Lower urinary tract symptoms

Lower urinary tract symptoms

In both sexes, non-specific symptoms of bladder dysfunction become more common with age, probably owing to impairment of smooth muscle function and neurovesical coordination. Not all symptoms of disturbed voiding in ageing men should therefore be attributed to BPH causing BOO. Urologists prefer the term LUTS and discourage the use of the descriptive term ‘prostatism’. The following conditions can coexist with BOO, leading to di ffi culty in diagnosis and in predicting the outcome of treat ment: /uni25CF idiopathic detrusor overactivity (see Chapter 83 ); /uni25CF neuropathic bladder dysfunction as a result of diabetes, stroke, Alzheimer’s disease or Parkinson’s disease (see Chapter 83 ); degeneration of bladder smooth muscle giv ing rise to impaired voiding and detrusor instability; /uni25CF BOO due to BPH. LUTS can be described as: /uni25CF V oiding: /uni25CF hesitancy (worsened if the bladder is very full); /uni25CF poor flow (unimproved by straining); Alois Alzheimer , 1864–1915, neurologist, worked at Heidelberg and Munich before being appointed Professor of Psychiatry at Breslau, Germany (now Wroc ł aw , Poland). James Parkinson , 1755–1824, general practitioner of Shoreditch, London, UK, published - e - - - /uni25CF intermittent stream – stops and starts; /uni25CF dribbling (including after micturition); /uni25CF sensation of poor bladder emptying; /uni25CF episodes of near retention. /uni25CF Storage: /uni25CF frequency; /uni25CF nocturia; /uni25CF urgency; /uni25CF urge incontinence; - /uni25CF nocturnal incontinence (enuresis). LUTS are usually assessed by means of scoring systems, which give a semiobjective measure of severity and may be helpful in assessing the outcome of the therapy . Severe irritativ e symptoms are usually associated with - detrusor instability . Postmicturition dribbling is now known not to be a consequence of BOO and is not usually improved by prostatectomy . It is due to retained urine in the urethra.

Trabeculae Diverticula Figure 84.3 Pathological specimen of bladder and kidneys in a case of bladder out /f_l ow obstruction caused by benign prostatic hyperpla

sia. Bladder trabeculation, bilateral hydroureter and hydronephrosis can be seen.