ByMelisa Sukarno Putri122.0118

Hyperplasia of epithelial and stromal components of prostateProgressive obstruction of urinary outflowIncreased activity of detrusor muscleCausesFrequency, nocturiaPoor flow , intermittent streamHesitation, terminal dribbling

Men > 50 = 41% have symptoms of LUTSOnly 18% have a diagnosisOnly 10% aware of drugs or surgery that will help it

Age? obesity

Poorly controlled diabetesNeurological disordersUrinary tract infectionsAbacterial prostatitisOveractive bladderDrugs diuretics, anticholinergics, antidepressantsLifestyle factors caffeine, alcohol, xs fluids

The presence of the following symptoms indicates referral to urologist for futher assessmentUrinary incontinenceRetentionDysuriaHaematuriaAcute change in symptoms

Palpation of abdomen for enlarged bladderenlarged kidneysconstipationRectal examination forSize and consistency of prostate gland

Blood testsFbc esrU&esFasting blood sugar? PSA level rises with increasing volume of prostate glandUrinalysisInfectionhaematuria

Additional tests as appropriate by GPUltrasound for residual urine volumeUrinary diaries

Reasons for doing themPatient reassurancePatient explanationObjective assessment of symptomsDiagnostic precisionRanking of treatment optionsPrediction of treatment outcome

Uroflowmetry max flow rate and volume of residual urine after voiding low flow rate indicates need for TURPBladder pressure studies pressure measurement during filling and emptying (cystometry) gives information on over/under activity of detrusor muscle and obstruction of bladder outlet. Predicts response to treatment. Use antimuscarinics for over activity and turp for bladder outlet obstruction

Urinary tract imagingUltrasound to estimate residual urineUrethroscopyVisual inspection of bladder and uerethra is used in dysuria or haematuria

A validated questionnaire using international prostate symptom scale.Completion gives total score of 351 7 mild8 19moderate20 35severeResponse to the quality of life questionnaire strong predictor or whether intervention is necessary

Ask 7 questions. Answers on scale 0 5 depending on severity of symptomsFor first 6 questions scores are Not at all = 0< 1 in 5 = 1< half the time= 2About half the time = 3> half the time = 4Almost always= 5Q7 Never = 0, once = 1, 2x = 2, 3x = 3, 4x = 4, 5x = 5

In last month how often have youHad sensation of not emptying bladder completelyHad urge to urinated < 2 hours after previously finishedFound you stopped and started again several timesFound it difficult to postpone urinationHad a weak stream (compared to when aged 30)Had to push or strain to begin urinationHow many times did you get out of bed per night to urinate

If you were to spend the rest of your life with your urinary condition the way it is now, how would you feel about that?Delighted0Pleased1Mostly satisfied2Mixed feelings3Mostly dissatisfied4Terrible5

Lifestyle modificationReduce fluid intakeStop diuretics if possAvoid xs night time fluid intake/caffeine /alcoholEmpty bladder before long trips/meetings

Treat co morbid contributing conditionsDiabetesuti

Drug therapyAlpha blockersImprove bladder and prostate smooth muscle toneMore effective than 5 alpha reductase inhibitorsAll work equally wellTamsulosin and alfuzosin require no dose titration

Drug therapy5 alpha reductase inhibitorsReduce prostate volumeReduces risk of prostate cancer, increases risk of high grade diseaseCombined therapyMen with large prostate > 40g or PSA >4 or moderate to severe symptoms combined therapy will prevent 2 episodes of clinical progression per 100men over 4yrs. Much less effective for men with smaller prostates

Drug therapyStorage problemsMen with symptoms of urinary urgency, frequency, small, urine volumes and nocturia in the absence of serious obstructive symptoms are categorised as over active bladderBladder training BiofeedbackAntimuscarinic drugs ( oxybutinin, tolteridine) alone or in combination with treatment for obstructive symptoms

SurgeryTURPGreatest improvement in symptoms5% severe haemorrhage riskRequires GAAlternative energy sources for TURPUltrasoundLasermicrowave

SurgeryAdverse effects of surgeryLoss of ejaculationErectile dysfunctionRetrograde ejaculationIncontinenceStricture formationUrinary retention

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