9/11/2023 0 Comments Nocturnal polyuria symptomsUltrasound if suspected incomplete emptying, recurrent infections, or raised creatinineĬonsider bladder diary (input vs output measured in a jug over three 24 hour periods). Initial assessment needs to rule out haematuria, UTI and symptoms of pelvic fullness / pain, in which case urgent scan and referral is required.ĭetermine if bladder emptying issues - poor flow, straining, incomplete emptying, vs overactive bladder - frequency, urgency +/- urge incontinence, nocturia, vs stress incontinence - leakage on coughing, straining etc.Įxclude faecal incontinence issues, symptoms of fistula (continuous leakage), history of previous pelvic cancer, previous incontinence surgery or neurological causes, which would require specialist referral.Įxclude palpable bladder, and vaginal examination to assess for prolapse, atrophy, lichen sclerosis or pelvic masses. Refer to specialist if severe symptoms, intolerance of medication, significant post-void residual (>150ml), UTIs, renal impairment if likely of urological origin.ĭiscuss with men the options of minimally invasive or traditional surgery instead of long term medication and the implication of long term bladder damage if outflow obstruction is inadequately managed. If overactive bladder symptoms dominant, and no major outflow problem, consider trial of generic anti-muscarinic eg tolterodine 2mg bd, or mirabegron 50mg od if anti-cholinergic contra-indicated (elderly, cognitive impairment) or unsuccessful / side effects. Can cause reduced libido, erectile dysfunction, tiredness. If prostate significantly enlarged, consider 5-alpha reductase inhibitor such as finasteride 5mg od, which works over 6 months plus to shrink prostate by 20% and prevent progression of symptoms. ![]() ![]() Alpha blocker such as Tamsulosin 400mcg MR od will help around 2/3rd of men, but commonly causes retrograde ejaculation and can cause postural hypotension / dizziness - caution when starting. If outflow obstruction suspected, treat with medication if desired. Try bladder training exercises (see link below) Drink around 2 litres per day to keep urine dilute, and avoid evening fluids if night time waking a problem. Lifestyle measures - avoid caffeine, fizzy or acidic drinks, alcohol. If suspicion of prostate cancer based on DRE or PSA, refer via rapid access if treatment likely to influence life expectancy (generally 10+ years for localised disease), or if risk of metastatic disease (PSA >20, new onset bone pain / weight loss). Ultrasound if palpable bladder, raised creatinine, UTI, and if persistent symptoms after initial treatment to assess prostate size and post void residual volume. To include genitalia, exclude palpable bladder and perform prostate examination to assess for size and indications of prostate cancer, (nodularity, hardness).ĭiscuss PSA testing according to NHS prostate risk management guidelines - implications of test, risk of inaccuracy and uncertainty of treatment outcomes if cancer.īladder diary (intake and output recorded over three 24 hour periods with jug) to quantify symptoms, and exclude nocturnal polyuria and excess intake. IPSS score can be used to stratify level of symptoms. Exclude neurological issues eg MS, spinal cord compression, cerebrovascular disease.ĭetermine risk factors for prostate cancer - family history, ethnicity, age.Īssess effects of comorbidity and medication eg diuretics, anti-hypertensives, CNS conditions. Specifically ask about nocturnal polyuria - excess volume of urine produciton at night, as this is a medical fluid balance issue, not urological. Urgent non-2ww if otherwise, but consider nephrological pathology especially if young patient, significant proteinuria, hypertension or raised creatinine.Īssessment to distinguish bladder outflow obstruction (poor flow, straining, incomplete emptying) from overactive bladder (frequency, urgency, nocturia). If haematuria present please refer according to national guidelines - 2 week wait if visible and age over 45, or if non-visible (dipstick) then with associated dysuria or raised blood white count over age of 60. ![]() Around half of men will suffer from urinary symptoms, especially after age 40 when prostatic hyperplasia starts to develop.
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