Lower Urinary Tract Symptoms and Urinary Retention

Question 1

What are the obstructive urinary symptoms?

Answer 1

Poor flow
Hesistancy
Intermittency
Terminal dribbling

Question 2

What are the irritative urinary symptoms?

Answer 2

Frequency
Urgency
Nocturia
Incontinence

Question 3

What are the causes of obstructive urinary symptoms?

Answer 3

Benign prostatic hypertrophy
Prostate cancer
Stricture

Question 4

What are the causes of irritative urinary symptoms?

Answer 4

Secondary to obstruction
UTI
Bladder cancer
Stone
Diabetes
TB

Question 5

What is the medical treatment for benign prostatic hypertrophy?

Answer 5

Alpha blockers
5-alpha reductase inhibitors
Combination of 2

Question 6

What is the surgical treatment for benign prostatic hypertrophy?

Answer 6

Transurethral resection of prostate (TURP)
Bladder neck incision
Open prostatectomy

Question 7

What is acute urinary retention?

Answer 7

Sudden and painful inability to pass urine

Question 8

What is the most frequent urological emergency?

Answer 8

Acute urinary retention

Question 9

What are the causes of urinary retention?

Answer 9

Benign prostatic hypertrophy
Prostate cancer
Stricture
Acute precipitants
- UTI
- Diuresis; eg: alcohol
- Constipation
- Drugs
- Postoperative
- Bleeding - clot retention
Neurological
- Beware spinal cord compression
- Diabetes
- Stroke
- Parkinson's disease
- Acute spinal cord injury

Question 10

What is the pathophysiology of spontaneous urinary retention?

Answer 10

Usually history of progressive lower urinary tract symptoms
Risk factors
- Ageing
- Established lower urinary tract symptoms
- Low urinary flow rate
- Large prostate
- Raised PSA

Question 11

What medications can cause urinary retention?

Answer 11

Anticholinergics

Question 12

What postoperative things can cause urinary retention?

Answer 12

Pain
Anaesthetic
Analgesics
Loss of mobility

Question 13

What are the causes of acute urinary retention in females?

Answer 13

Reflex acute urinary retention
- Urethritis
- UTI
Intrinsic compression
- Meatal stenosis/stricture
- Tumour
- Urethral diverticulum/stone
Extrinsic compression
- Severe prolapse
- Pelvis space occupying lesion

Question 14

What is the management of acute urinary retention?

Answer 14

Establish drainage
- Indwelling urethral catheter
- Intermittent self-catheterisation
- Suprapubic catheter
Look for evidence of complicated retention
- Obstructive nephropathy
- Sepsis

Question 15

What do you do if you cannot pass the urinary catheter?

Answer 15

?Hx of stricture/TURP
Evidence of trauma?
- Blood on catheter?
Ask for help
Try different size

Question 16

What is obstructive nephropathy?

Answer 16

Back pressure from acute urinary retention sufficient to cause renal dysfunction
Defined by
- Elevated creatinine
- Bilateral hydronephrosis

Question 17

What is the management for obstructive nephropathy?

Answer 17

Admit
Monitor urine hourly
Replace urine output with 1/2 volume normal saline
Monitor UEC regularly
Beware increased volume and decreased Na
Replace Mg phosphate as required

Question 18

What are the long-term treatment options for acute urinary retention?

Answer 18

Alpha-blocker and trial of void
Surgery
- TURP
- Laser
- Open
Long-term catheter