LUTS

Question 1

Causes of LUTS

Answer 1

• BPH
• UTI
• Bladder/prostate cancer

Question 2

History for LUTS/urology in general

Answer 2

Question 3

What can exacerbate LUTS apart of lifestyle?

Answer 3

• Drinking fluids late at night
• Excess alcohol
• Excess caffeine
• Polyuria eg due to diabetes or diuretic can exacerbate or mimic

Question 4

LUTS classification

Answer 4

FUN WISE
Storage:
* Frequency
* Urgency
* Nocturia

Voiding:
* Weak stream
* Intermittency/hesitancy
* Straining
* Emptying - feeling of incomplete

Question 5

Associated symptoms to ask about when someone presents with LUTS

Answer 5

• Visible haematuria
• Suprapubic discomfort
• Colicky pain

Question 6

Drugs that exacerbate LUTS

Answer 6

• Anticholinergics
• Antihistamines
• Bronchodilators

Question 7

What scoring system can be used to assess and monitor LUTS in men?

Answer 7

International prostate symptom score
* Monitor impact and QOL

Question 8

Initial investigations for LUTS

Answer 8

• Post void bladder scan - eg if OAB will be low, if BPH will be high –> distinguishes cause
• Flow rate - urinate into machine
• Bladder diary - patterns?
• Urinalysis + culture
• Bloods - FBC, U&E, PSA

Question 9

Specialist investigations for LUTS

Answer 9

• Urodynamic studies - assess flow rate, detrusor pressure and storage capacity (abdo (eg vagina/rectum), bladder, detrusor pressure)
• Cystoscopy - GOLD standard for lower urinary tract
• Upper urinary tract imaging - US or CT

Question 10

When are urodynamic studies done (for women specifically)?

Answer 10

• Failed medical treatment for OAB or stress urinary incontinence
• Being considered for more invasive options

Question 11

Management of LUTS - conservative

Answer 11

• Regulate fluid intake - reduce caffeine and alcohol in evenings
• Urethral milking techniques if voiding symptoms - manually emptying bulbar urethra
• Double voiding - pass and then remain before passing again
• Pelvic floor exercises - stress incont or post mic dribble
• Bladder training - OAB

Question 12

Medical management LUTS

Answer 12

• Anticholinergics - eg oxybutynin or tolterodine for OAB
• Mirabegron (B3 adrenergic agonist) can also help with OAB
• Alpha blockers eg Tamsulosin or 5a reductase inhibitors eg Finasteride for BPH
• Loop diuretics mid afternoon to prevent nocturia - unlicensed use (Desmopressin also shown to help this)

Question 13

Complications LUTS

Answer 13

• Increased risk infection, renal and bladder calculi - if retain post mic (stasis)
• Chronic –> bladder wall muscle hypertrophy or distension –> overflow incontinence
• Renal failure/hydronephrosis
• Acute retention