Urology 2: LUTs Flashcards
what are storage LUT symptoms
frequency
nocturia
urgency
urge incontinence
what are voiding LUTS
hesitancy
poor flow
incomplete emptying
terminal dribble
what are post micturition LUTS
pot-micturition dribble
what are some cause of OABs
primary
secondary to obstruction
carcinoma-in-situ
neurogenic
radiation
infection
what do you need to make patients aware of when they start finasteride
can take up to 6 months to feel the full effect
how do you define nocturia
> 1/3 of their daily urine output over night
what are some causes of nocturia
loss of circadian urine output rhythm with age
chronic venous insufficiency
congestive HF
COPD
sleep apnoea
diabetes
CKD
how can nocturia be managed
advise to reduce night time fluids
can trial low dose loop diuretic 4-6 hours before bed
desmopressin can be used last line, as can have issue with fluid retention or electrolyte disturbances in the elderly
how would you investigate LUTs
History
abdominal, genital exam, DRE
urine dipstick
frequency-volume chart
PSA
in secondary care: flow rate and post-void bladder scan, and urodynamics in select cases
what are some side effects of oxybutynin
dry mouth
urinary retention
dizziness
dry eyes
constipation
blurred vision
how can you manage OABs
topical vaginal oestrogen
anticholinergic (oxybutynin)
systemic oestrogen
then different anticholinergic
then mirabegron +/- anticholinergic
intravesical botox
sacral nerve stimulation
illiocystoplasty
how can you interpret flow rate for urinary LUTS
Qmax = max flow
10-15 = 60% chance of obstruction
<10 = 90% chance of obstruction
what can cause low/absent detrusor pressure
idiopathic
diabetes
neurological problem
follow on from chronic retention
what are lifestyle changes which can be used for LUTS
avoid bladder irritants: caffine, alcohol
avoid excessive fluids
bladder training
what are medical treatment options for BPH
alpha blockers - tamsulosin
5-alpha reductase inhibitors - finasteride
if they also have OAB symptoms then anticholinergic can be used
when is there indication for surgery for LUTS
failure of medical therapy
complications: chronic retention, bladder stones, haematuria
what complication can arise from TURP
TURP syndrome - dilutional hyponatraemia
- confusion, fits , visual symptoms, coma
glycine is used for irrigation of patients
absorption during long resection can lead to dilutional hyponatraemia
how do you define OABS
urgency +/- incontinence often accompanies by frequency and nocturia
how can you manage stress incontinence
lifestyle: weight loss, pelvic floor exercises
medication: duloxetine (risk of arrythmia and only 50% success rate)
surgical: autologous fascial sling, suturing of the perivaginal tisue, colposuspension
artifiscial sphincter
bladder neck bulking injections
describe acute and chronic urinary retention
acute: painful inability to void, 300-1500mls residual
chronic: painless, may still void, 300-4000mls residual vol
how do you manage acute urinary retention
catheterise and record urine output
treat obvious causes
men: alpha blocker, if fails to manage then TURP
what complications can arise from high pressure chronic urinary retention
abnormal Us+Es (hyperkalaemia)
hydronephrosis
how to manage high pressure chronic urinary retention
no trail without catheter
discuss with urology as may need TURP
catherter and record residual volume
monitor for post-obstruction diuresis
how is low pressure chronic urinary retention managed
TURP (only 50% will void again)
may need intermittent self-catheteriation or long term/ or suprapubic
what is post obstructive diuresis
the initial physiological off-loading of accumulated salt and water during chronic retention
can become excessively dehydrated or have severe electrolyte imbalance
generally can be managed by careful monitoring and oral fluid replacement
