60yo male teacher complains of difficulty emptying bladder. Voiding…
60yo male teacher complains of difficulty emptying bladder. Voiding symptoms -
Hesitancy, weak stream, straining, incomplete emptying.
Chronic LUTS - Storage Symptoms
Frequency, Nocturia, Urgency, Urgency incontinence
usually storage Sx but acute urinary retention
possible. sudden termination of voiding. Hx of stones (hematuria, renal colic), referred pain (tip of penis, scrotum, back, hip)
suprapubic tenderness, fullness & palpable, distended bladder (acute urinary retention)
: Painless hematuria, voiding, pain (advanced), FMHx
usually unremarkable, solid pelvic mass (advanced), induration/ fixation of prostate & bladder
Frequent urge to urinate with possible incontinence & nocturia.
Chronic LUTS - Voiding Symptoms
(Hesitancy, Poor stream, Intermittent flow, Straining to void, Incomplete emptying, Terminal dribbling, Dysuria, Overflow incontinence
↑Urinary Freq, Urgency, Hesitancy, Incomplete bladder emptying, Straining, ↓Force of stream, Dribbling. Typically appear slowly & progress gradually over a period of years. May cause urinary retention. Risk factor: Type II DM, FHx of BPH.
DRE (Enlarged prostate that is symmetric & smooth, palpable median sulcus, mobile rectal mucosa over prostate).
↓Force of stream, Incomplete bladder emptying. Spraying of urinary stream. Dysuria (Painful urination). Recurrent UTI. Sexual dysfunction. Hx of prior instrumentation, injury, or infection (STI).
Enlarged bladder, Enlarged or tender lymph nodes in groin.
Poor detrusor contractility
Acute urinary retention (cauda equina syndrome & cord compression (back pain, sciatica; Hx of trauma, mets), stroke (relevant signs), chronic LUTS (Hx of neurological dz; DM, MS)
PMHx of neurological disease, lax anal tone, abnormal lower limb neurological examination.
Anti-cholinergic (antihistamines, antipsychotics, TCAs, hyoscine), Opioids, Alpha agonists (e.g. pseudoephedrine)
Bladder Neck Stenosis
Bladder Neck Cancer)
DRE (Enlarged prostate that is asymmetric/firm/nodular, loss of median sulcus, non-mobile overlying rectal mucosa). Inguinal lymphadenopathy.
↑Urinary Freq, Urgency, Nocturia, Hesitancy. Weight loss. Painless Hematuria, Hematospermia
Risk factors: FHx of prostate cancer, >60yo, Smoking, Diet (↑Animal fat, ↓Vege)
Edema & tenderness of glans penis, painful swelling of retracted foreskin, constricting band of tissue at head of penis
Hx of balanitis; DM, piercings, mishandled prepuce (e.g. urinary catheter)
Lower - Cystitis (Mild fever)
Upper - Pyelonephritis (Fever, Hypotension, Flank pain, Positive renal punch)
Acute onset. Dysuria. Storage Symptoms with pyuria (Cloudy/Foul-smelling urine). May have hematuria, Suprapubic/Low back pain
Fever, Perineal pain or backache. Irritative urinary symptoms (dysuria, frequency, urgency). Unlike UTI, there is pain on ejaculation and a tender, enlarged prostate on rectal exam, ± suprapubic tenderness.
Dysuria + non-bloody urethral discharge
may be a sign of STD (e.g. gonorrhoea, chlamydia). Inspect genitals for discharge and STD lesions (ulcers, vesicles, crusting).
Pain (usu. Acute - Upper ureteral/renal pelvic lesions: Flank; Lower ureteral:Radiate to ipsilateral testicle/labia). Change in urine output, Hematuria.
Percussion (Enlarged bladder). Distended lower abdomen. Might have HTN, Abdominal mass.