Flashcards in RENAL - Lower urinary tract Deck (14):
1
Symptoms of obstructive LUTS
Poor Flow
Hesitancy
Intermittency
Terminal dribbling
2
Symptoms of irritative LUTS
Frequency
Urgency
Nocturia
Incontinence
3
Causes of obstructive LUTS
BPH
Ca Prostate
Stricture
4
Causes of irritative LUTS
Secondary to obstruction
UTI
Ca Bladder
Stone
Diabetes
TB
5
O/E in LUTS
•Abdomen: Is there a palpable / percussible bladder
•Genitalia: phimosis / balanitis / meatal stenosis / epididymitis
•DRE: CaP? Rectal Mass? (prostate size?)
6
Ix of LUTS
•MSU
•U/E and Cr
•?PSA
•Bladder diary
•Voiding flow rate
•USS
–residual urine
–hydronephrosis
7
Mx of LUTS
Exclude Medical Causes
–Diabetes
–Diuretics
–Nocturnal polyuria
–Caffeine / Alcohol
–Polydipsia
–Sleep Apnoea
–Drugs (anti-cholinergic, sympathomimetic)
Observe
Medical treatment
–alpha blockers
–5-alpha reductase inhibitors
–Combination
Surgical treatment
–TURP / BNI / Open prostatectomy
8
Describe acute urinary retention
•Sudden and PAINFUL inability to pass urine
•Acute precipitants:
–UTI
–Diuresis
–Constipation
–Drugs
–Postoperative
–Bleeding (clot retention)
•Neurological (beware spinal cord compression!!)
–Stroke
–Acute spinal cord injury
9
Risk factors of LUTS
–Aging
–Established LUTS
–Low urinary flow rate
–‘Large’ prostate
–Raised PSA
10
Precipitants of LUTS
•Medication (anticholinergic/sympathicomimetic)
•UTI
•Diuresis (alcohol)
•Postoperative (pain, anesthetic, analgesics, loss of mobility)
11
Acute urinary retention in female causes
•Reflex AUR
–Urethritis / UTI
•Intrinsic compression
–Meatal stenosis / stricture
–Tumour
–Urethral diverticulum / stone
•Extrinsic compression
–Severe prolapse
–Pelvic space occupying lesion
12
Mx of acute urinary retention
Establish drainage
–Indwelling urethal catheter
–Intermittent self catheterisation
–Suprapubic catheter
If unable to pass IDC,
•?Hx of stricture or TURP
•Evidence of trauma? Blood on catheter?
–Possible false passage
13
Describe obstructive nephropathy
Back pressure from AUR sufficient to cause renal dysfunction
–Elevated Cr
–B/L hydronephrosis
14