1 / 12

Lower Urinary Tract Symptoms (LUTS) in men

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.

seth
Download Presentation

Lower Urinary Tract Symptoms (LUTS) in men

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Lower Urinary Tract Symptoms (LUTS) in men Kamal Patel GPST2

  2. Objectives • Define ‘LUTS’ • Causes of LUTS • Initial assessment and management • Not covered • Mx of acute retention • Stress incontinence • Prostate Ca

  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 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.

  4. LUTS: definition • Storage (irritative) symptoms: • Urgency • Urinary frequency • Nocturia • Urinary incontinence • Voiding (obstructive) symptoms • Hesitancy, poor stream, terminal dribbling

  5. Causes of LUTS • Obstructive • BPH • Prostate/bladder/rectal cancer • Bladder neck/urethral strictures • Antimuscarinic drugs • Autonomic neuropathy/neurogenic bladder

  6. Causes of LUTS • Irritative • BPH • Bladder/prostate cancer • Infection • Bladder stones • Neurological • Dementia • Diabetes • Stroke

  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? • Alpha antagonist • 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 • 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

  11. 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

  12. Thank You

More Related