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Surgery AN > Urology- LUTS > Flashcards

Urology- LUTS Flashcards

(44 cards)

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1
Q

List the LUTS associated with a Problem in the STORAGE Phase

A

Frequency, Nocturia, Urgency, Incontinence

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2
Q

List the LUTS associated with a Problem in the Voiding Phase

A

Hesitancy, Slow Stream, Straining, Intermittency

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3
Q

List the LUTS associated with a Problem in Post-Micturition

A

Sensation of Incomplete Emptying

Post-Terminal Dribbling

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4
Q

What are the COMMON CAUSES of LUTS

A 
Bladder Outlet Obstruction (Secondary to BPH, Urethral Strictures)
Overactive Bladder (Primary or Secondary to Obstruction, Carcinoma-In-Situ, Neurogenic, Radiation, Infection)
UTI, Bladder Stones
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5
Q

What are the Investigations for LUTS

A

Urine Dipstick, Frequency Volume Chart, PSA
Flow Rate/Uroflowmetry
Post-Micturition Residual Volume
Urodynamic Studies

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6
Q

Define Uroflowmetry/Flow Rate

A

Provides a Visual Image of the Strength of a Patient’s Urinary Stream

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7
Q

Define Qmax?

A

Maximum Flow Rate

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8
Q

What does a Q max >15 ml/s mean in terms of Obstruction?

A

10-30% chance of Obstruction

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9
Q

What does a Q max 10-15 ml/s mean in terms of Obstruction?

A

60% chance of Obstruction

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10
Q

What does a Q max <10 ml/s mean in terms of Obstruction?

A

90% chance of Obstruction

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11
Q

What Factors affect Qmax

A

Volume of Urine Voided, Contractility of the Bladder

Conductivity/Resistance of the Urethra

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12
Q

What is the Minimum Voided Volume for a Uroflowmetry to be carried out?

A

150ml

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13
Q

What is an Urodynamic Study

A

Records Bladder Pressure during Bladder Filling and Voiding

Urodynamic Studies= Cystometry + Pressure-Flow Studies (PFS)

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14
Q

What is Cystometry

A

Records Bladder Pressure during Bladder Filling

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15
Q

What is Pressure-Flow Studies (PFS)

A

Records Bladder Pressure during Voiding

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16
Q

What Conditions cause Phasic Contractions on Cystometry

A

Urgency

Detrusor Overactivity

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17
Q

What does an Obstruction look like on a Pressure-Flow Study?

A

High Pressure, Low Flow

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18
Q

What does Detrusor Failure look like on Pressure-Flow Studies

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A

Low/Absent Pressure

Low Flow

19
Q

List the Secondary causes of Detrusor Failure

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A

Diabetes Mellitus

Neurological Disorders

20
Q

What is the MOST COMMON Cause of BOO (Bladder Outlet Obstruction)

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A

BPH (Benign Prostatic Hyperplasia)

21
Q

What are the Symptoms of BOO (Bladder Outlet Obstruction)

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A

LUTS associated with the Void Phase (Hesitancy, Slow Stream, Straining, Intermittency)

22
Q

What is the Conservative Management for Bladder Outlet Obstruction

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A

Lifestyle Advice (Modify Fluid Intake, Decrease Caffeine Intake)

23
Q

What is the Medical Management for Bladder Outlet Obstruction

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A

1st Line= Alpha Blockers (Tamsulosin, Alfuzosin)
2nd Line= 5-alpha Reductase Inhibitors (Finasteride, Dutasteride)
Anti-Cholinergics (if have Over-Active Bladder Symptoms)

24
Q

What is the Surgical Management of Bladder Outlet Obstruction

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A

TURP (Trans-Urethral Resection of Prostate)

25
What are the indications for Surgery for Bladder Outlet Obstruction
Failure of Medical Therapy (LUTS not controlled) | Development of Complications (Chronic Retention, Bladder Stones, Benign Prostatic Haematuria)
26
What is the Pathophysiology of TURP Syndrome
Irrigation during TURP is Glycine (Acts as Electrical insulator to prevent current dispersing) Glycine absorption during long resection can lead to Dilutional Hyponatraemia
27
What are Symptoms of TURP Syndrome
Confusion, Fits/Agitation, Visual Symptoms, Breathlessness, Coma
28
List 3 types of Alpha Blockers
Tamsulosin, Alfuzosin, Doxazosin
29
What indications is Doxazosin the preferred Alpha-Blocker of choice?
Patients with BPH and Hypertension
30
What is the Mechanism of Action of Alpha Blockers
Blocks Alpha-1 Adrenoceptor -> Relax Prostatic/Bladder Neck Smooth Muscle -> Reduces Resistance to Bladder Outflow
31
What are the ADR of Alpha Blockers
Retrograde Ejaculation | Postural Hypotension, Dizziness, Syncope (Stimulates Vasodilation -> Fall in BP)
32
What is the DIFFERENCE between Alpha Blockers and 5 -alpha Reductase Inhibitors in terms of their EFFECT on BPH Progression?
Alpha Blockers ONLY improve Symptoms (NO effect on BPH Progression) 5-Alpha Reductase Inhibitors REDUCE Progression of Disease as they DECREASE Prostatic Volume
33
List 2 types of 5-alpha Reductase Inhibitors
Finasteride | Dutasteride
34
What is the Mechanism of Action of 5-alpha Reductase Inhibitors
Reduce conversion of Testosterone to DHT (Dihydrotestosterone)-> Reduces Prostatic Volume
35
How large does the Prostate need to be for 5-alpha reductase inhibitors to have an EFFECT (Mention the PSA Value in which 5-alpha reductase inhibitors are effective at as well)
Prostate >30g (PSA >1.4)
36
How long does it take for 5-alpha reductase inhibitors to have an effect?
6 months
37
What are the ADR of 5-alpha reductase inhibitors
Impotence/Erectile Dysfunction, Decreased Libido, Gynaecomastia, Increases Risk of Breast Cancer Hair Growth, Rash
38
What are the CI for 5-alpha Reductase Inhibitors
Women of Child Bearing age should AVOID handling Tablets | Abnormal development of Foetal External Genitalia
39
Define Nocturnal Polyuria
Isolated Nocturia with a 1/3 of Urine Output at Night
40
What is the Aetiology of Nocturnal Polyuria
Loss of Circadian Urine Output Rhythm with Age
41
What factors contribute to Nocturia Polyuria
Deep Venous Insufficiency, Congestive Cardiac Failure COPD, Sleep Apnoea Diabetes Mellitus, Chronic Kidney Disease
42
What is the Management of Nocturnal Polyuria
Reduce Night-Time Fluids, Low Dose Loop Diuretic 4-6 hours before Bed Last Line= Desmopressin
43
What are the ADR of Desmopressin
Electrolyte Imbalance | Fluid Retention
44
What are the Risk Factors for Urinary Incontinence
Pregnancy, Child Birth, Pelvic Prolapse, Menopause, Obesity

Surgery AN (2 decks)

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