Primary Care Management of Male Lower Urinary Tract Symptoms. Matthew B.K. Shaw Consultant Urological Surgeon

Size: px
Start display at page:

Download "Primary Care Management of Male Lower Urinary Tract Symptoms. Matthew B.K. Shaw Consultant Urological Surgeon"

Transcription

1 Primary Care Management of Male Lower Urinary Tract Symptoms Matthew B.K. Shaw Consultant Urological Surgeon

2 NICE LUTS Guidelines Lower Urinary Tract Symptoms (LUTS) in men. NICE Clinical Guideline 97 (2010) Published 19 th May 2010

3 Assessment LUTS Voiding Storage weak or intermittent urinary stream straining hesitancy terminal dribbling urgency frequency incontinence nocturia incomplete emptying

4 LUTS Voiding symptoms are usually due to bladder outflow obstruction (B.O.O) Storage symptoms are usually due to overactive Bladder (O.A.B) Bladder outflow obstruction may cause over activity

5 Aetiology LUTS Young Men Infective: UTI s and STI s Strictures Illicit Drugs Idiopathic Urinary tract Stone disease Neurological diseases (MS) Congenital abnormalities Medication Rarely Neoplastic Older Men Benign prostatic enlargement (BPE) Infective : utis / Prostatitis Medication: Diuretics Detrusor failure Iatrogenic Neoplastic diseases of urinary tract Neurological diseases

6 LUTS Assessment

7 LUTS Investigations Urine dipstick frequency volume chart IPSS PSA test : Offer men information, advice and time -If prostate feels abnormal -Concerned about prostate cancer Serum creatinine only if indications of renal impairment

8 LUTS Assessment

9 LUTS Assessment Not routinely required: Imaging of the upper urinary tract to men with no evidence of bladder abnormality Flow-rate measurement Post void residual volume measurement

10 Treatment of mild/moderate LUTS Bothersome to the patient? No Yes Active surveillance? offer advice on lifestyle and information Offer review if symptoms change. Active intervention drug treatment or surgery Offer baseline assessment (e.g. IPSS)

11 NICE recommended drug treatment Moderate to severe LUTS Offer an alpha blocker (Tamsulosin or Alfuzosin) Mild LUTS and a prostate estimated to be larger than 30g Offer a 5-Alpha reductase inhibitor (5ARI) (Finasteride or Dutasteride) moderate to severe LUTS, and a prostate estimated to be larger than 30g Consider combination treatment with an alpha blocker and a 5ARI 1. Accessed 20th May 2010

12 Drug Treatment OAB OAB Mixed symptoms despite treatment with an alpha blocker alone Offer an anticholinergic Consider adding an anticholinergic

13 Recommended Drug Treatment Review Review men on drug treatments to assess symptoms, the effect of quality of life and side effects from treatment. Repeat IPSS Alpha blockers or anticholinergic Review at 4-6 weeks and then every 6-12 months 5ARI Review at 3-6 months and then every 6-12 months

14 Rationale for combination treatment 5ARIs -blockers Improve symptoms/flow Onset of symptom relief in 1 2 weeks Maintain symptom/flow improvements Prevent symptomatic progression Reduce longer-term risk of AUR and surgery

15 Reasons for Urological Referral Failure to improve with treatment Unable to tolerate treatment Complex patient Persistent or recurrent UTI s Haematuria Palpable bladder Urinary Retention Incontinence Suspected cancer Renal impairment

16 Haematuria Matthew B.K. Shaw Consultant Urological Surgeon

17 Urine testing for haematuria should only be performed for identifiable clinical reasons; there is currently no evidence to support opportunistic screening of the general population.

18 New Terminology Visible Haematuria (VH) Non-visible Haematuria (NVH) Symptomatic NVH (s-nvh) Asymptomatic NVH (a-nvh)

19 What is a positive sample? Dipstick vs microscopy Urine dipstick of a fresh voided spec is sensitive Specimens sent to lab for microscopy have a significant false negative rate so routine microscopy to confirm dipstick haematuria is unnecessary

20 What is a positive sample? Trace vs or greater is significant. Trace is not significant Haemolysed vs non-haemolysed No distinction in significance. 1+ of either is considered equally significant

21 Significant Haematuria Any single episode of VH Any single episode of s-nvh (in absence of UTI or other transient cause) Persistent a-nvh 2 out of 3 (in absence of UTI or other transient cause)

22 Causes of Transient Non-visible Haematuria UTI treat infection then repeat dipstick if positive refer. UTI can be the first presentation of significant genitourinary pathology Exercise induced non-visible haematuria Menstruation

23 Who to refer All patients with visible haematuria (>16) All patients with s-nvh (any age) All patients with persistent a-nvh aged 40yrs

24 Risk Factors Smoking history History of visible haematuria > 50yrs Storage voiding symptoms Previous urological history Previous pelvic irradiation Cyclophosphamide Occupational exposure

25 Imaging Choices Visible haematuria: Non visible haematuria: under 40: US & Xray KUB if re referred then CTIVU US & Xray KUB Over 40: CTIVU (3 phase)

26 Follow up Re-refer if: Visible haematuria or s-nvh recurs Nephrology referral if: Significant proteinuria ACR>30 or PCR>50 egfr <30 or deteriorating egfr >5ml/min/year or 10ml/min over within 5 yrs haematuria Recurrent a-nvh does not need reinvestigation

