LUTS Prof Mark Nelson Chair Discipline of General Practice

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LUTS Prof Mark NelsonChair Discipline
of General Practice
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LUTS in adults

• Many different presentations e.g.
• Dark urine (?haematuria, metabolic disorder,
  proteinuria, concentrated urine)
• Incontinence
• Nocturia
• Frequency
• Lump / weakness prolapse
• Burning or pain on micturition

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Symptoms suggestive of UTI

• Frequency and dysuria (/- suprapubic pain,
  systemic symptoms such as fever, sweats, unwell)
• Age and gender will give clue as to what is
  likely
• Young female cystitis 2? to sexual activity
• Older male cystitis 2? to bladder neck
  dysfunction (BPH)

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Management UTI

• Older male
• Ix Rx as per female
• confirmed UTI
• - U/S - full bladder (prostate size) post
  micturition (residual volume)

• Young female
• Ix FWTU / urine catalase test / microscopy
• - MSU MCS (/-)
• Rx TMP 300mg daily for 3/7
• - clear fluids
• - urinary alkaliniser

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MSU results

• ve
• If bacteria sensitive to antibiotic fine if not
  check with the patient for resolution of symptoms
• Yes no change
• No change AB according to sensitivity
• Mixed growth contamination look for WCC if
  gt105 probably UTI Mx on clinical grounds

• -ve
• Think of other Dx

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Important DDx

• Urethritis especially new or multiple sexual
  partner(s) NSU, gonorrhoea onset dysuria
  genital herpes
• Vaginitis infective (younger), atrophic (post
  menopausal)
• Interstitial cystitis (older woman with UTI Sx
  sterile MSU)
• Pyelonephritis ascending infection loin
  pain, systemically unwell