LUTS

Question 1

Types of LUTS

Answer 1

Voiding - hesitancy, poor/intermittent stream, straining, incomplete emptying, terminal dribbling, slow stream
Stoarge- urgency, frequency, nocturia, urinary incontincenc, abnormal bladder sensation
Post micturition- dribbling, sensation of incomplete emptying

Question 2

Causes of LUTS

Answer 2

Bladder outlet obstruction - urethral stricture, BPH, primary bladdder neck obstruction, bladder neck contracture, prostate ca

Overactive bladder- neurogenic: CVA, parkinsons, MS, spinal cord injury
- non neurogenic: post op pelvic surgery, bladder stones, foreign bodies

Combination

Question 3

Evaluation of LUTS

Answer 3

Hx- meds like antidepressants, diuretics, bronchodilators, antihistamines. Neurological symptoms
O/E- abdo, pelvis, perineum, neurological, DRE
IX- U/A (hematuria, glucosuria, pyuria, bacteriuria), UEC, glucose, PSA

Question 4

Management of LUTS

Answer 4

Lifestyle mods: decrease fluid intake, decrease intake of diuretics like ETOH and caffiene, avoid constipation, increase activity incl strenuous exercise, weight control, timed voiding,m double voiding, pelvic floor training

Predom voiding symptoms: 1. lifestlye 2.Apha blockers- tamsulosin, alfuzosin 3. if enlarged prostate and increased risk for progression- 5 alpha reductase inhibitors - finasteride, dutasteride 4. if enlarged prostate and moderate/severe sx- alpha blocker and 5Areducatse 5.mixed storage and voiding not responding to alpha blocker = antimuscarinic/anticholingeric- oxybutinin

Predom overactive bladder: 1. lifestlye, 2. antimuscarinincs 3.mirabegron

Nocturia 1. lifestlye 2.frusemide 40mg at night or desmopressin