27 Urolithiasis Matthew B.K. Shaw Consultant Urological Surgeon

28 Urolithiasis Increasing prevalence in developed countries Germany: 1.1% - 5% Italy: 5% - 9% Overall prevalence 7% -Peak incidence years

29 Urolithiasis Risk Factors Intrinsic Extrinsic Age Sex 3M:1F Genetics Climate and season Geography Diet Water consumption Occupation

30 Urolithiasis Types of Urinary Stones 70% Idiopathic 25% Infective 5% Metabolic

31 Urolithiasis Composition of Urinary Stones Calcium oxalate 70% Calcium oxalate/phosphate 15% Uric acid 7% Infection (struvite) 5% Cystine 1%

32 Urolithiasis Presentation Pain Incidental discovery Haematuria Infection Metabolic derangement

33 Urolithiasis Assessment Urinalysis (RBC/WBC) Temperature Creatinine, electrolytes, calcium and urate Ultrasound and KUB radiograph If acute presentation: Urology SpR via Freeman switchboard

34 Urolithiasis

35 Urolithiasis Natural history of renal stones Complex Stone composition Stone size Stone location

36 Urolithiasis -Treatment Observation Lifestyle advice Increased fluids Low animal protein Low salt Controlled weight loss Medical expulsive therapy -Ureteric stones

37 Urolithiasis -Treatment

38 Urolithiasis Regional Guidelines Suspected renal stones Symptomatic (eg flank pain - consider emergency / urgent referral if severe pain) No, ie coincidental finding on imaging Yes Renal ultrasound and plain plain radiograph (no CT scan) Refer to urology for assessment and further management including recommendations about follow up (do not arrange CT scan before referral) Yes Renal stones confirmed? No Reassess, manage appropriately

39 Acknowledgement All members of Urology GP training group Mr. Toby Page Mr. Edgar Paez Mr. Mark Johnson

NORTH OF TYNE AND GATESHEAD GUIDELINES FOR MANAGEMENT OF COMMON UROLOGICAL CONDITIONS IN ADULTS 18 YEARS. July 2013

NORTH OF TYNE AND GATESHEAD GUIDELINES FOR MANAGEMENT OF COMMON UROLOGICAL CONDITIONS IN ADULTS 18 YEARS. July 2013 NORTH OF TYNE AND GATESHEAD GUIDELINES FOR MANAGEMENT OF COMMON UROLOGICAL CONDITIONS IN ADULTS 18 YEARS July 2013 1 CONTENTS Page Introduction 3 Scrotal lumps 4 Haematuria 5 Urinary tract infection 6

More information

Open the Flood Gates Urinary Obstruction and Kidney Stones. Dr. Jeffrey Rosenberg Dr. Emilio Lastarria Dr. Richard Kasulke

Open the Flood Gates Urinary Obstruction and Kidney Stones. Dr. Jeffrey Rosenberg Dr. Emilio Lastarria Dr. Richard Kasulke Open the Flood Gates Urinary Obstruction and Kidney Stones Dr. Jeffrey Rosenberg Dr. Emilio Lastarria Dr. Richard Kasulke Nephrology vs. Urology Nephrologist a physician who has been trained in the diagnosis

More information

NICE Pathways bring together all NICE guidance, quality standards and other NICE information on a specific topic.

NICE Pathways bring together all NICE guidance, quality standards and other NICE information on a specific topic. Initial assessment and investigation of urinary incontinence bring together all NICE guidance, quality standards and other NICE information on a specific topic. are interactive and designed to be used

More information

Guideline for Microalbuminuria Screening

Guideline for Microalbuminuria Screening East Lancashire Diabetes Network Guideline for Microalbuminuria Screening Produced by: Task and Finish Group, Clinical Standards Group Produced: August 2006 Approved by: East Lancashire Diabetes Network

More information

Diabetic nephropathy is detected clinically by the presence of persistent microalbuminuria or proteinuria.

Diabetic nephropathy is detected clinically by the presence of persistent microalbuminuria or proteinuria. Kidney Complications Diabetic Nephropathy Diabetic nephropathy is detected clinically by the presence of persistent microalbuminuria or proteinuria. The peak incidence of nephropathy is usually 15-25 years

More information

Improving access and reducing costs of care for overactive bladder through a multidisciplinary delivery model

Improving access and reducing costs of care for overactive bladder through a multidisciplinary delivery model Improving access and reducing costs of care for overactive bladder through a multidisciplinary delivery model Trafford Crump, Ph.D. Department of Surgery, University of Calgary Presentation to: Canadian

More information

Topic review: Clinical presentation and diagnosis of urinary incontinence in the elderly. Prapa Pattrapornpisut 7 June 2012

Topic review: Clinical presentation and diagnosis of urinary incontinence in the elderly. Prapa Pattrapornpisut 7 June 2012 1 Topic review: Clinical presentation and diagnosis of urinary incontinence in the elderly Prapa Pattrapornpisut 7 June 2012 2 Urinary incontinence Definition the complaint of any involuntary leakage of

More information

Gwen Griffith Clinical Nurse Specialist Bolton NHS foundation Trust

Gwen Griffith Clinical Nurse Specialist Bolton NHS foundation Trust Gwen Griffith Clinical Nurse Specialist Bolton NHS foundation Trust Overview Setting the Scene Beginning of the journey & specialist nurse role Why people with MS experience bladder problems MS and the

