mg BD - increase to QID as needed.
- Start with 2.5mg in elderly
- Available in a patch.
- Solifenacin - 5-10mg once daily.
5. Botox injection
6. Sacral nerve stimulator
7. No treatment - 1/3 of women with urge only incontinence will have spontaneous resolution of symptoms within 2 years.
Urinary retention - four groups of causes
- Obstructive cause
- Neurological
- Infective
- Medication SE
Urinary retention - obstructive causes
Urethra / bladder neck
- stricture
- stone
- clot
- Tumour
- Phimosis
- Traumatic damage
Prostate
- BPH
- Prostate cancer
External factor
- Constipation
- Pelvic mass
Urinary retention - neurological causes
Neurogenic bladder
- Detrussor muscle innervation damage
- Diabetes
- Micurition reflex damage
- Damage to the S2/S3
- Spinal trauma
- Spinal MS
- Herpes or syphillis affecting the doral root
- Shock phase of an higher spinal or brain insult (will progress to urge incontinence with detrussor hyper-reflexia in stable phase)
Urinary retention - infective causes
UTI
Prostatitis
Varicella zoster / herpes (pain)
Urinary retention - medications
Anti-cholinergics Opioids Ephidrine / psuedoephidrine Anti-histamines Antihypertensive methyldopa
Urinary retention - acute management
Acute retention
- Catether insertion
- If urethral trauma - urgent urology referral
- TOV - if precipitating factor has been addressed - TOV 3-5 days
- If BPH symptoms prior to retention - consider alpha 1 blocker for 2-3 days prior to TOV
- Tamsulosin 400mcg daily (Prazosin)
