Assessment of the Lower Urinary Tract

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Wapstra FH, Van Goor H, Navis G et al. (1996) Antiproteinuric effect predicts renal protection by angiotensin-converting enzyme inhibition in rats with established adriamycin nephrosis. Clin Sci 90 339-340 

Yayama K, Kawao M, Tujii H et aL (1993) Dup 753 prevents the development of puromycin aminonucleoside-induced nephrosis. Eur J Pharmacol 236 337-338 Yoneda H, Toriumi W, Ohmachi Y et al. (1998) Involvement of angiotensinll in development of spontaneous nephrosis in Dahl salt-sensitive rats. Eur J Pharmacol 362 213-219 

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VUD is the combination of VCU with pressure/ flow/electromyographic studies of the lower urinary tract. It is the gold standard for the assessment of children with neurogenic bladder. It is only a second-step study in children with nonneurogenic bladder-sphincter dysfunction. 

Complete work-up of the lower urinary tract regarding the simultaneous assessment of morphology and functional disorders can be achieved by video-urodynamics, if available (see Chap. 1.4). Since the bladder outlet and urethral morphology are of particular interest in these patients at any time of the staged surgical correction, there is no role for a direct radionuclide cystogram and sonographic VCU. 

In the neonatal period ultrasound can be used for assessment of coexisting renal and spinal malformations. Modified VCU assesses both lower urinary tract function and morphology. Video-urodynamics, if available, allows complete work-up of the lower urinary tract. After antireflux surgery abbreviated IVU should be used for evaluation of urine transport in equivocal cases it should be completed by isotope studies. 

When the nurse is administering any of the miscellaneous drugs, the nurse monitors die patient for a reduction in the symptoms obtained in die preadministration assessment such as dysuria, urinary frequency, urgency, nocturia, and relief of any pain associated widi irritation of die lower genitourinary tract. 

To assess the effects of Permixon in men with lower urinary tract symptoms and BPH, a meta analysis of all available clinical trial data was undertaken. Boyle et al. (2000), in randomized clinical trials involving 2859 patients, found that Permixon in the treatment of men with BPH revealed a significant improvement in peak flow rate and reduction in nocturia. 

Sexual function There was a clear association between a-adrenoceptor antagonists and ejaculatory dysfunction (pain/discom-fort) in an observational study in Spanish men with benign prostatic hyperplasia and/or lower urinary tract symptoms [106 ]. The presence and severity of symptoms were assessed using the male sexual health questionnaire there was an 83% prevalence of ejaculatory dysfunction in patients taking a-adrenoceptor antagonists. Most cases of ejaculatory dysfunction were mild and severe dysfunction occurred in only 4% of cases. Although the adverse effects on sexual function were seen with all of the a-adrenoceptor antagonists, alfuzosin was associated with better ejaculatory function than tamsulosin, terazosin, or doxazosin. 

A 24-year-old woman with spina bifida presented to the emergency department feeling unwell. Her ankles were swollen and she was noted to have recently had a urinary tract infection. She was treated with antibiotics and discharged home. A week later she was admitted to hospital with very swollen lower limbs, high blood pressure and raised central venous pressure. A diagnosis of hypertensive congestive cardiac failure was made, delayed a week because of an incomplete initial assessment in the emergency department. 

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