Urology Surgical Presentations Flashcards
what is a lower urinary tract symptom?
symptoms that affect the control and quality of micturition in the lower urinary tract
true or false: LUTS can only affect men
false.
they affect both men and women - but more common in older aged men
what are common causes for LUTS in males?
- BPH
- chronic prostatitis
- urethral stricture
what are common causes for LUTS in females?
- menopause
- urethral stricture
what are common causes for LUTS in both male and females?
- UTI
- urological malignancy
- detrusor muscle weakness/ instability
- external compression (pelvic tumour or faecal impaction)
- neurological disease (MS, spinal injury)
true or false: UTIs are the most common cause of LUTS in males and females
false.
females: UTIs
males: BPH
what lifestyle factors can make LUTS worse?
- excess alcohol intake
- excess caffeine intake
what are ‘storage’ symptoms of LUTS?
happens when the bladder should be storing urine common symptoms: - urgency - frequency - nocturnal - urgency incontinence
what are ‘voiding’ symptoms of LUTS?
happens usually due to bladder outlet obstruction - making passing urine more difficult common symptoms: - hesitancy - intermittency - straining - terminal dribbling - incomplete emptying
what are common associated symptoms with LUTS?
- visible haematuria
- suprapubic discomfort
- colicky pain
what medications can cause/ exacerbate LUTS?
- anticholinergics
- antihistamines
- bronchodilators
what initial investigations are important for someone with LUTS?
- urinalysis
- routine bloods
- post-void bladder scanning and flow rate
what could you find on a urinalysis of someone with LUTS and what pathology would this indicate?
- assess for signs of a UTI and send for urine culture
- haematuria (indicates bladder stones)
- glycosuria (diabetes)
what bloods would you do and what would they show in a person with LUTS?
FBC, U&Es, CRP - show a baseline as well as any signs of infection
PSA - check for prostate pathology
why would you do a post-void bladder scan and flow rate in someone with LUTS?
will be used to help distinguish between the causes of LUTS and the severity of the symptoms
what specialist investigations would you consider doing in a person with LUTS?
- urodynamic studies
- upper urinary tract imaging
when would a cystoscopy be indicated in a patient with LUTS?
history of recurrent infection or if the patient has haematuria
what do urodynamic studies assess in a patient with LUTS?
assesses flow rate, detrusor pressure, storage capacity
used when a patient may have a neurogenic bladder dysfunction
when would upper urinary tract imaging be used in a patient with LUTS?
ultrasound or CT scanning is useful if there is a history of chronic retention, recurrent infection, or if the patient has haematuria
what is the initial conservative management of a patient with LUTS?
- regulate fluid intake (timing and amount of drinks)
- urethral milking techniques (if patient has trouble voiding)
- pelvic floor exercises (in cases of stress incontinence)
- bladder training technique (increase duration between urge to void and micturition - useful in an overactive bladder)
what are the pharmacological interventions a patient with LUTS can have?
- over active bladder: anticholinergics
- BPH: alpha-blockers
how do anticholinergics help treat an overactive bladder?
helps relax the detrusor muscle by opposing the parasympathetic cholinergic control of contraction
what are the names of some commonly used anticholinergics?
oxybutinin and tolterodine
how do alpha blocker help relieve symptoms in BPH?
helps reduce prostate size by relaxing the prostatic muscle
what are the names of some commonly used alpha blockers?
alfuzosin and tamsulosin
what are the common complication of LUTS?
- untreated LUTS increase risk of infection and stone formation due to stagnant urine
- chronic obstruction can lead to bladder muscle hypertrophy leading to overflow incontinence
- renal complications such as hydronephrosis and renal failure
