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Lower urinary tract symptoms ( LUTS )

Lower urinary tract symptoms ( LUTS ). presented by : SAEED DOLGUM supervised by : Dr . Abdulmoiam tarifi . Lower Urinary Symptoms (LUTS). Voiding (Obstructive) Hesitancy Loss of force and decrease of caliber of the stream.

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Lower urinary tract symptoms ( LUTS )

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  1. Lower urinary tract symptoms ( LUTS ) presented by : SAEED DOLGUM supervised by : Dr . Abdulmoiam tarifi

  2. Lower Urinary Symptoms (LUTS) Voiding (Obstructive) • Hesitancy • Loss of force and decrease of caliber of the stream. • Straining for voiding • Retention: acute and chronic • Interruption of the urinary stream • Terminal dribbling.

  3. Storage (Irritaive) • Frequency • Nocturia • Urgency • Urge incontinence

  4. Post void Symptoms Post void Dribbling Sense of residual urine

  5. Lower Urinary Symptoms (LUTS) Causes • Males, according to age group • Females, according to age group

  6. LUTS other important Points History of • DM • Urological intervention • CNS problems and symptoms • Haematuria • Previous urinary retention • Burning Micturation and Febrile UTI • Drugs intake • Constipation

  7. Investigations Laboratory tests: Should include urinalysis, urine culture, CBC, serum creatinine, blood urea nitrogen, blood sugar and serum electrolytes .

  8. Assessment of upper tracts : routine assessment of the upper tracts is not recommended for pt with LUTS unless hematuria , recurrent UTI or history of urinary stones is present .

  9. U/S of the kidneys and bladder is the preferred means of initial radiological assessment , unless hematuria is detected { is a strong indication for CT urography and for IVU }

  10. US

  11. Assessment of the lower tract : 1- Ascending (Retrograde) Urethrogram : is performed by retrograde instillation of radiographic contrast medium into the male urethra. RUG is most useful in visualizing lesions of the ant. Urethra such as strictures and diverticula .

  12. Urodynamics • Voiding Diary • Uroflometry • Cystometry • Pressure/Flow Study

  13. Voiding Diary

  14. Uroflowmetry: an electronic flowmeter can provide a recording of urinary flow rate Vs time

  15. Cystometry: • is continuous recording of bladder pressure during gradual filling and during contraction. The examination in indicated in any pt with LUTS when detrusor instability or neurologic disease is suspected .

  16. Cystometry Pdetmax

  17. Over active Bladder

  18. Voiding cystourethrogram (VCUG) : is performed by filling the bladder with radiographic contrast agent through a urethral catheter or suprapubic tube. The entire process is monitored by fluroscopy. Static films are obtained with the bladder full , during micturition and after voiding.

  19. VCUG is an excellent method of diagnosing vesical neck obstruction , vesicosphincter dyssynergia and vesicoureteral reflux .

  20. for male pt over age 50 a test for prostate – specific antigen (PSA) is highly recommended to screen for prostate cancer .

  21. Management • Watchful Waiting • Alpha Blockers • 5 alpha Reductase Inhibitors

  22. BPH Indications for surgery • Renal impairment. • Hydronephrosis. • Recurrent UTI • secondary vesical stones • Recurrent Haematuria • Retention of urine • Significant symptoms not responding to medication

  23. Prostatectomy : - open - closed ( TURP )

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