3.1.2 Men's Health Urology II

Question 1

What are some common causes of urinary retention?

Answer 1

• Prostatic enlargement, BPH or cancer
• Phimosis/urethral stricture/meatal stenosis
• Constipation
• UTI
• Drugs- anticholinergics
• Over-distension- too much fluids
• Following surgery
• Neurological

Question 2

What are the different types of urinary retention?

Answer 2

Acute
Chronic
Acute on chronic

Question 3

Features of acute urinary retention

Answer 3

Painful
Pain relieved by catheter
Residual volume < 1000mls
No kidney insult

Question 4

Features of chronic urinary retention

Answer 4

Painless/less painful
May have some abdominal swelling
Residual volume >300mls (largest 5L)
May have kidney insult

Question 5

Features of acute on chronic urinary retention

Answer 5

Painful
Residual volume >1000mls
Usually have kidney insult

Question 6

How do you treat each type of urinary retention?

Answer 6

Acute- Trial without catheter, TWOC after treating exacerbating factor

Chronic - learn to self catherise

Acute on chronic - Long term catheter or surgical intervention (TWOC not usually successful as kidney insult)

Question 7

What does nocturnal enuresis in older men suggest?

Answer 7

Chronic retention with overflow incontinence

Question 8

How do you describe lower urinary tract symptoms?

Answer 8

Not disease specific, therefore do not say prostatism

Question 9

What are the different types of LUTs (lower urinary tract symtpms)?

Answer 9

Voiding:
- Hesitancy
- Poor flow
- Post micturition dribble

Storage:
- Urgency
- Frequency
- Nocturia

Question 10

What are some causes of storage LUTs?

Answer 10

Irritative eg bladder infection/inflammation, bladder stone, cancer

Overactive bladder - idiopathic or neuropathic (stroke, parkinsons, MS)

Low compliance of bladder (scarred) eg after TB, schistosomiasis, pelvic radiotherapy

Polyuria -
Global (eg from uncontrolled diabetes)
Nocturnal (venous stasis, sleep apnoea - leads to raised ANP levels)

Question 11

What can cause voiding symptoms?

Answer 11

Bladder outflow obstruction:
- Uethra (phimosis, structure), prostate (BPH, cancer, bladder neck)
- Dynamic - prostate and bladder neck?
- Neurological - lack of coordination between bladder and sphincters - upper motor neurone problem?

Reduced contractility:
- Physical
- Neurological LMN lesion

Question 12

What symptoms are suggestive of a stricture?

Answer 12

Urine spraying

Question 13

Why can the prostate lead to bladder outflow obstructions?

Answer 13

Sympathetic smooth muscular tone
(mediated by a1 receptors)

Question 14

What scoring system is used to assess LUTs?

Answer 14

IPSS, international postate symptom score

Question 15

What are the 7 questions asked on IPSS?

Answer 15

Incomplete Emptying
Frequency
Intermittency
Urgency
Weak Stream
Straining
Nocturia

FUN WINS

F-requency
U-rgency
N-octuria

W-eak stream
I-ncomplete emptying
iN-termittency
S-training

If you were to spend the rest of your life with your urinary condition how would you feel?

Question 16

How is IPSS scored?

Answer 16

Each 0-5

Mild - 0-7
Moderate - 8-19
Severe - 20-35

Question 17

What examinations are used for LUTs?

Answer 17

DRE
Is the bladder palpable?
Neurological if suggestive history

Question 18

What investigations are there for LUTs?

Answer 18

Dipstick, UTI, blood

Consider PSA (prostate specific antigen) - not a surrogat for DRE, if UTI treat first and if palpably benign prostate wait 4-6 weeks

Question 19

What lifestyle changes should be made to manage BPH?

Answer 19

• Reduce caffeine intake
• Avoid fizzy drinks
• No need to drink more than 2.5L day

Question 20

What can medication can be given for BPH?

Answer 20

Alpa blockers
5 alpha reductase inhibitors

Question 21

How do alpha blockers relieve BPH symptoms?

Answer 21

Relaxing smooth muscle within prostate and bladder neck

Rapid symptom relief

Tamulosin

Question 22

How do 5a Reductase Inhibitors work?

Answer 22

Prevents conversion of testosterone to DHT which is a more potent androgen

Shrinks the prostate, slower symptom relief than alpha blockers
Slows progression
Reduces risk of retention

Finasteride

Question 23

What is the first thing to do when managing BPH in secondary care?

Answer 23

Flow rate before considering surgery

Question 24

What are the indications for surgery for BPH?

Answer 24

Failed lifestyle and medical management

Urinary retention needing intervention

Question 25

What is the standard surgery for BPH?

Answer 25

Transurethral resection of prostate (TURP)

Monopolar/laser/bipolar