More information

symptoms of Incontinence

symptoms of Incontinence Types, causes and symptoms of Urinary Incontinence Aims and Objectives Aim: To have an understanding of the types and causes of urinary incontinence. Objectives: To be aware of the incidence and prevalence

More information

LCD for Prostate Specific Antigen (PSA)

LCD for Prostate Specific Antigen (PSA) LCD for Prostate Specific Antigen (PSA) Applicable CPT Code(s): 84152 Prostate Specific Antigen (PSA); Complexed (Direct Measurement) 84153 Prostate Specific Antigen (PSA); Total 84154 Prostate Specific

More information

Bladder Health Promotion

Bladder Health Promotion Bladder Health Promotion Community Awareness Presentation Content contributions provided by the Society of Urologic Nurses (SUNA) National Association for Continence (NAFC) Simon Foundation for Continence

More information

Adult Urodynamics: American Urological Association (AUA)/Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction (SUFU) Guideline

Adult Urodynamics: American Urological Association (AUA)/Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction (SUFU) Guideline Adult Urodynamics: American Urological Association (AUA)/Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction (SUFU) Guideline RECOMMENDATIONS 1 Conditional: Clinicians who are making

More information

1 ST JAMAICAN PAEDIATRIC NEPHROLOGY CONFERENCE

1 ST JAMAICAN PAEDIATRIC NEPHROLOGY CONFERENCE in association with 1 ST JAMAICAN PAEDIATRIC NEPHROLOGY CONFERENCE Jamaica Conference Centre Kingston, Jamaica October 4 th 2014 VOIDING DISORDERS IN CHILDREN Dr. Colin Abel Paediatric Urologist Bustamante

More information

PROCEDURE FOR THE ASSESSMENT OF ADULTS AND CHILDREN WITH BLADDER OR BOWEL DYSFUNCTION

PROCEDURE FOR THE ASSESSMENT OF ADULTS AND CHILDREN WITH BLADDER OR BOWEL DYSFUNCTION PROCEDURE FOR THE ASSESSMENT OF ADULTS AND CHILDREN WITH BLADDER OR BOWEL DYSFUNCTION First Issued Issue Version One Purpose of Issue/Description of Change Planned Review Date Procedure for the effective

More information

Bladder and Bowel Assessment Ann Yates Director of Continence Services. 18/07/2008 Cardiff and Vale NHS Trust

Bladder and Bowel Assessment Ann Yates Director of Continence Services. 18/07/2008 Cardiff and Vale NHS Trust Bladder and Bowel Assessment Ann Yates Director of Continence Services Types of continence problems Bladder Stress incontinence Urgency and urge Incontinence Mixed incontinence Obstructive incontinence

More information

A PRINTED copy of this guideline may not be the most recent version. The OFFICIAL version is located on IHNET at the Policies & Procedures Home Page

A PRINTED copy of this guideline may not be the most recent version. The OFFICIAL version is located on IHNET at the Policies & Procedures Home Page A PRINTED copy of this guideline may not be the most recent version. The OFFICIAL version is located on IHNET at the Policies & Procedures Home Page IX0200: Prevention & Control of Catheter Associated

More information

Classification of Mixed Incontinence

Classification of Mixed Incontinence european urology supplements 5 (2006) 837 841 available at www.sciencedirect.com journal homepage: www.europeanurology.com Classification of Mixed Incontinence Christopher Chapple * Sheffield Hallam University,

More information

Overactive Bladder and/or Nocturia (Female)

Overactive Bladder and/or Nocturia (Female) Overactive Bladder and/or Nocturia (Female) Definition: Increased urinary frequency > 8 voids / day More than 1 void/night in women 80 years old Diagnosis

More information

MANAGEMENT OF PROSTATE ENLARGEMENT/BPH

MANAGEMENT OF PROSTATE ENLARGEMENT/BPH MANAGEMENT OF PROSTATE ENLARGEMENT/BPH J E S S I C A E. P A O N E S S A, M. D. A S S I S T A N T P R O F E S S O R D E P A R T M E N T O F U R O L O G Y S U N Y U P S T A T E M E D I C A L U N I V E R

More information

Bladder and Bowel Control

Bladder and Bowel Control Bladder and Bowel Control Dr Sue Woodward Lecturer, Florence Nightingale School of Nursing and Midwifery 2 Why do we need to understand anatomy? Normal physiology Normal adult bladder capacity = 450-500mls

More information

Bladder Health Promotion

Bladder Health Promotion Bladder Health Promotion Community Awareness Presentation endorsed by the Society of Urologic Nurses (SUNA) National Association for Continence( NAFC) Simon Foundation for Continence This presentation

More information

Chapter 31: Lower Urinary Tract Conditions in Elderly Patients

Chapter 31: Lower Urinary Tract Conditions in Elderly Patients Chapter 31: Lower Urinary Tract Conditions in Elderly Patients Damon Dyche and Jay Hollander William Beaumont Hospital, Royal Oak, Michigan As our population ages, the number of patients presenting to

More information

Lower Urinary Tract Symptoms (LUTS) in Middle-Aged and Elderly Men

Lower Urinary Tract Symptoms (LUTS) in Middle-Aged and Elderly Men Prostatic Diseases Lower Urinary Tract Symptoms (LUTS) in Middle-Aged and Elderly Men JMAJ 47(12): 543 548, 2004 Tomonori YAMANISHI Associate Professor, Department of Urology, Dokkyo University School

