Tutorial 11 - Women's and men's health - LUTS

Question 1

How can lower urinary tract (LUT) symptoms be classed?

Answer 1

1. Storage - Ask about FIU - frequency, incontinence and urgency.
2. Voiding - Hesitancy, weak stream, dribbling, needing to strain.
3. Post micturition - Dribble afterwards, feeling bladder not empty.

Question 2

Name the types of urinary incontinence.

Answer 2

1. SUI - Becoming incontinent on exertion i.e., cough, sneeze, lifting - often due to weakened pelvic floor.
2. UUI - Strong sensation of voiding, followed by incontinence - often due to overactive detrusor muscle.
3. Mixed - Mix of SUI & UUI
4. FUI - Functional UI is where the urinary tract is normal but physical/mental problems make accessing a toilet difficult i.e., dementia or severe arthiritis.

Question 3

What is functional urinary incontinence?

Answer 3

• FUI is when the urinary tract is working optimally but the patient has a neurological/physical health comorbidity which makes accessing the toilet at the right time hard - leading to incontinence.
• I.e., dementia or severe arthiritis.

Question 4

Name some common cause of LUTS in both men and women.

Answer 4

• UTI (more so females though).
• Stones.
• Co - morbidities - diabetes, MS.
• Medications i.e., diuretics.

Question 5

Name some causes of LUTS in women.

Answer 5

• Menopause
• UTI
• Stones
• Recent pregnancy (pelvic floor muscles)

Question 6

Name some causes of LUTS in men.

Answer 6

• Stones
• Anatomical issues i.e., phimosis
• BPH

Question 7

What are the red flag causes of LUTS?

Answer 7

• Bladder cancer
• prostate cancer
• Sciatica

Question 8

What is the management for SUI?

Answer 8

• Lifestyle advice - Weight loss, smoking cessation, avoid constipation.
• Training - Pelvic floor muscle training (8 contractions, 3X a day).
• Medication - Duloxetine (combined noradrenaline and serotonin uptake inhibitor), increases tone on EUS.
• Surgery

Question 9

What is the management for UUI?

Answer 9

• Lifestyle - Weight loss, smoking cessation, avoid constipation(high fibre diet)
• Training - Timed voiding sessions
• Mediations - Anticholinergics(muscarinic receptors induce detrusor contraction ), beta agonists(beta receptors allow relaxation and filling of bladder).
• Surgery.