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Year 3 GP > Urinary Symptoms > Flashcards

Urinary Symptoms Flashcards

1
Q

Urinary frequency

A

Going often but with the same volume

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2
Q

Polyuria

A

Passing more urine 3L +

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3
Q

Nocturia

A

Urinating at night and waking up

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4
Q

Hesitancy

A

Initial delay in flow

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5
Q

Terminal dribbling

A

Dibble of urine at end of urinations

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6
Q

Storage symptoms

A 
Urgency 
Polyuria
Nocturia 
Incontinence - bed wetting
Needing to urinate again straight after urinating
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7
Q

Voiding symptoms

A 
Hesitancy 
Weak or intermittent stream 
Spraying 
Straining 
Terminal dribbling 
Incomplete emptying
Dysuria
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8
Q

Post micturition symptoms

A

Post micturition Dribble

Incomplete emptying

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9
Q

Stress incontinence

A

When exerting, coughing and increased intra-thoracic pressure

  • pelvic floor problem
  • 1st line Mx = pelvic floor exercises
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10
Q

Urge incontinence

A

Urgently feeling the need to urinate and not being able to hold it in.

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11
Q

Mixed incontinence

A

Stress + urge

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12
Q

Flow volume chart

A

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
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13
Q

Common causes of UTI

A 
T2DM 
Stones 
Cancer 
Neurological - MS
Medication - furosemide
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14
Q

Investigation and Mx of female UTI

A

Durinary dipstick and culture
Blood glucose

Mx:

  • avoid caffeine
  • pelvic exercises
  • lose weight
  • Nitrofurantoin or Trimethoprim - 3 days
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15
Q

Ix for LUTS in men

A

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)

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16
Q

Red flag signs of LUTS

A 
Unexplained haematuria 
Loin pain
Rigors
N/V
Lower back pain 
Weight loss 
Bone pain 
Hard and irregular prostate

2ww referral
Sepsis

17
Q

Mx of voiding problem in men

A

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

18
Q

Mx of BPH

A

Finasteride- 5 alpha reductase inhibitor

19
Q

Man has mixed storage and voiding symptoms Mx

A

If persists after giving alpha blocker, give oxybutynin

Do not offer oxybutynin in frail old men - causes confusion

Alternative: tolterodine

20
Q

Mx of overactive bladder in men

A

Pelvic floor exercises
Oxybutynin
Mirabegronon- Beta 3 agonist - decreased sensitivity

21
Q

Mx of stress urinary incontinence in men

A

Sustained fluid intake

If due to prostatectomy:

  • pelvic floor muscle training
  • catheterization

If not prostatectomy - address other causes such as medication

22
Q

Mx of acute urinary retention in men

A

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

23
Q

Mx of chronic urinary retention in a man

A

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).
24
Q

Mx of post micturition dribble not due to urinary obstruction in man

A

Milking urethra after urinating

25
Q

Mx of acute lower UTI without haematuria in a woman who is not pregnant or catheterized

A

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

26
Q

Mx of women with suspected UTI associated with visible or non-visible haematuria

A

Re-test urine after completing treatment with an appropriate antibiotic

27
Q

Mx of a woman who is not pregnant or catheterized with recurrent UTI not associated with haematuria

A

Manage acute UTI
Refer/seek specialist advice on further investigation and management - if cause unknown
Discuss behavioural and personal hygiene measures

28
Q

Pregnant women

A

Trimethoprim is contraindicated

29
Q

LUTS

A
  • frequency
  • Urgency
  • Haematuria
  • Dysuria
  • Hesitancy
  • Incontinence - urge
  • Terminal dribbling
  • Nocturia
  • Weak flow
  • Overflow
30
Q

Commonest cause of LUTS in men

A

BPH

31
Q

Tamsulosin

A

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

32
Q

Finasteride

A

5 alpha reductase inhibitor - less testosterone to prevent prostate growth

Takes 6 months

33
Q

Oxybutynin

A

Anticholinergic - inhibits voiding by preventing abnormal contractions

Side effects:

  • dry mouth
  • constipation
  • blurred vision
34
Q

Nocturnal polyuria

A

Passing more urine at night - more than 1/3rd of total output at night between sleeping and waking

Year 3 GP (20 decks)

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