Irritative voiding symptoms

When monitoring efficacy of drug treatment for benign prostatic hyperplasia, subjective endpoints include relief of obstructive and irritative voiding symptoms. Objective endpoints include improvements of urinary flow rates, decreased post-void residual urinary volume, and decreased complications of disease. 

Patients may or may not be in acute distress. In early stages of disease, the patient may complain of obstructive voiding symptoms. If untreated, in late stages of disease the patient may complain of irritative voiding symptoms, or acute urinary retention, which is painful due to maximal distention of the urinary bladder. Also, the patient may be symptomatic of disease complications, including urosepsis, pyelonephritis, cystitis, or overflow urinary incontinence. 

Urinalysis to rule out urinary tract infection as the cause of irritative voiding symptoms. 

Below is a list of several items clinicians should tell patients to do to minimize obstructive and irritative voiding symptoms ... 

Peak urinary flow rate <10 mL/s Postvoid residual urine volume >25-50 mL Increased BUN and serum creatinine All of the above signs plus obstructive voiding symptoms and irritative voiding symptoms (signs of detrusor instability)... 

Obstructive and irritative voiding symptoms are collectively referred to as lower urinary tract symptoms (LUTS). However, LUTS are not pathognomonic for BPH and LUTS may be caused by other diseases. ... 

Another characteristic of BPH is that some men suffer from silent prostatism. While they have obstructive or irritative voiding symptoms, they adapt to them and do not voluntarily complain about them. Such patients do not present for medical treatment until complications of BPH disease arise. 

Thepatient s perception of the severity of BPH symptoms guides development of a therapeutic plan. To evaluate perceptions objectively, validated instruments, such as the American Urological Association (AUA) Symptom Index, are commonly used. Using the AUA index, the patient rates the bothersomeness of seven obstructive and irritative voiding symptoms. Each item is rated for severity on a scale of 1 to 5 such that 35 is the maximum score and is consistent with the most severe symptoms. 

Prostatectomy is ineffective for relieving irritative voiding symptoms of BPH because prostatectomy does not affect the detrusor muscle of the bladder. These patients may respond to oral anticholinergic agents (e.g., oxybutynin or L-hyoscyamine), which improve bladder compliance and decrease detrusor muscle irritability, as discussed in Chap. 83. 

Validated questionnaire in which the patient assesses the level of annoyance of 7 obstructive and irritative voiding symptoms. 

In primary monosymptomatic enuresis nocturna and in children with minor wetting before treatment and without irritative voiding symptoms and without urinary tract infection, VCU should not be performed. 

TABLE 49-5. Drugs That Can Cause Irritative or Obstructive Voiding Symptoms... 

Lower urinary tract symptoms—Term that collectively refers to obstructive and irritative urinary voiding symptoms of benign prostatic hypertrophy (BPH). 

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