LUTS and bladder outflow obstruction Flashcards
(39 cards)
what can cause bladder outflow obstruction
bladder cancer urethral cancer anti cholinergics, nasal decongestants pelvic cancer spinal injuries causing sphincter abnormalities detrusor muscle dys-synergia
men BPH urethral strictures prostate cancer bladder stones (occur secondary to enlarged prostate- obstruct when they cluster at orifice) penile cancer phimosis (foreskin)
women
cystocoele (prolapsed bladder)
urethral polyp
vaginal atrophy (distorts urethra), prolapse or cysts (extrinsic compression)
what spinal levels gives innervation to the bladder
S1,2,3
what is the role of the prostate
secretions contribute to semen
Produces PSA which keeps semen in liquid form
what happens to bladder when prostate is enlarged
becomes hypertrophic
what are LUTS
lower urinary tract symptoms
storage- frequency, urgency, nocturia
voiding- hesitancy, poor flow, intermittent flow, sensation of incomplete voiding, post micturition dribbling
what is bed wetting a sign of
high pressure chronic retention
what is the difference between acute and chronic urinary retention
acute- painful, sudden episode of urinary retention
chronic- patient is able to pass urine but is unaware they are holding 1-2 litres of urine
what are the complications of chronic urinary renetion
puts back pressure on the kidneys- hydronephrosis
what are the red flags of a urinary obstruction history
haematuria, subrapubic pain, recurrent UTIs (if present suspect bladder cancer)
back pain and neurological symptoms (sciatica, lower limb weakness, sensory symptoms)
is obstruction more common in males or females
males
is an overactive bladder (frequency and urgency) more common in males or females
females
what are the voiding symptoms (due to blockage affect)
poor flow intermittent stream spraying of stream/ deviating stream hesitancy post micturition dribbling straining
what are the storage symptoms (due to the secondary effects of blockage)
frequency of urination urgency urgency incontinence nocturia sense of incomplete emptying pain with bladder filling
what lifestyle factor can cause urgency
caffine
what PMH can cause urinary obstruction
urethral injury
instrumentation
pelvic surgery
neurological disorders (parkinsons, stroke, MS, spinal stenosis)
how do you asses the severity of prostate symptoms
international prostate system score: 0-7 mild, 8-19 mod, severe 20-35. QoL 0-6 (this score not used for diagnosis but more monitoring of treatment and severity of symptoms)
what are you feeling for in the DRE
size, consistency, nodules of the prostate
anal tone and sensation
skin changes
blood and mucous on finger
what other than a DRE should you do in urinary obstruction exam
external genitalia exam- meatus
neuro exam in younger patients
general features
-renal failure, fluid over load, uraemia signs
what investigations into LUTS
frequency -volume chart (polyuria and nocturnal polyuria)
serum creatinine for renal function
PSA (after counselling) (if recent trauma, infect or instrumentation will be raised so do again in 4 weeks)
flow rate )Qmax <10 = 90% chance of obstruction
renal USS - if there is impaired renal function, loin pain, haematuria or a renal mass on exam
cystoscopy- previous urological surgery , haematuria, Hx of stricture, pain (shouldnt have pain in BPH and LUTS), recurrent UTIS (suggests bladder cancer)
transrectal USS if PSA elevated and prostate feels abnormal
what can cause noctural polyuria
heart failure- exacerbated by lying down to go to sleep
what is nocturnal polyuria
when more than 1/3rd of urine is produced at night
how should you ask about frequency in a history
how often do you pass urine a day
how should you ask about nocturia in a history
how often a night are you woken from sleep because you need to pee
how should you ask about urgency in a history
when you get the feeling of wanting to pass urine, can you hold it or do you need to go immediately
if you are watching your favourite TV programme do you leave or wait till it finishes to go pee?