More information

Recurrent Kidney Stones

Recurrent Kidney Stones Recurrent Kidney Stones Sean A. Pierre, MD; and Darren T. Beiko, MD, FRCSC As presented at the College of Canadian Family Physicians Annual Family Medicine Forum, Toronto, Ontario. Family physicians are

More information

Published on: 07/04/2015 Page 1 of 5

Published on: 07/04/2015 Page 1 of 5 Bladder Stones A DNA test for Hyperunicosuria (HUU) to find the gene which is implicated in the development of URATE stones has been developed which work with Bulldogs and many other breeds including Black

More information

HEALTH NEWS PROSTATE CANCER THE PROSTATE

HEALTH NEWS PROSTATE CANCER THE PROSTATE HEALTH NEWS PROSTATE CANCER THE PROSTATE Prostate comes from the Greek meaning to stand in front of ; this is very different than prostrate which means to lie down flat. The prostate is a walnut-sized

More information

NEPHROLITHIASIS Diagnosis & Treatment

NEPHROLITHIASIS Diagnosis & Treatment Learning Objectives NEPHROLITHIASIS Diagnosis & Treatment Jai Radhakrishnan, MD, MS Professor of Clinical Medicine Columbia University Management of the first episode of renal colic: Optimal Imaging Treatment

More information

Care of the Catheterised Patient and Urinalysis

Care of the Catheterised Patient and Urinalysis Care of the Catheterised Patient and Urinalysis Male Pelvic Anatomy Female Pelvic Anatomy What does a urinary catheter do? Urinary Catheters Urinary Catheters Urinary Catheters Why do patients have catheters?

More information

150640_Brochure_B 4/12/07 2:58 PM Page 2. Patient Information. Freedom From an Enlarged Prostate

150640_Brochure_B 4/12/07 2:58 PM Page 2. Patient Information. Freedom From an Enlarged Prostate 150640_Brochure_B 4/12/07 2:58 PM Page 2 Patient Information Freedom From an Enlarged Prostate 150640_Brochure_B 4/12/07 2:58 PM Page 3 GreenLight Laser Therapy 1 150640_Brochure_B 4/12/07 2:58 PM Page

More information

Urinary Continence. Second edition FAST FACTS. by Julian Shah and Gary Leach. Anatomy and physiology 7. Investigations and diagnosis 11

Urinary Continence. Second edition FAST FACTS. by Julian Shah and Gary Leach. Anatomy and physiology 7. Investigations and diagnosis 11 FAST FACTS Urinary Continence Second edition Indispensable Guides to by Julian Shah and Gary Leach Clinical Practice Anatomy and physiology 7 Investigations and diagnosis 11 Detrusor instability 28 Primary

More information

CARE PROCESS STEP EXPECTATIONS RATIONALE

CARE PROCESS STEP EXPECTATIONS RATIONALE URINARY INCONTINENCE CARE PROCESS STEP EXPECTATIONS RATIONALE ASSESSMENT/PROBLEM RECOGNITION 1. Did the staff and physician seek and document risk factors for urinary incontinence and any history of urinary

More information

Chronic Kidney Disease (CKD) Algorithm. Chronic Kidney Disease (CKD) Algorithm Page 1

Chronic Kidney Disease (CKD) Algorithm. Chronic Kidney Disease (CKD) Algorithm Page 1 Chronic Kidney Disease (CKD) Algorithm Chronic Kidney Disease (CKD) Algorithm Page 1 Chronic Kidney Disease (CKD) Algorithm (See NICE Clinical Guideline CG73 1 and Quality Standards 2 ) Who should have

More information

Prostate Specific Antigen (PSA) Blood Test

Prostate Specific Antigen (PSA) Blood Test TO PROVIDE THE VERY BEST CARE FOR EACH PATIENT ON EVERY OCCASION Prostate Specific Antigen (PSA) Blood Test An information guide Prostate Specific Antigen (PSA) Blood Test Prostate Specific Antigen (PSA)

More information

Overactive Bladder (OAB)

Overactive Bladder (OAB) Overactive Bladder (OAB) Overactive bladder is a problem with bladder storage function that causes a sudden urge to urinate. The urge may be difficult to suppress, and overactive bladder can lead to the

More information

Primary Care management of Overactive Bladder (OAB)

Primary Care management of Overactive Bladder (OAB) DERBYSHIRE JOINT AREA PRESCRIBING COMMITTEE (JAPC) Primary Care management of Overactive Bladder (OAB) Prescribing Tips All medicines for OAB have similar dose-related efficacy. More than one agent (up

More information

Victoria Sharp, MD, MBA, FAAFP

Victoria Sharp, MD, MBA, FAAFP Victoria Sharp, MD, MBA, FAAFP Clinical Professor of Urology and Family Medicine Victoria Sharp, MD, MBA, FAAFP Market Chief Medial Officer AmeriHealth Caritas Family of Companies Office phone: (515) 330-3740

More information

Identifying and treating long-term kidney problems (chronic kidney disease)

Identifying and treating long-term kidney problems (chronic kidney disease) Understanding NICE guidance Information for people who use NHS services Identifying and treating long-term kidney problems (chronic kidney disease) NICE clinical guidelines advise the NHS on caring for

More information

1. What is the prostate-specific antigen (PSA) test?

1. What is the prostate-specific antigen (PSA) test? 1. What is the prostate-specific antigen (PSA) test? Prostate-specific antigen (PSA) is a protein produced by the cells of the prostate gland. The PSA test measures the level of PSA in the blood. The doctor

