Lower Urinary Tract Dysfunction

Question 1

What is Urinary Incontinence?

What are the 2 Types of Urinary Incontinence?

Answer 1

A loss of control of urination.

Types : Urge Incontinence and Stress Incontinence.

Question 2

Epidemiology of LUTS.

Answer 2

50% of men over the age of 50 suffer from LUTS.

Question 3

Give 8 causes of LUTS.

Answer 3

1. BPH (Males).
2. UTIs.
3. Urological Malignancy.
4. Detrusor Muscle Weakness.
5. Chronic Prostatitis (Males).
6. Urethral Stricture.
7. External Compression e.g. Pelvic Tumour, Faecal Impaction.
8. Neurological Disease e.g. MS, CNS Injury.

Question 4

What is a Urethral Stricture?

Answer 4

A narrowing of the urethra - congenital; iatrogenic trauma (e.g. urethral instrumentation, anastomosis); non-iatrogenic trauma (e.g. astride injury).

Question 5

Give 3 lifestyle factors that can exacerbate LUTS.

Answer 5

1. Drinking fluids late at night.
2. Excess Alcohol Intake.
3. Excess Caffeine Intake.

Question 6

What is Urge Incontinence?

Answer 6

The sudden urge to pass urine; also known as Overactive Bladder, caused by overactivity of the Detrusor muscle.

Question 7

What is Neurogenic Bladder?

Answer 7

Abnormal activity of the Detrusor muscle or Sphincter muscles due to an abnormal function of the nerves, resulting in urge incontinence, intravesical pressure and obstructive uropathy.

Question 8

What is Stress Incontinence?

Answer 8

Leakage of urine at times of increased pressure of the bladder (intra-abdominal) e.g. laughing, coughing, due to a weakness of the pelvic floor.

Question 9

What is the Pelvic Floor?

Answer 9

A sling of muscles supporting the contents of the pelvis - a weakness causes the canals to become lax and organs to become poorly supported.

Question 10

What is Overflow Incontinence?

Aetiology (3).

Answer 10

Overflow of urine and incontinence without the urge to pass urine.
Aetiology : Chronic Urinary Retention (Obstructive Uropathy); Anticholinergics; Neurological Conditions.

Question 11

What should the patient be advised about urodynamic testing?

Answer 11

Stop taking any anticholinergic/bladder-related medications 5 days before testing.

Question 12

Why are Urine Frequency Volume Charts useful? (2)

Answer 12

Distinguish between :

1. Nocturne and Nocturnal Polyuria.
2. Urinary Frequency and Polyuria.

Question 13

What is the gold standard investigation for assessing the lower urinary tract?

Answer 13

Cystoscopy.

Question 14

Management of LUTS (2).

Answer 14

1. Distinguish between Urge and Stress Incontinence and Treat.
2. Treat underlying pathology.

Question 15

Conservative Management of Voiding LUTS (3).

Answer 15

1. Pelvic Floor Muscle (supervised) & Bladder Training.
2. Restrict Fluid Intake.
3. Containment Products.

Question 16

Conservative Management of Storage LUTS (3).

Answer 16

1. Restrict Fluid Intake.
2. Bladder Training.
3. Antimuscarinics.

Question 17

What Antimuscarinic drugs can be given? (3)

Answer 17

1. Oxybutynin (immediate release).
2. Tolterodine (immediate release).
3. Darifenacin (once-daily preparation)

Question 18

Management of Stress Incontinence (5).

Answer 18

1. Supervised Pelvic Floor Exercises for at least 3 months before surgery.
2. TVT - Tension-Free Vaginal Tape : mesh sling that supports the urethra.
3. Autologous Sling Procedure.
4. Colposuspension (stitching anterior vaginal wall around urethra to support urethra).
5. Intramural Urethral Bulking (injection to reduce urethral diameter).

Question 19

Management of Urge Incontinence (5)

Answer 19

1. Bladder Retraining for at least 6 weeks.
2. Anticholinergics.
3. Botulinum Toxin Type A Injection on Bladder Wall.
4. Percutaneous Sacral Nerve Stimulation (device).
5. Augmentation Cystoplasty (bowel tissue to enlarge bladder).
6. Urinary Diversion (Urostomy).

Question 20

What is the alternative of Anticholinergic medications?

• Name.
• Mechanism of Action.
• Adverse Effects (2).
• Contraindication.

Answer 20

Mirabegron - B3 Agonist that stimulates the SNS.
Adverse Effect : Hypertensive crisis + increased risk of TIA/Stroke.
Contraindication : Uncontrolled Hypertension.

Question 21

Complications of LUTS (3).

Answer 21

1. Infection (Stasis).
2. Formation of Renal and Ureteric Calculi (Stasis).
3. Renal Failure and Hydronephrosis.