Urinary obstruction and altered voiding Flashcards
What are the common symptoms of lower urinary tract problems? (LUTS)
Storage - Incontinence, urgency, frequency, nocturia
Voiding - Poor stream (weak/intermittent), hesitancy, dysuria, intermittency, double voiding, retention, straining, incomplete emptying, terminal dribbling
Post-micturition - terminal dribble and the sensation of incomplete emptying
What are the problems associated with urinary incontinence?
Social/health problem
QoL impact
Skin breakdown - pressure sores
What are the different types of incontinence?
Stress (poor sphincter resistance)
Urge/urgency (overactive bladder)
Mixed (stress and urge)
Overflow (chronic retention and detrusor failure)
Continuous
Childhood
Functional (psychological. cognitive or physical imp)
If a patient was taking furosemide and they needed to urinate after taking it and maybe need to get up at night as well, what type of incontinence is this?
Functional incontinence
Describe the history, examination and investigations you would perform for incontinence.
H: Precipitating events, duration, pad usage, bother; medical/surgical history
E: Abdomen, pelvic (genitalia), digital rectum exam
Neurologic exam, mental status & mobility
I: dipstick, microscopy, sensitivity and culture. cytology, FBC, U&Es, glucose, freq-vol chart (bladder diary), urodynamics
What is urodynamics?
Study of pressure and flow during storage, transport and expulsion of urine in the (lower) urinary tract
What is outflow cystometry?
Fill bladder with fluid (+/- contrast for imaging)
record pressures in bladder and rectum.
Bladder emptied and pressures recorded
Bladder – rectum = detrusor
What are the treatment options/management plan for a patient with continuous incontinence?
surgical treatment of underlying anatomical disorder
catheterisation
What are the treatment options/management plan for a patient with stress incontinence?
Incontinence protection
Pharmacological
Surgery
What are the treatment options/management plan for a patient with urge incontinence?
Avoid stimulants Bladder retaining Anticholinergics: OXYBUTYNIN Beta3 adrenergic agonists Surgery
What are the treatment options/management plan for a patient with urinary retention?
Restore bladder emptying Intermittent self-catheterisation Long-term catheter α blockers: TAMSULOSIN Surgical treatment of bladder outflow obstruction
What is oxybutynin used to treat, what is its MoA and side effects?
Urge incontinence/overactive bladder
Anticholinergic - inhibits muscarinic receptors by blocking acetylcholine receptors - reduces detrusor muscle activity.
SE: Blurred vision, glaucoma, Fatigue, Tachycardia, urinary retention
What are the differential diagnoses for urinary retention (urinary obstruction)?
BPH Prostate cancer Prostatitis Haematuria Tumours Stones Structural
What are the symptoms of BPH? (benign prostate hyperplasia)
Enlarged prostate - compresses urethra (>50)
Hesitancy
Straining/taking a long time while urinating
weak flow of urine
“stop-start” peeing
Urinate urgently/frequently, nocturia
feeling that your bladder has not emptied fully
How can you assess the impact of BPH on a patient?
Calculate the international prostate symptom score (7 qs and 1 QoL q)
What examinations/investigations can you perform to diagnose BPH?
International prostate symptom score Inc prostate specific antigen (PSA) Abdo exam DRE Imaging: transrectal ultrasound scan
What are the different ways you can help a patient manage BPH? (hint: lifestyle, drugs, surgery, complications)
Lifestyle: less caffeine, fizzy drinks, alcohol/ do exercise
Drugs: Tamsulosin - selective alpha1 blocker
Surgery: Transurethral resection of prostate
Complications: UTI, acute urinary retention, incontinence, erectile problems
What is tamsulosin used to treat, what is its MoA and side effects?
Urinary retention and BPH
Selective alpha1 blocker -> smooth muscle relaxation -> urine flow -> flow proportional to vessel diameter
SE: Dizziness, sexual dysfunction
During a prostate, digital rectal examination, what texture can indicate cancer?
Hard/lumpy/irregular
Identify the common risk factors and common causes of urinary tract stone formation.
Common (10%). M>F (2-4x)
Age (peak onset 20-30)
Fluid intake (dehydration facilitates stones: urine concentrated)
Family history
Describe the common presentation signs and symptoms of urinary tract stones.
Loin to groin pain (ureteric colic)
Haematuria
Vomiting
Irritative voiding symptoms
Where can kidney stones form and get stuck?
Pelvic ureteric junction
Pelvic brim
Vesicoureteric junction
Bladder urethra outlet
What are the most common type of kidney stones?
Calcium Oxalate