More information

Urinary Incontinence in Women. Susan Hingle, M.D. Department of Medicine

Urinary Incontinence in Women. Susan Hingle, M.D. Department of Medicine Urinary Incontinence in Women Susan Hingle, M.D. Department of Medicine Background Estimated 13 million Americans with urinary incontinence Women are affected twice as frequently as men Only 25% will seek

More information

Diabetes and the Kidneys

Diabetes and the Kidneys Diabetes and the Kidneys Aim(s) and objective(s) This guideline focuses on the detection, prevention, and management of kidney disease in people with diabetes. The management of end-stage renal disease

More information

Overactive bladder and urgency incontinence

Overactive bladder and urgency incontinence Overactive bladder and urgency incontinence As a health care provider you can make a significant difference to the quality of life of patients like these by addressing urinary incontinence, introducing

More information

OAB (Overactive Bladder)

OAB (Overactive Bladder) OAB (Overactive Bladder) PharmCon is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. This webcast has been supported by an educational grant

More information

A Summary of the Guideline for the Diagnosis and Management of. Urinary Tract Infections in Long Term Care

A Summary of the Guideline for the Diagnosis and Management of. Urinary Tract Infections in Long Term Care A Summary of the Guideline for the Diagnosis and Management of Urinary Tract Infections in Long Term Care Exclusions Community acquired UTIs UTIs in acute care Prevention Limit use of catheters Ensure

More information

Kidney Disease WHAT IS KIDNEY DISEASE? TESTS TO DETECT OR DIAGNOSE KIDNEY DISEASE TREATMENT STRATEGIES FOR KIDNEY DISEASE

Kidney Disease WHAT IS KIDNEY DISEASE? TESTS TO DETECT OR DIAGNOSE KIDNEY DISEASE TREATMENT STRATEGIES FOR KIDNEY DISEASE Kidney Disease WHAT IS KIDNEY DISEASE? Kidney disease is when your kidneys are damaged and not functioning as they should. When kidney disease is not going away it is called chronic kidney disease or CKD.

More information

Pyelonephritis: Kidney Infection

Pyelonephritis: Kidney Infection Pyelonephritis: Kidney Infection National Kidney and Urologic Diseases Information Clearinghouse U.S. Department of Health and Human Services NATIONAL INSTITUTES OF HEALTH What is pyelonephritis? Pyelonephritis

More information

Renal Disease in Type 2 Diabetes Mellitus

Renal Disease in Type 2 Diabetes Mellitus Renal Disease in Type 2 Diabetes Mellitus 6th Collaborative DiGP/HSE/UCC Conference 25 th September 2013 Dr. Eoin O Sullivan Consultant Endocrinologist Bon Secours Hospital Cork Case 69 year old woman

More information

Medical Tests for Prostate Problems

Medical Tests for Prostate Problems Medical Tests for Prostate Problems National Kidney and Urologic Diseases Information Clearinghouse U.S. Department of Health and Human Services NATIONAL INSTITUTES OF HEALTH What is the prostate? The

More information

Study Design Of Medical Research

Study Design Of Medical Research Study Design Of Medical Research By Ahmed A.Shokeir, MD,PHD, FEBU Prof. Urology, Urology & Nephrology Center, Mansoura, Egypt Study Designs In Medical Research Topics Classification Case series studies

More information

Overactive bladder syndrome (OAB)

Overactive bladder syndrome (OAB) Overactive bladder syndrome (OAB) Exceptional healthcare, personally delivered What is OAB? An overactive bladder or OAB is where a person regularly gets a sudden and compelling need or desire to pass

More information

Nephrology (Renal Medicine)

Nephrology (Renal Medicine) Nephrology (Renal Medicine) Dr Shabbir Moochhala Consultant Nephrologist, Royal Free Hospital, London Cystinuria Patient Day 1 st Feb 2014 Nephrologist Urologist The Kidney designed for the job The body

More information

Botox treatment for an overactive bladder in women. Information for patients Gynaecology

Botox treatment for an overactive bladder in women. Information for patients Gynaecology Botox treatment for an overactive bladder in women Information for patients Gynaecology What is bladder overactivity (OAB)? Bladder overactivity is a common condition, affecting around one in five people.

More information

FEMALE INCONTINENCE REVIEW

FEMALE INCONTINENCE REVIEW 200 S. Wenona Suite 298 Steven L. Jensen, M.D. 5400 Mackinaw, Suite 4302 Bay City, MI 48706 Frank H. Kim, M.D. Saginaw, MI 48604 Telephone (989) 895-2634 Adult & Pediatric Urologists (989) 791-4020 Fax

More information

Case Based Urology Learning Program

Case Based Urology Learning Program Case Based Urology Learning Program Resident s Corner: UROLOGY Case Number 21 CBULP 2011 068 Case Based Urology Learning Program Editor: Associate Editors: Manager: Case Contributors: Steven C. Campbell,

More information

POAC CLINICAL GUIDELINE

POAC CLINICAL GUIDELINE POAC CLINICAL GUIDELINE Acute Pylonephritis DIAGNOSIS COMPLICATED PYELONEPHRITIS EXCLUSION CRITERIA: Male Known or suspected renal impairment (egfr < 60) Abnormality of renal tract Known or suspected renal

More information

Bladder changes after bowel cancer treatment

Bladder changes after bowel cancer treatment Bladder changes after bowel cancer treatment This information is from the booklet Managing the late effects of bowel cancer treatment. You may find the full booklet helpful. We can send you a free copy

More information

Guidelines for Management of Renal Cancer

Guidelines for Management of Renal Cancer Guidelines for Management of Renal Cancer Date Approved by Network Governance July 2012 Date for Review July 2015 Changes Between Versions 2 and 3 Section 5 updated bullets 5.3 and 5.4 Section 6 updated

More information

Southern Derbyshire Shared Care Pathology Guidelines. AKI guidelines for primary care

Southern Derbyshire Shared Care Pathology Guidelines. AKI guidelines for primary care Southern Derbyshire Shared Care Pathology Guidelines AKI guidelines for primary care Contents: FLOW DIAGRAM: MANAGEMENT OF PATIENTS WITH AKI DETECTED IN PRIMARY CARE...2 FLOW DIAGRAM: POST AKI MANAGEMENT

More information

Urinary Incontinence FAQ Sheet

Urinary Incontinence FAQ Sheet Urinary Incontinence FAQ Sheet Are you reluctant to talk to your doctor about your bladder control problem? Don t be. There is help. Loss of bladder control is called urinary incontinence. It can happen

More information

Acute urinary retention evaluated with urodynamic assessment in elder male W23, 16 October 2012 09:00-10:30

Acute urinary retention evaluated with urodynamic assessment in elder male W23, 16 October 2012 09:00-10:30 Acute urinary retention evaluated with urodynamic assessment in elder male W23, 16 October 2012 09:00-10:30 Start End Topic Speakers 09:00 09:05 Introduction Jianquan Hou 09:05 09:20 Acute urinary retention

More information

UTI in children. Quick reference guide. Issue date: August 2007. Urinary tract infection in children: diagnosis, treatment and long-term management

UTI in children. Quick reference guide. Issue date: August 2007. Urinary tract infection in children: diagnosis, treatment and long-term management Issue date: August 2007 UTI in children Urinary tract infection in children: diagnosis, treatment and long-term management Developed by the National Collaborating Centre for Women s and Children s Health

More information

Overview of Urinary Incontinence in the Long Term Care Setting

Overview of Urinary Incontinence in the Long Term Care Setting Overview of Urinary Incontinence in the Long Term Care Setting Management Strategies for the Nursing Assistant Ann M. Spenard RN, C, MSN Courtney Lyder ND, GNP Learning Objectives Describe common types

More information

URINARY INCONTINENCE IN WOMEN

URINARY INCONTINENCE IN WOMEN URINARY INCONTINENCE IN WOMEN Definition Urinary incontinence (UI) is defined as involuntary loss of urine that is a social or hygienic problem (International Continence Society, 1973) Magnitude of the

More information

National Hospital for Neurology and Neurosurgery

National Hospital for Neurology and Neurosurgery National Hospital for Neurology and Neurosurgery Botulinum toxin injections for the bladder Department of Uro-Neurology If you would like this document in another language or format, or require the services

More information

COMMITTEE FOR PROPRIETARY MEDICINAL PRODUCTS (CPMP)

COMMITTEE FOR PROPRIETARY MEDICINAL PRODUCTS (CPMP) The European Agency for the Evaluation of Medicinal Products Evaluation of Medicines for Human Use London, 18 December 2002 COMMITTEE FOR PROPRIETARY MEDICINAL PRODUCTS (CPMP) NOTE FOR GUIDANCE ON THE

More information

Question ID: 6 Question type: Intervention Question: Does treatment of overactive bladder symptoms prevent falls in the elderly?

Question ID: 6 Question type: Intervention Question: Does treatment of overactive bladder symptoms prevent falls in the elderly? PRIORITY BRIEFING The purpose of this briefing paper is to aid Stakeholders in prioritising topics to be taken further by PenCLAHRC as the basis for a specific evaluation or implementation projects. QUESTION

More information

Early Prostate Cancer: Questions and Answers. Key Points

Early Prostate Cancer: Questions and Answers. Key Points CANCER FACTS N a t i o n a l C a n c e r I n s t i t u t e N a t i o n a l I n s t i t u t e s o f H e a l t h D e p a r t m e n t o f H e a l t h a n d H u m a n S e r v i c e s Early Prostate Cancer:

More information

7. Prostate cancer in PSA relapse

7. Prostate cancer in PSA relapse 7. Prostate cancer in PSA relapse A patient with prostate cancer in PSA relapse is one who, having received a primary treatment with intent to cure, has a raised PSA (prostate-specific antigen) level defined

More information

Urinary Incontinence. Causes of Incontinence. What s Happening?

Urinary Incontinence. Causes of Incontinence. What s Happening? National Institute on Aging AgePage Urinary Incontinence Sarah loves to spend time with her friends talking about her grandchildren and going to exercise classes with neighbors. But she s started to have

More information

Blood in the urine (hematuria)

Blood in the urine (hematuria) Blood in the urine (hematuria) Hematuria refers to the presence of blood in the urine. It is important to investigate the cause of hematuria because rarely, it is caused by a serious condition, such as

More information

GSK Clinical Study Register

GSK Clinical Study Register In February 2013, GlaxoSmithKline (GSK) announced a commitment to further clinical transparency through the public disclosure of GSK Clinical Study Reports (CSRs) on the GSK Clinical Study Register. The

More information

Nocturnal Enuresis Clinical Management Tool (CMT)

