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1. Lower Urinary Tract Symptoms (LUTS) in men Kamal Patel GPST2
2. Objectives Define ?LUTS?
Causes of LUTS
Initial assessment and management
Mx of acute retention
3. 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 5a-reductase inhibitors include ejaculation disorders and gynaecomastia
Possible presentation include recurrent UTI
5a-reductase inhibitors typically decrease the PSA
More common in black men.
4. LUTS: definition Storage (irritative) symptoms:
Voiding (obstructive) symptoms
Hesitancy, poor stream, terminal dribbling
5. Causes of LUTS Obstructive
Bladder neck/urethral strictures
Autonomic neuropathy/neurogenic bladder
6. Causes of LUTS Irritative
7. Assessment 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
8. 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?
5-alpha reductase inhibitor
Non-urgent referral for TURP
Empirical tx with cipro for 2 weeks
Urgent referral to urology.
9. A patient is started on finasteride for the management of BPH. How long should the patients be told that treatment may take to be effective?
Within 8hrs of taking the tablet
Within 3 days
Up to 7 days
Up to 4 weeks
Up to 6 months
10. Management Urine dip +/- culture
Hx of renal stones
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
11. Obstructive symptoms
Alpha blocker: e.g tamsulosin
5a ? reductase inhibitors
Exclude/manage treatable causes
Urine containment devices
Supervised bladder retraining
Anticholinergics e.g oxybutinin
12. Thank You