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Symptoms (LUTS)
Presented by: Saad al-saad,
Osamah al-sewilim, faisal al-sheban
Objectives
Definition:
LUTS, or lower urinary tract symptoms , is a
Storage symptoms:
Daytime frequency
Urgency: sudden desire for urination that is
difficult to postponed.
Nocturia : urinary urgency that awakens the
pt. from sleep.
Urge incontinence
Enuresis: incontinence during sleep.
Voiding symptoms
hesitancy: delay in starting micturation.
Intermittent folw
Weak stream: diminished force and caliber with
Causes of LUTS:
In males:
Outflow obstruction
BPH
Meatal stenosis
NM dysfunction
Detrusor instability
Impaired detrusor contractility
Psychogenic voiding dysfunction
CONT
Infection
neoplastic
Others:
In females :
Mostly storage symptoms
UTI
Pregnancy
Anxiety
Overactive bladder
Interstitial cystitis
Postmenopausal urogenital atrophy
Bladder tumor or stone
Genital prolapses or pelvic mass
Haematuria
Fever
Loin & pelvic pain
PMH of renal colic, UTI
Sexual/erectile difficulties
Medications
Bone pain
DM, HTN
In female:
Dyspareunia , vaginal dryness, genitourinary prolapses(low back
pain, heaviness, dragging sensation)
On examination:
General condition and vital signs
Sign of uremia and enlarged lymph node
Abdominal exam. For:
Palpable kidney
Palpable bladder
Renal & bladder tenderness
Ext. genitalia
Perineal sensation
Rectal exam. (prostate: size, tenderness, nodule)
Investigation
*Laboratory tests:
Urinalysis, urine culture.
Voiding Dairy
Cont.
Investigation
US
Ascending Urethrogram
Cont.
Investigation
2- voiding cystourethrogram(VCUG):
Is performed by filling the bladder with radiographic
contrast agent through a urethral catheter or suprapubic
tube
. The process is monitoring by fluoroscopy .static film are
obtained with the bladder full, during micturation and
after voiding.
. VCUG is excellent method of diagnosing vesical neck
obstruction and vesicoureteral reflux.
Cont.
Investigation
*Uroflowmetry:
*Cystourethroscopy
* Cystometry:
Cont.
Investigation
*Assessment of lower
tract:
1- Ascending retrograde
urethrogram:
-RUG is most useful in visualizing
lesion of the ant. Uretha
-stricture
- diverticula
TREATMENT
*Obstructive ureter:
- Suprapubic cystostomy
- Ureteric catheter drainage
Cont
TREATMENT
A. Distal urethra:
*Urethral strictures:
-Dilation
- - Visual urethrotomy
transurethral balloon dilation catheter
- Urethroplasty
*Meatal stenosis:
-Dilation
-surgical meatotomy
BENIGN PROSTATE
HYPERTROPHY
Pathophysiology
The mechanism of prostate hypertrophy is unknown
But there are multiple theories:
-Male hormones(testerone,DHT,granular epithelium of
prostate,BPH)
- Urinary retention
- Renal impairment
- Urinary tract infection
- Gross hematuria
- Bladder stones
- Bladder decompensation
- Overflow incontinence as
a result of retention
Risk factors
-Age : at late 40s only 3.5% of men
at 80s it raise to 35%
-Ethnic
-Family history
-Medical condition :
Obesity
Heart and circulatory disease
Type 2 DM
The DRE :
-A benign prostate:
Feels smooth
Symmetric
-Prostate cancer
Palpable nodule
Feel hard
Asymmetric gland
Treatment
-Watchful waiting :
A- IPSS score 0 to 7
B- 30% improvement
C- 1-5% symptom progression
-Pharmacological therapy:
A- alpha-1 adrenergic blocker (terazosin, doxazosin, prazosin)
B-finasteroide (reduce prostate size 20%)
C-phytotherapy
-Catheters: