LUTS

Question 1

Most common cause of LUTS in older men

Answer 1

BPE most commonly due to BPH

Question 2

Most common in females

Answer 2

Lower UTI

Question 3

Causes of luts in men and women

Answer 3

Question 4

Lifestyle factors that can cause LUTS

Answer 4

Drinking fluids late at night

Excess alcohol intake

Excess caffeine intake

Question 5

Voiding symptoms

Answer 5

Hesitancy

Poor flow

Intermittency

Straining

Terminal dribbling

Incomplete emptying

Question 6

Storage symptoms

Answer 6

Increased freq

Nocturia

Sense of urgency

Urge incontinence

Question 7

History and Examination

Answer 7

Determine whether storage or voiding

Ask about haematuria, suprpubic discomfort, colicky pain

DH of anticholinergics, antihistamines, bronchodilator (all known to exacerbate LUTS)

DRE and ex of external genitalia might be helpfull

International Prostate Symptom score might be done

Question 8

Initial investigations

Answer 8

Post-void bladder scanning and flow rate to distinguish between causes

Urinary frequency and volume chart can also be done

Urinalysis

Urine culture

Routine blood tests with FBC and U&Es

PSA might be done

Question 9

Specialist investigations

Answer 9

Urodynamic studies to assess flow rate, detrusor pressure and storage capacity

Cytoscopy is gold standard for assessing the lower urinary tract.

Upper urinary tract imaging by ultrasound or CT scanning

Question 10

Conserative management

Answer 10

Treat underlying pathology

Regulating fluid intake + reducing caffeinated and alcoholic drinks

Urethral milking techniques for voiding

Double voiding (passing urine then remaining for a short time before passing again)

Pelvic floor exercises

Bladder training techniques

Question 11

Indications for pharmacological management

Answer 11

When conservative measures are insufficient or inappropriate

Question 12

Pharmacological management

Answer 12

Anticholinergics like oxybutynin and tolterodine for overactive bladder to help relax bladder muscle by opposing parasympathetic cholinergic control of contractino. Mirabegro can also be used

Alpha blockers like alfuzosin or tamsulosin +/- 5a-reductase inhibitors like finasteride for BPH

Loop diuretics like furosemide and bumetanide can be used as well.

Question 13

Complications

Answer 13

Increased risk of infection

FOrmation of renal and bladder calculi

Chronic obstruction may lead to bladder wall muscle hypertrophy or distention which can lead to overflow incontinence

Renal failure and bilateral hydronephrisis

Acute urinary retention in BPH