Urinary Symptoms Flashcards
Urinary frequency
Going often but with the same volume
Polyuria
Passing more urine 3L +
Nocturia
Urinating at night and waking up
Hesitancy
Initial delay in flow
Terminal dribbling
Dibble of urine at end of urinations
Storage symptoms
Urgency Polyuria Nocturia Incontinence - bed wetting Needing to urinate again straight after urinating
Voiding symptoms
Hesitancy Weak or intermittent stream Spraying Straining Terminal dribbling Incomplete emptying Dysuria
Post micturition symptoms
Post micturition Dribble
Incomplete emptying
Stress incontinence
When exerting, coughing and increased intra-thoracic pressure
- pelvic floor problem
- 1st line Mx = pelvic floor exercises
Urge incontinence
Urgently feeling the need to urinate and not being able to hold it in.
Mixed incontinence
Stress + urge
Flow volume chart
Measure of bladder function:
- fluid intake vs urinary output
- initial assessment
- aids diagnosis
- baseline for planning bladder training regime
- monitor progress + treatment
Measure:
- time when urinating
- flow and volume
- bladder diary
- minimum 3 days
Common causes of UTI
T2DM Stones Cancer Neurological - MS Medication - furosemide
Investigation and Mx of female UTI
Durinary dipstick and culture
Blood glucose
Mx:
- avoid caffeine
- pelvic exercises
- lose weight
- Nitrofurantoin or Trimethoprim - 3 days
Ix for LUTS in men
Examine abdomen - distension or dullness on percussion
Examine external genitalia
DRE
Urinary frequency - volume chart for 3+ days
Urine dipstick
eGFR - U+Es
PSA (before DRE)
Red flag signs of LUTS
Unexplained haematuria Loin pain Rigors N/V Lower back pain Weight loss Bone pain Hard and irregular prostate
2ww referral
Sepsis
Mx of voiding problem in men
Conservative:
- pelvic floor training
- avoid caffeine and fizzy drinks
Medication:
- moderate - severe - alpha - blocker e.g. tamsulosin or doxazosin
- follow up after 4 - 6 weeks
If also has prostate enlargement - alpha blocker and finasteride
Mx of BPH
Finasteride- 5 alpha reductase inhibitor
Man has mixed storage and voiding symptoms Mx
If persists after giving alpha blocker, give oxybutynin
Do not offer oxybutynin in frail old men - causes confusion
Alternative: tolterodine
Mx of overactive bladder in men
Pelvic floor exercises
Oxybutynin
Mirabegronon- Beta 3 agonist - decreased sensitivity
Mx of stress urinary incontinence in men
Sustained fluid intake
If due to prostatectomy:
- pelvic floor muscle training
- catheterization
If not prostatectomy - address other causes such as medication
Mx of acute urinary retention in men
1st episode - arrange hospital admission
Recurrent acute retention or acute-on-chronic urinary retention, admit the man, or insert a urethral catheter
An alpha-blocker - modified-release alfuzosin — in men over 65 years of age.
- atleast 24 hrs before catheter removal
Mx of chronic urinary retention in a man
Exclude non-obstructive causes of reduced urine flow (such as chronic heart failure).
Check serum creatinine to assess renal function.
Refer the man for specialist assessmen`t.
Advise the man about management options in secondary care, including:
- No catheterization, but follow up with regular monitoring
- Intermittent urethral catheterization
- A permanent indwelling catheter.
- Surgery to divert the urine externally (urostomy).
Mx of post micturition dribble not due to urinary obstruction in man
Milking urethra after urinating
Mx of acute lower UTI without haematuria in a woman who is not pregnant or catheterized
Simple analgesia such as paracetamol
Encourage intake of enough fluids to avoid dehydration
Antibiotics depending on severity of symptoms
- Nitrofurantoin 3 days
- Trimethoprim 3 days
- can prescribe as delayed back up after 48 hrs
Mx of women with suspected UTI associated with visible or non-visible haematuria
Re-test urine after completing treatment with an appropriate antibiotic
Mx of a woman who is not pregnant or catheterized with recurrent UTI not associated with haematuria
Manage acute UTI
Refer/seek specialist advice on further investigation and management - if cause unknown
Discuss behavioural and personal hygiene measures
Pregnant women
Trimethoprim is contraindicated
LUTS
- frequency
- Urgency
- Haematuria
- Dysuria
- Hesitancy
- Incontinence - urge
- Terminal dribbling
- Nocturia
- Weak flow
- Overflow
Commonest cause of LUTS in men
BPH
Tamsulosin
Alpha blocker - acts on bladder neck
- relaxation of bladder neck to improve flow and empty better
Side effects - low blood pressure causing postural hypotension therefore take at night
Finasteride
5 alpha reductase inhibitor - less testosterone to prevent prostate growth
Takes 6 months
Oxybutynin
Anticholinergic - inhibits voiding by preventing abnormal contractions
Side effects:
- dry mouth
- constipation
- blurred vision
Nocturnal polyuria
Passing more urine at night - more than 1/3rd of total output at night between sleeping and waking
