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Flashcards in LUTS Deck (13)
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1

Most common cause of LUTS in older men

BPE most commonly due to BPH

2

Most common in females

Lower UTI

3

Causes of luts in men and women

4

Lifestyle factors that can cause LUTS

Drinking fluids late at night

Excess alcohol intake

Excess caffeine intake

5

Voiding symptoms

Hesitancy

Poor flow

Intermittency

Straining

Terminal dribbling

Incomplete emptying

6

Storage symptoms

Increased freq

Nocturia

Sense of urgency

Urge incontinence

7

History and Examination

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

8

Initial investigations

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

9

Specialist investigations

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

10

Conserative management

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

11

Indications for pharmacological management

When conservative measures are insufficient or inappropriate

12

Pharmacological management

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.

13

Complications

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