Urinary obstruction and altered voiding Flashcards
What are the common storage LUT symptoms?
Incontinence
Urgency
Frequency
Nocturia
What are the common voiding LUT symptoms?
Poor stream Hesistancy Dysuria Intermittency Double voiding Retention Straining Incomplete emptying
What symptom is classed as a post-micturition LUT symptom?
Terminal dribbling (slow dribble at the end of voiding)
What is urinary incontinence?
Involuntary loss of urine in sufficient amount or frequency to constitute a social and/or health problem
What is stress incontinence?
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.
What is urge incontinence?
Involuntary urine leakage accompanied or preceded by urgency (overactive bladder) Usually idiopathic (e.g. infection, tumour, stones, stroke, dementia)
What is overflow incontinence?
Prolonged problems with bladder emptying (e.g. due to BPH, stones, constipation etc.) leading to chronic retention and detrusor failure
What is functional incontinence?
A consequence of something not involving the LUT (psychological, cognitive or physical impairment e.g. mobility, dementia or diuretics)
What is continuous incontinence?
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
What medication can be used to treat urge incontinence?
Oxybutinin (an anticholinergic)
MoA = competitive antagonist of Muscarinic ACh receptors leading to reduced detrusor activity
What medication can be used to treat urinary retention?
Doxazosin (an alpha-blocker)
MoA = blocks alpha adrenoreceptors of sympathetic nervous system to relax smooth muscle sphincters allowing micturition
What are the possible SEs of Oxybutynin?
Dry mouth/ dry eyes
Blurred vision
Fatigue
Tachycardia
[blocks muscarinic receptors throughout body]
What are the symptoms of BPH?
Hesitancy Straining Weak flow Frequent urination/ nocturia Urinary incontinence
How can BPH be examined/ investigated?
International prostate symptom score (7 symptom questions + 1 QoL question) Prostate-Specific Antigen Abdominal examination DRE Imaging (transrectal ultrasound scan)
What is the management for BPH?
Lifestyle changes (reduce alcohol, caffeine, fizzy drinks etc.)
Doxasozin (alpha1-blocker)
Surgery (transurethral resection of prostate)
What are the possible side effects of Doxazosin?
Nausea, dry mouth, fatigue, constipation, anxiety
[Blocks a1 receptors throughout body]
How are urinary tract stones formed?
- Crystalline growth on organic scaffold
- Stone formers produce more crystals than normal
- Crystals aggregate to form small stones
Where do urinary tract stones commonly get stuck?
Pelvic Ureteric Junction (Kidney)
Pelvic brim
Vesicoureteric Junction
Bladder urethra outlet
What is urodynamics?
Study of pressure and flow during storage, transport and expulsion of urine in the lower urinary tract
What are the most common form of urinary tract stones?
Calcium Oxalate
Caused by hypercalciuria or hyperoxaluria
What causes hypercalciuria?
Idiopathic Genetic disorders Hyperparathyroidism Malignancy TB
What is hyperoxaluria?
Excessive urinary excretion of oxalate
Can be genetic, dietary or enteric
How are struvite stones formed?
Form in alkaline urine containing ammonia (which increases urine pH
Caused by urinary infection by urea-splitting bacteria
What are the risk factors for developing struvite stones?
Always UTI related - risk factors: Female Catheters Neurogenic bladder Urinary tract abnormalities Stagnant urine
What causes uric acid stones?
Accumulation of urate from purine metabolism (red meat, alcohol)
Gout (due to uric acid deposits)
Some medications (e.g. chemotherapy)
Hyperuricaemia or hyperuricosuria
How do urinary tract stones usually present?
Loin to groin pain
Haematuria
Vomiting
Irritative voiding symptoms
What investigations should be done for suspected urinary tract stones?
History (previous stones etc.) Urine dipstick Urine microscopy nd culture U+Es, serum calcium, urate WCC + CRP (if fever) Imaging
When do stones need to be removed?
Pain/ failure to pass Recurrent infection Renal impairment Obstruction Bleeding Increase in size Some jobs (pilots)
[Infected obstructed kidney requires immediate drainage!]
How can stones be removed?
Fragmentation
Ureteroscopic removal
Percutaneous nephrolithotomy (kidney punctured for stone removal or fragmentation)