Nocturnal Enuresis Clinical Management Tool (CMT) Nocturnal Enuresis Clinical Management Tool (CMT) This tool and additional educational resources can be found at www.stopbedwetting.org Zinc Code: DN/360/2010/UKe(1)a Date of Preparation of website: August

More information

Diagnostics: Page 2 of 5

Diagnostics: Page 2 of 5 Proteinuria Proteinuria is a condition in which there are increased amounts of protein in the urine. There are a number of different diseases which can result in proteinuria. In the early stages of the

More information

The PSA Test for Prostate Cancer Screening:

The PSA Test for Prostate Cancer Screening: For more information, please contact your local VA Medical Center or Health Clinic. U.S. Department of Veterans Affairs Veterans Health Administration Patient Care Services Health Promotion and Disease

More information

Nocturnal Enuresis Clinical Management Tool (CMT)

Nocturnal Enuresis Clinical Management Tool (CMT) Nocturnal Enuresis Clinical Management Tool (CMT) Nocturnal Enuresis Clinical Management Tool Why this management tool? 1. The aim of this tool is to use a simple questionnaire and non-invasive screening,

More information

Preventing Catheter Blockages: A Guide for Health Professionals

Preventing Catheter Blockages: A Guide for Health Professionals Introduction Preventing Catheter Blockages: A Guide for Health Professionals and Long term catheterisation is common for someone with a spinal cord injury (SCI). However, it poses a concern as this method

More information

Prostate Cancer Screening. A Decision Guide for African Americans

Prostate Cancer Screening. A Decision Guide for African Americans Prostate Cancer Screening A Decision Guide for African Americans This booklet was developed by the U.S. Department of Health and Human Services, Centers for Disease Control and Prevention (CDC). Published

More information

X-Plain Kidney Stones Reference Summary

X-Plain Kidney Stones Reference Summary X-Plain Kidney Stones Reference Summary Introduction Kidney stones are fairly common. Although they can be very painful, they are treatable, and in many cases preventable. This reference summary will help

More information

Female Urinary Disorders and Pelvic Organ Prolapse

Female Urinary Disorders and Pelvic Organ Prolapse Female Urinary Disorders and Pelvic Organ Prolapse Richard S. Bercik, M.D. Director, Division of Urogynecology & Reconstruction Pelvic Surgery Department of Obstetrics, Gynecology & Reproductive Sciences

More information

PCA3 DETECTION TEST FOR PROSTATE CANCER DO YOU KNOW YOUR RISK OF HAVING CANCER?

PCA3 DETECTION TEST FOR PROSTATE CANCER DO YOU KNOW YOUR RISK OF HAVING CANCER? PCA3 DETECTION TEST FOR PROSTATE CANCER DO YOU KNOW YOUR RISK OF HAVING CANCER? PCA3 DETECTION TEST FOR PROSTATE CANCER There is a range of methods available to your healthcare professional to verify the

More information

6/3/2011. High Prevalence and Incidence. Low back pain is 5 th most common reason for all physician office visits in the U.S.

6/3/2011. High Prevalence and Incidence. Low back pain is 5 th most common reason for all physician office visits in the U.S. High Prevalence and Incidence Prevalence 85% of Americans will experience low back pain at some time in their life. Incidence 5% annual Timothy C. Shen, M.D. Physical Medicine and Rehabilitation Sub-specialty

More information

Information for men considering a male sling procedure

Information for men considering a male sling procedure Information for men considering a male sling procedure Delivering the best in care UHB is a no smoking Trust To see all of our current patient information leaflets please visit www.uhb.nhs.uk/patient-information-leaflets.htm

More information

Clinical evaluation of Himplasia in Benign Prostatic Hyperplasia: An Open Clinical Trial

Clinical evaluation of Himplasia in Benign Prostatic Hyperplasia: An Open Clinical Trial [Medicine Update (2003): (11), 1, 75-78] Clinical evaluation of Himplasia in Benign Prostatic Hyperplasia: An Open Clinical Trial Manoranjan Sahu, Reader and Head, Ramesh Bhat, P. Research Scholar, Department

More information

Learning Resource Guide. Understanding Incontinence. 2000 Prism Innovations, Inc. All Rights Reserved

Learning Resource Guide. Understanding Incontinence. 2000 Prism Innovations, Inc. All Rights Reserved Learning Resource Guide Understanding Incontinence 2000 Prism Innovations, Inc. All Rights Reserved ElderCare Online s Learning Resource Guide Understanding Incontinence Table of Contents Introduction

More information

Spinal Cord and Bladder Management Male: Intermittent Catheter

Spinal Cord and Bladder Management Male: Intermittent Catheter Spinal Cord and Bladder Management Male: Intermittent Catheter The 5 parts of the urinary system work together to get rid of waste and make urine. Urine is made in your kidneys and travels down 2 thin

More information

Have a shower, rather than a bath to avoid exposing your genitals to the chemicals in your cleaning products for too long. Always empty your bladder

Have a shower, rather than a bath to avoid exposing your genitals to the chemicals in your cleaning products for too long. Always empty your bladder Cystitis, Avenue Medical Practice Neat Guideline Introduction Cystitis means 'inflammation of the bladder'. It causes: an urgent and frequent need to urinate, and Pain, or stinging, when passing urine.

