RENAL - Lower urinary tract

Question 1

Symptoms of obstructive LUTS

Answer 1

Poor Flow
Hesitancy
Intermittency
Terminal dribbling

Question 2

Symptoms of irritative LUTS

Answer 2

Frequency
Urgency
Nocturia
Incontinence

Question 3

Causes of obstructive LUTS

Answer 3

BPH
Ca Prostate
Stricture

Question 4

Causes of irritative LUTS

Answer 4

Secondary to obstruction
UTI
Ca Bladder
Stone
Diabetes
TB

Question 5

O/E in LUTS

Answer 5

• Abdomen: Is there a palpable / percussible bladder
• Genitalia: phimosis / balanitis / meatal stenosis / epididymitis
• DRE: CaP? Rectal Mass? (prostate size?)

Question 6

Ix of LUTS

Answer 6

•MSU
•U/E and Cr
•?PSA
•Bladder diary
•Voiding flow rate
•USS
–residual urine
–hydronephrosis

Question 7

Mx of LUTS

Answer 7

Exclude Medical Causes
–Diabetes
–Diuretics
–Nocturnal polyuria
–Caffeine / Alcohol
–Polydipsia
–Sleep Apnoea
–Drugs (anti-cholinergic, sympathomimetic)

Observe

Medical treatment
–alpha blockers
–5-alpha reductase inhibitors
–Combination

Surgical treatment
–TURP / BNI / Open prostatectomy

Question 8

Describe acute urinary retention

Answer 8

•Sudden and PAINFUL inability to pass urine

•Acute precipitants:
–UTI
–Diuresis
–Constipation
–Drugs
–Postoperative
–Bleeding (clot retention)

•Neurological (beware spinal cord compression!!)
–Stroke
–Acute spinal cord injury

Question 9

Risk factors of LUTS

Answer 9

–Aging
–Established LUTS
–Low urinary flow rate
–‘Large’ prostate
–Raised PSA

Question 10

Precipitants of LUTS

Answer 10

• Medication (anticholinergic/sympathicomimetic)
• UTI
• Diuresis (alcohol)
• Postoperative (pain, anesthetic, analgesics, loss of mobility)

Question 11

Acute urinary retention in female causes

Answer 11

•Reflex AUR
–Urethritis / UTI

•Intrinsic compression
–Meatal stenosis / stricture
–Tumour
–Urethral diverticulum / stone

•Extrinsic compression
–Severe prolapse
–Pelvic space occupying lesion

Question 12

Mx of acute urinary retention

Answer 12

Establish drainage
–Indwelling urethal catheter
–Intermittent self catheterisation
–Suprapubic catheter

If unable to pass IDC,
•?Hx of stricture or TURP
•Evidence of trauma? Blood on catheter?
–Possible false passage

Question 13

Describe obstructive nephropathy

Answer 13

Back pressure from AUR sufficient to cause renal dysfunction

–Elevated Cr
–B/L hydronephrosis

Question 14

Mx of obstructive nephropathy

Answer 14

• Admit
• Monitor urine hourly
• Replace urine output with ½ volume 0.9% NaCl
• Monitor U+Es regularly
• Beware increased volume & reduced sodium concentration
• Replace Mg2+ PO43- as required

•Alpha-blocker and Trial of Void (TOV)
•Surgery
–TURP
–Laser
–Open
•Longterm IDC / ISC