Flashcards in EAU 2020 Non-Neurogenic Male LUTS Deck (97)
Acute urinary retention
Acute retention of urine is defined as a painful, palpable or percussible bladder, when the patient is unable to pass any urine.
Chronic urinary retention
Chronic retention of urine is defined as a non-painful bladder, which remains palpable or percussible after the patient has passed urine. Such patients may be incontinent.
Bladder outlet obstruction
Bladder outlet obstruction is the generic term for obstruction during voiding and is characterised
by INCREASED DETRUSOR PRESSURE and REDUCED URINE FLOW RATE. It is usually diagnosed by studying the
synchronous values of flow-rate and detrusor pressure
Benign prostatic obstruction
A form of BOO and may be diagnosed when the cause of outlet obstruction is known to be BPE.
Benign prostatic hyperplasia
Benign prostatic hyperplasia is a term used (and reserved) for the typical histological pattern, which
defines the disease.
Detrusor overactivity (DO)
Detrusor overactivity (DO) is a urodynamic observation characterised by INVOLUNTARY DETRUSOR CONTRACTIONS during the FILLING PHASE which may be spontaneous or provoked.
Overactive bladder syndrome
Overactive bladder syndrome is characterised by urinary URGENCY, with or without urgency urinary incontinence, usually with INCREASED DAYTIME FREQUENCY and NOCTURIA, if there is no proven infection or other obvious pathology
Frequency volume charts record:
A bladder diary records:
FVC: volume and time of each void
Bladder diary: FVC + fluid intake, use of pads, activities during recording, symptom scores
___ and ___ day FVCs provide reliable measurement of urinary symptoms in patients with LUTS.
Three and seven day FVCs.
Use a bladder diary to assess male LUTS with:
A prominent storage component or nocturia.
Tell the patient to complete a bladder diary for at least ____ days.
DRE has ______ correlation to actual prostate volume, especially where volume > 30 mL.
Perform a physical examination including ____ in the assessment of male LUTS.
Use urinalysis (by ____ or _____) in the assessment of male LUTS.
Dipstick or urinary sediment
Age-specific criteria (PSA level) for detecting men with prostate glands > 40 mL:
50s: > 1.6 ng/mL
60s: > 2.0 ng/mL
70s: > 2.3 ng/mL
Measure prostate-specific antigen (PSA) if: ___ and ___
If a diagnosis of prostate cancer will change management
if it assists in the treatment and/or decision making process.
Assess renal function if: ___
Renal impairment is suspected based on history and clinical examination, or in the presence of hydronephrosis,
when considering surgical treatment for male LUTS.
The diagnostic accuracy of PVR measurement, using a PVR threshold of ______, has a PPV of 63% 3 and a NPV of 52% for the prediction of ____.
Key parameters (2): ____, ____
Voided volume should be: _____
Repeat uroflow if (2): ____ or _____
Key parameters : Qmax, flow pattern
Voided volume should be: >150mL
Repeat uroflow if (2): <150 mL voided volume or abnormal flow pattern
Perform uroflowmetry in the initial assessment of male LUTS and _______.
Prior to medical or invasive treatment.
Is VCUG recommended in the routine diagnostic workup of male LUTS?
BUT, it may be useful for the detection of vesico-ureteral reflux, bladder diverticula, or urethral pathologies. RUG may be useful for stricture evaluation.
Patients with (3) ______ who present with LUTS should undergo urethrocystoscopy.
Micro or gross hematuria
Perform urethrocystoscopy in men with LUTS prior to ____ if _____.
Prior to minimally invasive/surgical therapies if the findings may change treatment.
Perform PFS in the following situations (5):
- Previous unsuccessful (invasive) treatment for LUTS)
- Considering invasive treatment but cannot void >150mL
- Considering surgery, predominantly voiding LUTS, Qmax > 10 mL/s
- Considering invasive therapy, bothersome voiding LUTS with PVR > 300 mL
- Considering invasive treatment, bothersome voiding LUTS >80years old or <50years old
Do NOT offer ________ as an alternative to ______ for diagnosing bladder outlet obstruction in men.
Pressure flow studies
" It was found that specificity, sensitivity, PPV and NPV of the non-invasive tests were highly variable. Therefore, even though several tests have shown promising results regarding non-invasive diagnosis of BOO, invasive urodynamics remains the modality of choice."
Watchful waiting is usually a safe alternative for:
Men who are less bothered by urinary difficulty
who wish to delay treatment.
The treatment failure rate over a period of five years was 21%; 79% of patients were clinically stable.
Offer WW to men with (2):
- Mild/moderate symptoms
- Minimally bothered by their symptoms
MOA: Inhibit the effect of endogenously released noradrenaline on smooth muscle cells in the prostate and thereby reduce prostate tone and BOO
Efficacy: Reduces IPSS and improves Qmax; does NOT reduce prostate size, does NOT prevent AUR
Safety: Intraop floppy iris syndrome (IFIS), abnormal ejaculation, orthostatic hypotension
Do ⍺1-blockers cause retrograde ejaculation?
No. Only abnormal ejaculation.
"Originally, abnormal ejaculation was thought to be retrograde, but more recent data demonstrate that it is due to a decrease or absence of seminal fluid during ejaculation, with young age being an apparent risk factor."