Urinary obstruction and altered voiding Flashcards

1
Q

What are the common symptoms of lower urinary tract problems? (LUTS)

A

Storage - Incontinence, urgency, frequency, nocturia
Voiding - Poor stream (weak/intermittent), hesitancy, dysuria, intermittency, double voiding, retention, straining, incomplete emptying, terminal dribbling
Post-micturition - terminal dribble and the sensation of incomplete emptying

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the problems associated with urinary incontinence?

A

Social/health problem
QoL impact
Skin breakdown - pressure sores

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the different types of incontinence?

A

Stress (poor sphincter resistance)
Urge/urgency (overactive bladder)
Mixed (stress and urge)
Overflow (chronic retention and detrusor failure)
Continuous
Childhood
Functional (psychological. cognitive or physical imp)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

If a patient was taking furosemide and they needed to urinate after taking it and maybe need to get up at night as well, what type of incontinence is this?

A

Functional incontinence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Describe the history, examination and investigations you would perform for incontinence.

A

H: Precipitating events, duration, pad usage, bother; medical/surgical history
E: Abdomen, pelvic (genitalia), digital rectum exam
Neurologic exam, mental status & mobility
I: dipstick, microscopy, sensitivity and culture. cytology, FBC, U&Es, glucose, freq-vol chart (bladder diary), urodynamics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is urodynamics?

A

Study of pressure and flow during storage, transport and expulsion of urine in the (lower) urinary tract

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is outflow cystometry?

A

Fill bladder with fluid (+/- contrast for imaging)
record pressures in bladder and rectum.
Bladder emptied and pressures recorded
Bladder – rectum = detrusor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the treatment options/management plan for a patient with continuous incontinence?

A

surgical treatment of underlying anatomical disorder

catheterisation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the treatment options/management plan for a patient with stress incontinence?

A

Incontinence protection
Pharmacological
Surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the treatment options/management plan for a patient with urge incontinence?

A
Avoid stimulants
Bladder retaining
Anticholinergics: OXYBUTYNIN
Beta3 adrenergic agonists
Surgery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the treatment options/management plan for a patient with urinary retention?

A
Restore bladder emptying
Intermittent self-catheterisation
Long-term catheter
α blockers: TAMSULOSIN
Surgical treatment of bladder outflow obstruction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is oxybutynin used to treat, what is its MoA and side effects?

A

Urge incontinence/overactive bladder
Anticholinergic - inhibits muscarinic receptors by blocking acetylcholine receptors - reduces detrusor muscle activity.
SE: Blurred vision, glaucoma, Fatigue, Tachycardia, urinary retention

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the differential diagnoses for urinary retention (urinary obstruction)?

A
BPH
Prostate cancer
Prostatitis
Haematuria 
Tumours
Stones
Structural
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the symptoms of BPH? (benign prostate hyperplasia)

A

Enlarged prostate - compresses urethra (>50)
Hesitancy
Straining/taking a long time while urinating
weak flow of urine
“stop-start” peeing
Urinate urgently/frequently, nocturia
feeling that your bladder has not emptied fully

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How can you assess the impact of BPH on a patient?

A

Calculate the international prostate symptom score (7 qs and 1 QoL q)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What examinations/investigations can you perform to diagnose BPH?

A
International prostate symptom score
Inc prostate specific antigen (PSA)
Abdo exam
DRE
Imaging: transrectal ultrasound scan
17
Q

What are the different ways you can help a patient manage BPH? (hint: lifestyle, drugs, surgery, complications)

A

Lifestyle: less caffeine, fizzy drinks, alcohol/ do exercise
Drugs: Tamsulosin - selective alpha1 blocker
Surgery: Transurethral resection of prostate
Complications: UTI, acute urinary retention, incontinence, erectile problems

18
Q

What is tamsulosin used to treat, what is its MoA and side effects?

A

Urinary retention and BPH
Selective alpha1 blocker -> smooth muscle relaxation -> urine flow -> flow proportional to vessel diameter
SE: Dizziness, sexual dysfunction

19
Q

During a prostate, digital rectal examination, what texture can indicate cancer?

A

Hard/lumpy/irregular

20
Q

Identify the common risk factors and common causes of urinary tract stone formation.

A

Common (10%). M>F (2-4x)
Age (peak onset 20-30)
Fluid intake (dehydration facilitates stones: urine concentrated)
Family history

21
Q

Describe the common presentation signs and symptoms of urinary tract stones.

A

Loin to groin pain (ureteric colic)
Haematuria
Vomiting
Irritative voiding symptoms

22
Q

Where can kidney stones form and get stuck?

A

Pelvic ureteric junction
Pelvic brim
Vesicoureteric junction
Bladder urethra outlet

23
Q

What are the most common type of kidney stones?

A

Calcium Oxalate