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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
Objectives
  • Define ‘LUTS’
  • Causes of LUTS
  • Initial assessment and management
  • Not covered
    • Mx of acute retention
    • Stress incontinence
    • Prostate Ca
slide3
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.
luts definition
LUTS: definition
  • Storage (irritative) symptoms:
    • Urgency
    • Urinary frequency
    • Nocturia
    • Urinary incontinence
  • Voiding (obstructive) symptoms
    • Hesitancy, poor stream, terminal dribbling
causes of luts
Causes of LUTS
  • Obstructive
    • BPH
    • Prostate/bladder/rectal cancer
    • Bladder neck/urethral strictures
    • Antimuscarinic drugs
    • Autonomic neuropathy/neurogenic bladder
causes of luts6
Causes of LUTS
  • Irritative
    • BPH
    • Bladder/prostate cancer
    • Infection
    • Bladder stones
    • Neurological
      • Dementia
      • Diabetes
      • Stroke
assessment
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
slide8
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.
slide9
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
management
Management
  • 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
slide11
Obstructive symptoms
    • 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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