![]() ![]() The findings of this study may allow more objective stratification of CES risk and therefore result in more efficient rationing of valuable healthcare resources. This algorithm has been employed in the clinical practice of the lead investigator for the past 26 months, in which time no patient has come to any harm from its application. Patients with normal perianal sensation and residual urine volume (volume of urine left in the bladder) less than 100ml will be classified as low risk and receive MRI as an outpatient within one working week, whereas those with abnormal perianal sensation or residual urine volume greater than 100ml will be deemed high risk and undergo urgent MRI. Appendix 1 outlines the algorithm that will be followed. By determining the likelihood of acute CES, clinicians may be able to ration the use of out of hours emergency MRI more effectively.Īll patients presenting to the Royal Devon and Exeter NHS Foundation Trust with suspected acute CES who meet our pre-defined inclusion criteria will be included in this study. The aim of this study is to test a clinical algorithm which employs both clinical examination and ultrasound bladder scanning to stratify patients into high and low risk groups of having acute CES. Urgent use out of hours MRI scanning for these patients is expensive, wasteful and places strain on limited NHS resources. Magnetic resonance imaging (MRI) provides definitive evidence of CES, however the majority of patients who undergo this investigation do not demonstrate cauda equina compression and therefore do not require surgery. Patient presentation is variable and therefore diagnosing CES based on clinical features can be unreliable and subjective. Review efficacy and side effects of alpha blockers/ anticholinergics/ mirabegron 6 weeks after initiation.Acute cauda equina syndrome is a relatively rare but potentially devastating spinal surgical emergency. oxybutynin/vesicare/toviaz) increase as tolerated. It is therefore worth trying at least 3 different preparations if response is limited or side effects are not tolerated.įor products with variable dose (e.g. Response and side effect profiles vary between individuals. Third line: Mirabegron (Betmiga) 50mg (25mg if eGFR<30)Ĭonsider Mirabegron earlier if cognitive side effect of anticholinergics are of concern Trospium (Regurin XL) 60mg oxybutynin patch (Kentera) twice weekly Second line (once daily): Solifenacin (Vesicare) 5/10mg Fesoteridine (Toviaz 4/8mg frequency, urgency, nocturia) continue to cause bother.įirst line: Oxybutinin 5mg (2.5mg elderly?) bd-tds, immediate release tolterodine 2mg bd ![]() oxybutynin, tolterodine, fesoterodine, trospium xl, solifenacin etc) Consider in addition to above if storage symptoms (ie. Bladder capacity is normally about 250 CCs to 300 CCs in seniors. Residual volume 30cc, “plum” on rectal examination, or PSA > 1.4) Post void residual bladder scan (where available, NB need voided volume> 150mls for validity) Delay PSA testing if – active UTI, ejaculation or strenuous exercise within last 48hrs, prostate biopsy within last 6 weeks).( Informed consent/coun s elli ng re interpretation of results - see patient information below).Routine PSA testing if normal DRE and over 75years is not advocated If suspected chronic retention- renal USS to exclude hydronephrosisĬonsider PSA test - if bladder outlet obstruction symptoms or abnormal prostate examination To diagnose nocturnal polyuria (1/3 total 24hr urine output passes at night)Ĭheck renal function if suspected chronic urinary retention (LUTS with palpable bladder/raised post void residual) recurrent UTs history of renal stones To assess type and quantity of fluids prior to conservative treatments Frequency volume chart (drinking/voiding diary for 3days).Straightforward LUTS can be reasonably managed in primary care. Renal impairment secondary to bladder outlet obstruction ie hydronephrosisīenign prostatic obstruction, most likely diagnosis age 55 - 80 Voiding: Hesitancy, poor flow, terminal dribblingįailed medical/conservative treatment and patient bothered by symptoms. Storage: Frequency, nocturia, urgency, incontinence Lower urinary tract symptoms may be classed as: Information for GDPs / Dental Practices.Management of acute urinary retention in men.Scrotal Mass Suspicious for Testicular Cancer & Benign Masses.Chronic Fatigue Syndrome/Myalgic Encephalomyelitis. ![]()
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |