Figure 1 - The internal surface of the bladder, highlighting the trigone Aetiology Desmopressin is also unlicensed but has been shown to aid in reducing nocturia.furosemide, bumetanide), though unlicensed, may be taken mid-afternoon to prevent nocturia finasteride) for BPH can help in reducing prostate size by relaxing prostatic muscle alfuzosin, tamsulosin) and / or 5α-reductase inhibitors (e.g. Mirabegron, a β3 adrenergic agonist, may also be useful in managing overactive symptoms. oxybutynin, tolterodine) for overactive bladder, helping to relax bladder muscle by opposing parasympathetic cholinergic control of contraction The recommended pharmacological management is depends on symptomatology and underlying pathology, examples include: Pharmacological therapies can be offered to patients in whom conservative measures are insufficient or inappropriate. *Particularly useful in men with significant post-micturition dribble Pharmacological Management Pelvic floor exercises to strengthen the pelvic floor are useful in cases of stress incontinence or post-micturition dribble.īladder training techniques, which aim to increase the duration between the urge to void and micturition, when done properly (under supervision) these may be useful in overactive bladder. Individuals suffering from voiding symptoms may benefit from urethral milking techniques* (manually emptying the bulbar urethra of residual urine) or double voiding (passing urine and then remaining for a short time before passing urine again) Regulating fluid intake, such as timing and volume of drinks consumed and reducing caffeinated and alcoholic beverages in evenings, is important for all patients. However, there are a number of conservative measures that may be useful in the initial management of LUTS in some patients whilst investigation of the underlying cause is ongoing. Initial management is usually treatment of the underlying pathology. Upper urinary tract imaging, such as via ultrasound or CT scanning, may be useful if there is a history of chronic retention, history of recurrent infection, or the presence of haematuria. Urodynamics is essential in women who have failed medical treatment for an overactive bladder or stress urinary incontinence and are being considered for more invasive treatment options.Ĭystoscopy is the gold standard investigation for assessing the lower urinary tract and may be offered if clinically indicated, such as a history of recurrent infection or the presence of haematuria. 3) can be used to assess flow rate, detrusor pressure, and storage capacity if indicated (for example, in patients where neurogenic bladder dysfunction is a differential). *For example, in overactive bladder there will be a low post-void residual, whereas in BPH there will may be high post-void residual with a flow rate low Specialist Investigations Prostate-Specific Antigen (PSA) may be useful (after appropriate counselling) if there is clinical suspicion of prostatic pathology. Routine blood tests, including FBC and U&Es, are useful as part of a baseline assessment, particularly if there is clinical suspicion of renal impairment or infection. Urine culture should be sent to further investigate infection if relevant. diabetes mellitus) may also aid in initial investigations. 2) is usually one of the first investigations to be undertaken, assessing for signs of UTI predominantly, however also haematuria (e.g.
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