Urology 2: LUTs Flashcards

1
Q

what are storage LUT symptoms

A

frequency
nocturia
urgency
urge incontinence

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2
Q

what are voiding LUTS

A

hesitancy
poor flow
incomplete emptying
terminal dribble

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3
Q

what are post micturition LUTS

A

pot-micturition dribble

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4
Q

what are some cause of OABs

A

primary
secondary to obstruction
carcinoma-in-situ
neurogenic
radiation
infection

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5
Q

what do you need to make patients aware of when they start finasteride

A

can take up to 6 months to feel the full effect

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6
Q

how do you define nocturia

A

> 1/3 of their daily urine output over night

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7
Q

what are some causes of nocturia

A

loss of circadian urine output rhythm with age
chronic venous insufficiency
congestive HF
COPD
sleep apnoea
diabetes
CKD

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8
Q

how can nocturia be managed

A

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

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9
Q

how would you investigate LUTs

A

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

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10
Q

what are some side effects of oxybutynin

A

dry mouth
urinary retention
dizziness
dry eyes
constipation
blurred vision

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11
Q

how can you manage OABs

A

topical vaginal oestrogen
anticholinergic (oxybutynin)
systemic oestrogen
then different anticholinergic
then mirabegron +/- anticholinergic
intravesical botox
sacral nerve stimulation
illiocystoplasty

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12
Q

how can you interpret flow rate for urinary LUTS

A

Qmax = max flow
10-15 = 60% chance of obstruction
<10 = 90% chance of obstruction

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13
Q

what can cause low/absent detrusor pressure

A

idiopathic
diabetes
neurological problem
follow on from chronic retention

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14
Q

what are lifestyle changes which can be used for LUTS

A

avoid bladder irritants: caffine, alcohol
avoid excessive fluids
bladder training

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15
Q

what are medical treatment options for BPH

A

alpha blockers - tamsulosin
5-alpha reductase inhibitors - finasteride

if they also have OAB symptoms then anticholinergic can be used

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16
Q

when is there indication for surgery for LUTS

A

failure of medical therapy
complications: chronic retention, bladder stones, haematuria

17
Q

what complication can arise from TURP

A

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

18
Q

how do you define OABS

A

urgency +/- incontinence often accompanies by frequency and nocturia

19
Q

how can you manage stress incontinence

A

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

20
Q

describe acute and chronic urinary retention

A

acute: painful inability to void, 300-1500mls residual

chronic: painless, may still void, 300-4000mls residual vol

21
Q

how do you manage acute urinary retention

A

catheterise and record urine output
treat obvious causes
men: alpha blocker, if fails to manage then TURP

22
Q

what complications can arise from high pressure chronic urinary retention

A

abnormal Us+Es (hyperkalaemia)
hydronephrosis

23
Q

how to manage high pressure chronic urinary retention

A

no trail without catheter
discuss with urology as may need TURP
catherter and record residual volume
monitor for post-obstruction diuresis

24
Q

how is low pressure chronic urinary retention managed

A

TURP (only 50% will void again)
may need intermittent self-catheteriation or long term/ or suprapubic

25
Q

what is post obstructive diuresis

A

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