Urinary obstruction and altered voiding

Question 1

What are the common storage LUT symptoms?

Answer 1

Incontinence
Urgency
Frequency
Nocturia

Question 2

What are the common voiding LUT symptoms?

Answer 2

Poor stream 
Hesistancy 
Dysuria 
Intermittency 
Double voiding 
Retention 
Straining 
Incomplete emptying

Question 3

What symptom is classed as a post-micturition LUT symptom?

Answer 3

Terminal dribbling (slow dribble at the end of voiding)

Question 4

What is urinary incontinence?

Answer 4

Involuntary loss of urine in sufficient amount or frequency to constitute a social and/or health problem

Question 5

What is stress incontinence?

Answer 5

Involuntary urine leakage on effort or exertion caused by raised intra-pelvic pressure causing leakage due to poor sphincter resistance
Common in females after child-bearing, in pregnancy or obesity. Less common in males except post-prostate surgery.

Question 6

What is urge incontinence?

Answer 6

Involuntary urine leakage accompanied or preceded by urgency (overactive bladder) 
Usually idiopathic (e.g. infection, tumour, stones, stroke, dementia)

Question 7

What is overflow incontinence?

Answer 7

Prolonged problems with bladder emptying (e.g. due to BPH, stones, constipation etc.) leading to chronic retention and detrusor failure

Question 8

What is functional incontinence?

Answer 8

A consequence of something not involving the LUT (psychological, cognitive or physical impairment e.g. mobility, dementia or diuretics)

Question 9

What is continuous incontinence?

Answer 9

Continuous leakage not related to bladder sensation or other events (e.g. due to spinal cord injury, bladder fistula or can be congenital)
Requires treatment of underlying anatomical cause + catheterisation

Question 10

What medication can be used to treat urge incontinence?

Answer 10

Oxybutinin (an anticholinergic)

MoA = competitive antagonist of Muscarinic ACh receptors leading to reduced detrusor activity

Question 11

What medication can be used to treat urinary retention?

Answer 11

Doxazosin (an alpha-blocker)

MoA = blocks alpha adrenoreceptors of sympathetic nervous system to relax smooth muscle sphincters allowing micturition

Question 12

What are the possible SEs of Oxybutynin?

Answer 12

Dry mouth/ dry eyes
Blurred vision
Fatigue
Tachycardia

[blocks muscarinic receptors throughout body]

Question 13

What are the symptoms of BPH?

Answer 13

Hesitancy 
Straining 
Weak flow 
Frequent urination/ nocturia 
Urinary incontinence

Question 14

How can BPH be examined/ investigated?

Answer 14

International prostate symptom score (7 symptom questions + 1 QoL question) 
Prostate-Specific Antigen 
Abdominal examination 
DRE 
Imaging (transrectal ultrasound scan)

Question 15

What is the management for BPH?

Answer 15

Lifestyle changes (reduce alcohol, caffeine, fizzy drinks etc.)
Doxasozin (alpha1-blocker)
Surgery (transurethral resection of prostate)

Question 16

What are the possible side effects of Doxazosin?

Answer 16

Nausea, dry mouth, fatigue, constipation, anxiety

[Blocks a1 receptors throughout body]

Question 17

How are urinary tract stones formed?

Answer 17

1. Crystalline growth on organic scaffold
2. Stone formers produce more crystals than normal
3. Crystals aggregate to form small stones

Question 18

Where do urinary tract stones commonly get stuck?

Answer 18

Pelvic Ureteric Junction (Kidney)
Pelvic brim
Vesicoureteric Junction
Bladder urethra outlet

Question 19

What is urodynamics?

Answer 19

Study of pressure and flow during storage, transport and expulsion of urine in the lower urinary tract

Question 20

What are the most common form of urinary tract stones?

Answer 20

Calcium Oxalate

Caused by hypercalciuria or hyperoxaluria

Question 21

What causes hypercalciuria?

Answer 21

Idiopathic 
Genetic disorders
Hyperparathyroidism 
Malignancy 
TB

Question 22

What is hyperoxaluria?

Answer 22

Excessive urinary excretion of oxalate

Can be genetic, dietary or enteric

Question 23

How are struvite stones formed?

Answer 23

Form in alkaline urine containing ammonia (which increases urine pH
Caused by urinary infection by urea-splitting bacteria

Question 24

What are the risk factors for developing struvite stones?

Answer 24

Always UTI related - risk factors:
Female 
Catheters
Neurogenic bladder
Urinary tract abnormalities
Stagnant urine

Question 25

What causes uric acid stones?

Answer 25

Accumulation of urate from purine metabolism (red meat, alcohol)
Gout (due to uric acid deposits)
Some medications (e.g. chemotherapy)
Hyperuricaemia or hyperuricosuria

Question 26

How do urinary tract stones usually present?

Answer 26

Loin to groin pain
Haematuria
Vomiting
Irritative voiding symptoms

Question 27

What investigations should be done for suspected urinary tract stones?

Answer 27

History (previous stones etc.) 
Urine dipstick 
Urine microscopy nd culture
U+Es, serum calcium, urate 
WCC + CRP (if fever) 
Imaging

Question 28

When do stones need to be removed?

Answer 28

Pain/ failure to pass 
Recurrent infection 
Renal impairment 
Obstruction 
Bleeding 
Increase in size
Some jobs (pilots) 

[Infected obstructed kidney requires immediate drainage!]

Question 29

How can stones be removed?

Answer 29

Fragmentation
Ureteroscopic removal
Percutaneous nephrolithotomy (kidney punctured for stone removal or fragmentation)