Lower urinary tract symptoms luts in men
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Lower Urinary Tract Symptoms (LUTS) in men. Kamal Patel GPST2. Objectives. Define ‘LUTS’ Causes of LUTS Initial assessment and management Not covered Mx of acute retention Stress incontinence Prostate Ca.

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Presentation Transcript

Objectives l.jpg
Objectives

  • Define ‘LUTS’

  • Causes of LUTS

  • Initial assessment and management

  • Not covered

    • Mx of acute retention

    • Stress incontinence

    • Prostate Ca


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  • A 79 year-old man complains of LUTS. Which one of the following regarding BPH is incorrect?

    • Goserelin is licensed for refractory cases

    • Side effects of 5α-reductase inhibitors include ejaculation disorders and gynaecomastia

    • Possible presentation include recurrent UTI

    • 5α-reductase inhibitors typically decrease the PSA

    • More common in black men.


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LUTS: definition following regarding BPH is

  • Storage (irritative) symptoms:

    • Urgency

    • Urinary frequency

    • Nocturia

    • Urinary incontinence

  • Voiding (obstructive) symptoms

    • Hesitancy, poor stream, terminal dribbling


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Causes of LUTS following regarding BPH is

  • Obstructive

    • BPH

    • Prostate/bladder/rectal cancer

    • Bladder neck/urethral strictures

    • Antimuscarinic drugs

    • Autonomic neuropathy/neurogenic bladder


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Causes of LUTS following regarding BPH is

  • Irritative

    • BPH

    • Bladder/prostate cancer

    • Infection

    • Bladder stones

    • Neurological

      • Dementia

      • Diabetes

      • Stroke


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Assessment following regarding BPH is

  • History – type of LUTS, duration of Sx, how bothersome are they?

  • Examination – abdomen (distended bladder), external genitalia, DRE

  • International Prostate Symptom Score:

    • Used to assess severity of symptoms

    • Score of 0-5 for seven symptoms (total 35):

      • 0-7 – mildly symptomatic

      • 8-19 – moderately symptomatic

      • 20-35 – severely symptomatic


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  • A 62 year-old man presents with nocturia, hesitancy and terminal dribbling. DRE reveals a moderately enlarged prostate with no irregular features. PSA1.3 What is the most appropriate mx?

    • Alpha antagonist

    • 5-alpha reductase inhibitor

    • Non-urgent referral for TURP

    • Empirical tx with cipro for 2 weeks

    • Urgent referral to urology.


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Management BPH. How long should the patients be told that treatment may take to be effective?

  • Urine dip +/- culture

  • U&E

    • Chronic retention

    • Recurrent UTI

    • Hx of renal stones

  • PSA

  • Urinary frequency-volume chart

    • Ask patient to note down when they drink fluid/pass water and to comment on type of fluid

    • Allows to differentiate between frequency of urine, polyuria and nocturia


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  • Obstructive symptoms BPH. How long should the patients be told that treatment may take to be effective?

    • Lifestyle changes.

    • Alpha blocker: e.g tamsulosin

    • 5α – reductase inhibitors

  • Irritative symptoms

    • Exclude/manage treatable causes

    • Urine containment devices

    • Supervised bladder retraining

    • Anticholinergics e.g oxybutinin


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Thank You BPH. How long should the patients be told that treatment may take to be effective?


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