Urological Sx: LUTS, Incontinence, Haematuria Flashcards
What are LUTS? RF (9)?
- LUTs are storage, voiding , postmicturition Sx affecting lower urinary tract.
- They can spontaneously resolve (50%)
- It can reduce QoL and indicate serious pathology
RF
- in men it’s associated with BPH
- in women it’s associated with OAB
- Inc Age
- Enlarged prostate
- Sexual intercourse
- Slow urinary flow rate
- Obesity
- Pregnancy, following birth
- Post-menopausal women
Causes of LUTS (9)
- BPH
- OAB
- UTI
- Chronic pancreatitis
- Failure of detrusor muscles
- Foreign body in bladder or urethra
- Neuropathy
- Excessive fluid intake
- Drugs - diuretics, CCBs, caffeine, alcohol, ketamine
What are storage Sx?
- Frequency: going toilet more frequently
- Urgency: sudden and need to void
- Nocturia: disturbs their sleep
- Incontinence
–> more common in women, OAB
What are Voiding Sx? (6)
It is more common in men, obstruction
- poor stream: stop start, dribble
- hesitancy: waiting to start
- terminal dribbling
- intermittency: starts and stops
- Straining during urination
- Spitting or spraying during urination
What are Postmicturition Sx?
- incomplete emptying
- postmicturition dribble: voiding continued after finishing
What examinations and investigations would you do for LUTS? (9)
- Abdo (distended bladder?), genitalia, DRE, neurological examinations
- Bladder diary
- Urinalysis and culture: UTI?
- Asses renal function: GFR, creatinine
- US: measures residual urine in overflow incontinence
- Cystometrogram, Urodynamic testing: measures bladder function, urine flow rates
- CT and Cystoscopy
- MRI
- PSA if appropriate
Management for LUTS
- Urinary frequency-volume chart
- Exclude serious pathologies (Cancer, infection of sciatica etc)
- Lifestyle advice
- Referral to specialist depending on cause
Classifications of incontinence (7.)
Incontinence is the involuntary loss of urine (failure of storage)
- Urge - intense need to void
- Stress - leak during cough, sneeze, exercise etc
- Mixed - combination of stress & urgency
- Overflow - Bladder cannot completely empty –> swelling, trickling
- Total (severe)- constant passing of urine, leakage, large amounts
- Continuous - due to fistula
- Social - in dementia
Pathophysiology and aetiology (7) of urgency incontinence
- urgency with inc frequency +/- nocturia
- Usually due to an OAB i.e. detrusor overactivity that inc bladder pressure that overcomes urethral sphincter
- Triggered by running water, change position, orgasm etc
- Aetiology: idiopathic, UTI, bladder stone, neurological conditions, diabetes, diuretics, inc age
Mx of urgent incontinence (5).
- Bladder retraining, pelvic floor exercise
- Lifestyle: reduce caffeine, alcohol, consider aids like pads, incontinenece chart
- Drugs that target ANS
- Anti-cholinergic = dec parasymp
- B3 agonist = Inc symp
- Botox = blocks Ach release - Sacral neuromodulation
- Surgery - Augmentation cystoplasty: Use of intestine, stomach to make bladder larger so can hold more urine
Ix and Mx of Stress Incontinence
Ix = Examine cough leak when standing w/full bladder
Mx
- Pelvic floor physiotherapy (1st line)
- Intravaginal electrical stimulation may help
- Ring pessary may help with uterine prolapse
- Duloxetine: inc contraction of urethral sphincter
- Surgery: Sling (TVT, TOT), urethral bulking agent etc
Medical management of incontinence (stress and urgency)
(1. ) Duloxetine (an SNRI) for stress incontinence
- If surgery is unsuitable
- Increase the muscle tone of the urethra and help keep it closed
(2. ) Antimuscarinic for OAB/urgency
- B3 agonist, alpha antagonist
- If fails consider BOTOX (specialist referral)
What are voiding-LUTS caused by?
Obstruction:
- BPE
- urethral strictures
- prolapse/mass
Non-obstructive:
- Detrusor underactivity where bladder has lost ability to contract so can’t get urine out
Mx of voiding LUTS?
(1. ) If due to obstruction:
- alpha blockers +/- 5-alpha reductase inhibitor
- OR PED5i (Viagra) if erectile dysfunction present, helps men empty the bladder
- If fails: TURP (removal of prostate adenoma tissue)
(2. ) If non-obstructive
- Long term catherization
- Urethral milking
- Surgery for voiding: TURP, TUVP
What is Pseudohaematuria and what may cause it?
- Pseudohaematuria is red or brown urine that is not due to the presence of haemoglobin thus NOT haematuria
Causes include:
- medication: rifampicin, methyldopa
- Hyperbilirubinuria
- Myoglobinuria
- Foods: beetroot or rhubarb
- Menstruation
- Recent intercourse
