Pathway
Pathway Diagram
Images
Image Gallery
Note: These images open in a new page |
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Prostatitis
Image 1 (Ultrasound): Bulky prostate of approximately 49mL.
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Neurogenic Bladder
Image 2 (Ultrasound): Thick-walled bladder consistent with neurogenic bladder. |
Teaching Points
Teaching Points
- Lower Urinary Tract symptoms (LUTS) may be irritative and/or obstructive
- Ultrasound is indicated in all patients to assess the upper tracts (for hydronephrosis) and the bladder post-void residual volume
- MSU is performed routinely
- Cystoscopy may be required
- If there is a suspicion of urinary calculi, non-contrast enhanced CT scan may be performed
ivp
Intravenous Pyelogram (IVP)
- Routine use is not indicated in every patient with symptoms of lower urinary
tract symptoms 1,5,6
- Indicated in patients with other associated findings such as 1,2
- Stones on plain films
- Haematuria
- Atypical history
- Imaging of upper urinary tract with IVP allows 1
- Determination of the presence, degree and cause of upper urinary tract
obstruction (hydronephrosis)
- Evaluation of the bladder
- Detection of incidental upper tract (renal or ureteral) malignancies
or stones
- Limitations - less sensitive for evaluation of lower urinary tract
- Disadvantages - requires the use of contrast agent and involves exposure
to ionising radiation
luts
Lower Urinary Tract Symptoms (LUTS)
- Lower urinary tract symptoms (LUTS) is the complex of obstructive and irritative
urinary symptoms 1
- Symptoms include urinary hesitancy, poor "stream", straining,
frequency, incomplete bladder emptying, urgency, terminal urinary dribbling,
and nocturia 1
- LUTS may be caused by a variety of factors including changes in the bladder,
prostate, urethra or upper urinary tract. Common causes include urinary tract
infection, benign prostatic hypertrophy, urethral stricture, neurogenic bladder,
bladder neck contracture, prostate and bladder cancer 1
- Management of patients with LUTS is based on making a diagnosis and subjective
measurements of symptom severity and bother 1
us
Ultrasound
- Transabdominal ultrasound is indicated in all patients with LUTS and renal
insufficiency 1,2
- Allows
- Assessment of upper tract changes such as hydronephrosis
- Determination of post-void residual 3
- Superior to IVP in detecting secondary changes of the bladder outlet obstruction
such as bladder wall thickening 4
- Advantages - non-invasive, no ionising radiation and does not require the
use of contrast agent
References
References
References are graded from Level I to V according to the Oxford Centre for Evidence-Based Medicine, Levels of Evidence. Download the document
- Grossfield GD, Coakley FV. Benign prostatic hyperplasia:
clinical overview and value of diagnostic imaging. Radiol Clin North Am. 2000;38(1):31-47. (Review article)
- Scheckowitz EM, Resnick MI. Imaging of the prostate:
benign prostatic hyperplasia. Urol Clin North Am. 1995;22(2):321-32. (Review article)
- Roehrborn CG, Chinn HK, Fulgham PF, et al. The role
of transabdominal ultrasound in the evaluation of patients with benign prostatic
hypertrophy. J Urol. 1986;135(6):1190-3. (Level II evidence). View the reference
- Cascione CJ, Bartone FF, Hussain MB. Transabdominal
ultrasound versus excretory urography in preoperative evaluation of patients
with prostatism. J Urol. 1987;137(5):883-5. (Level II/III evidence)
- Wasserman NF, Lapointe S, Eckmann DR, et al. Assessment
of prostatism: role of intravenous urography. Radiology. 1987;165(3):831-5.
(Level II/III evidence)
- De Lacey G, Johnson S, Mee D. Prostatism: how useful
is routine imaging of the urinary tract? Br Med J. 1988;296(6627):965-7.
(Level II evidence). View the reference
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