RENAL - Lower urinary tract Flashcards Preview

► Med Misc 43 > RENAL - Lower urinary tract > Flashcards

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

Mx of obstructive nephropathy

•Admit
•Monitor urine hourly
•Replace urine output with ½ volume 0.9% NaCl
•Monitor U+Es regularly
•Beware increased volume & reduced sodium concentration
•Replace Mg2+ PO43- as required

•Alpha-blocker and Trial of Void (TOV)
•Surgery
–TURP
–Laser
–Open
•Longterm IDC / ISC

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