Session 6 - Urology/LUTS Flashcards
What are LUTS? and what are they split into?
Lower urinary tract symptoms:
Storage: frequency, urgency, nocturia, incontinence
Voiding: hesitancy, intermittency, reduced flow, terminal dribbling
Post-micturition: post micturition dribbling, incomplete bladder emptying
Aetiology of LUTS?
malignancy- prostate or bladder cancer
BPH- benign prostate hyperplasia
UTI
Prostatitis
urinary stone
detrusor muscle weakness
urethral stricture
neurological disease: MS, spinal cord injury, cauda equina
overactive bladder
ketamine abuse
What is important to ask in the history taking of LUTS?
Look at if its storage, voiding or post micturition symptoms mainly or a mix
Duration
Timing
Severity- incontinence episodes
Treatment already tried
How bothersome they symptoms are: IPSS score- international prostate symptoms score
Associated/other symptoms- ED?
Fluid type+intake, colour of urine etc
illicit drug use- ketamine?
Previous surgery, trauma or neurological problems
what investigations are done on someone presenting with LUTS?
Clinical Examination- Abdomen, looking for enlarged bladder (retention?), also look at external genitalia,
DRE- feel for prostate enlargement (benign or malignant)
Urine Dipstick- frequency could be diabetes, (glucose) UTI (nitrites and leukocytes)
BP
IPSS- international prostate symptoms score- QUW SNIIF (QoL, urgency, weak stream, straining, nocturia, intermittency, incomplete emptying, frequency)
Counselling for PSA testing must include warnings such as?
False Positives:
- PSA levels can be raised in conditions other than cancer- i.e. BPH or UTI
- May cause you to have unnecessary worrying or extra testing like biopsy which may lead to infection/bleeding.
- May pick up a slow growing cancer that wouldn’t have caused any problems in the life time so have unnecessary treatment with bad side effects
False Negatives:
- May not be raised by still have cancer so false reassurance
Why might you still choose to get your PSA tested despite the lack of sensitivity and specificity?
- may pick up prostate cancer early, so treated earlier and better prognosis
- may provide reassurance that you don’t have the cancer if comes back normal
Interpretation of PSA results?
different for individual men, the older you are the bigger the prostate so the higher the normal value
40-49:2ng/ml
50-59:3ng/ml
60-69:4ng/ml
etc but can have been effected by ejaculation, exercise, infection
Management of PSA results
decision to do further tests would be on:
how high the PSA result is, personal risk of prostate cancer (age, family history), what the prostate feels like, and your general health.
if suggests likely cancer,
referral to urologist
MRI scan of the prostate
Biopsy - using ultrasound to guide (transrectal)
(often refer to urologist anyway if raised)
if prostate cancer is found, what is done next?
Gleason grading
MRI to stage
Bone scan- to look for spread
What system is used to grade prostate cancer?
gleason grading
What are the options for treatment of BPH?
Watchful waiting - if the IPSS score is low, treatment likely to have more side effects than improve QoL.
Medication - various
Surgery - to relieve bladder outlet obstruction (TURP- transurethral resection of prostate
What medications can be used in the treatment of BPH? and how do they work?
Alpha 1 receptor blockers: relaxes smooth muscle in the prostate gland, so less pressure on urethra and can urinate more easily. (i.e. tamulosin)
5- alpha reductase inhibitor- prevents the conversion of testosterone to strong androgens, which normally causes the contraction of smooth muscle. so it relaxes
anticholinergics: blocks the muscarinic receptors on the detrusor muscle, so induces smooth muscle relaxation, so don’t feel the need to urinate as often, decreases contractility.