More information

Patient with: 3 or more UTI in 6 months 4 or more UTI in 12 months

Patient with: 3 or more UTI in 6 months 4 or more UTI in 12 months Recurrent UTI Management Pathway adult females Initial assessment Assessment questionnaire questionnaire bladder scan dipstick dipstick of of urine urine pregnancy neurological disease long - term catheters

More information

Dr Eva Fong. Urologist Auckland

Dr Eva Fong. Urologist Auckland Dr Eva Fong Urologist Auckland Urinary incontinence: Treatment options GPCME 2013 Eva Fong Urologist Urinary incontinence Is not normal part of aging or childbearing We can make it better Urinary incontinence:

More information

Incontinence. What is incontinence?

Incontinence. What is incontinence? Incontinence What is incontinence? Broadly speaking, the medical term incontinence refers to any involuntary release of bodily fluids, but many people associate it strongly with the inability to control

More information

Prostate Cancer Screening. A Decision Guide

Prostate Cancer Screening. A Decision Guide Prostate Cancer Screening A Decision Guide This booklet was developed by the U.S. Department of Health and Human Services, Centers for Disease Control and Prevention (CDC). Is screening right for you?

More information

OVERACTIVE BLADDER DIAGNOSIS AND TREATMENT OF OVERACTIVE BLADDER IN ADULTS:

OVERACTIVE BLADDER DIAGNOSIS AND TREATMENT OF OVERACTIVE BLADDER IN ADULTS: 2014 OVERACTIVE BLADDER DIAGNOSIS AND TREATMENT OF OVERACTIVE BLADDER IN ADULTS: AUA/SUFU Guideline (2012); Amended (2014) For Primary Care Providers OVERACTIVE BLADDER Diagnosis and Treatment of Overactive

More information

Saint Mary s Hospital. Gynaecology Service Warrell Unit. Overactive Bladder. Information for Patients

Saint Mary s Hospital. Gynaecology Service Warrell Unit. Overactive Bladder. Information for Patients Saint Mary s Hospital Gynaecology Service Warrell Unit Overactive Bladder Information for Patients What is Overactive Bladder (OAB)? OAB is a condition that causes you to need to pass urine more often

More information

Feline Cystitis (Feline Lower Urinary Tract Disease)

Feline Cystitis (Feline Lower Urinary Tract Disease) Feline Cystitis (Feline Lower Urinary Tract Disease) The term "cystitis" literally means inflammation of the urinary bladder. Although this term is rather general, there is a common form of cystitis that

More information

Title: Microbiology Urine Screening Effective date: 05/08/2013. Summary of Significant Changes at this Revision

Title: Microbiology Urine Screening Effective date: 05/08/2013. Summary of Significant Changes at this Revision COPY Summary of Significant Changes at this Revision Add maintenance procedure and not doing dipstick from urine collected into boric acid Purpose and Scope Items Required The purpose of this process is

More information

Case 1: Classification of Lower Urinary Tract Symptoms (LUTS) and Urinary Incontinence (UI)

Case 1: Classification of Lower Urinary Tract Symptoms (LUTS) and Urinary Incontinence (UI) cme case presentation For more information see below. Case 1: Classification of Lower Urinary Tract Symptoms (LUTS) and Urinary Incontinence (UI) David R. Staskin, MD Associate Professor of Urology Director,

More information

Urinary Tract Infection in Stone Patients and in Patients with Indwelling Urethral Catheters

Urinary Tract Infection in Stone Patients and in Patients with Indwelling Urethral Catheters Urinary Tract Infection in Stone Patients and in Patients with Indwelling Urethral Catheters Pages with reference to book, From 254 To 258 Farakh A. Khan, Salman H. Siddiqui, Nasreen Akhtar ( Department

More information

Night frequency None 1 2 3 4 5 6 7 8 9 10. Not enough warning before needing to urinate. none mild moderate severe

Night frequency None 1 2 3 4 5 6 7 8 9 10. Not enough warning before needing to urinate. none mild moderate severe {Patient Label} SYMPTOMS SURVEY: FREQUENCY: How many times do you urinate during the day and get up from sleep to urinate at night? Day frequency 3 4 5 6 7 8 9 10 11 12 13 14 15 More Night frequency None

More information

es of Urinary Incontinence:

es of Urinary Incontinence: Reversible Cause Urinary incontinence is a loss of control over the passing of urine. Urine loss can occur in very small amounts (enough only to dampen underwear) to very large amounts (requiring a change

More information

Urinary Tract Infections

Urinary Tract Infections Urinary Tract Infections Overview A urine culture must ALWAYS be interpreted in the context of the urinalysis and patient symptoms. If a patient has no signs of infection on urinalysis, no symptoms of

More information

Bowel and Bladder Dysfunction in MS. Tracy Walker, WOCN, MSCN, FNP C Nurse Practitioner MS Institute at Shepherd Center. Bladder Dysfunction

Bowel and Bladder Dysfunction in MS. Tracy Walker, WOCN, MSCN, FNP C Nurse Practitioner MS Institute at Shepherd Center. Bladder Dysfunction Bowel and Bladder Dysfunction in MS Tracy Walker, WOCN, MSCN, FNP C Nurse Practitioner MS Institute at Shepherd Center Bladder Dysfunction Approximately 75% of people with MS experience bladder problems

More information

Renal Cysts What should I do now?

Renal Cysts What should I do now? Renal Cysts What should I do now? Dr Edmund Chiong Asst. Professor & Consultant Department of Urology National University Hospital What are renal cysts? Fluid-filled structures in the kidney that are not

More information