{"id":14031,"date":"2023-11-10T10:04:25","date_gmt":"2023-11-10T10:04:25","guid":{"rendered":"https:\/\/leicesterleicestershireandrutland.icb.nhs.uk\/?p=14031"},"modified":"2023-11-10T10:04:27","modified_gmt":"2023-11-10T10:04:27","slug":"llr-lower-urinary-tract-symptoms-luts","status":"publish","type":"post","link":"https:\/\/leicesterleicestershireandrutland.icb.nhs.uk\/pl\/llr-lower-urinary-tract-symptoms-luts\/","title":{"rendered":"LLR Objawy dolnych dr\u00f3g moczowych (LUTS)"},"content":{"rendered":"

Kategoria<\/strong><\/p>\n\n\n\n

Kryteria progowe<\/p>\n\n\n\n

Objawy z dolnych dr\u00f3g moczowych (LUTS) odnosz\u0105 si\u0119 do grupy objaw\u00f3w klinicznych objawy<\/a> z udzia\u0142em p\u0119cherz moczowy<\/a>, zwieracz cewki moczowej<\/a>, cewka moczowa<\/a>, a u m\u0119\u017cczyzn prostata<\/a>. <\/p>\n\n\n\n

LUTS s\u0105 cz\u0119stym problemem. \u015acie\u017cka umo\u017cliwia przeprowadzenie pe\u0142nych wymaganych bada\u0144 w podstawowej opiece zdrowotnej, aby zapewni\u0107 szybk\u0105 wizyt\u0119 w szpitalu, dok\u0142adne zbadanie, a nast\u0119pnie, je\u015bli to mo\u017cliwe, skierowanie z powrotem do podstawowej opieki zdrowotnej, gdzie mo\u017cna bezpiecznie leczy\u0107 wi\u0119kszo\u015b\u0107 LUTS.<\/p>\n\n\n\n

Uprawnienia<\/strong><\/p>\n\n\n\n

LLR ICB sfinansuje skierowanie do opieki specjalistycznej z powodu objaw\u00f3w ze strony dolnych dr\u00f3g moczowych, je\u015bli w podstawowej opiece zdrowotnej dokonano nast\u0119puj\u0105cej oceny<\/strong>
\u00a0
Pacjenci powinni by\u0107 kierowani drog\u0105 II wojny \u015bwiatowej, je\u015bli tak jest<\/strong>
\u2013 Podwy\u017cszony poziom PSA zwi\u0105zany z wiekiem
\u2013 Twarda, nieregularna prostata
\u2013 Znacz\u0105cy krwiomocz
\u00a0
Pacjenci z jednym lub wi\u0119ksz\u0105 liczb\u0105 objaw\u00f3w:<\/strong>
- Cz\u0119stotliwo\u015b\u0107
\u2013 Nokturia
\u2013 Trudno\u015bci w oddawaniu moczu
\u2013 Drybling
\u00a0
Wst\u0119pna konsultacja<\/strong>
Historia
\u2013 Problemy medyczne, emocjonalne, fizyczne, psychologiczne, seksualne i spo\u0142eczne
\u2013 Przegl\u0105d wszystkich aktualnie stosowanych lek\u00f3w (w tym lek\u00f3w dost\u0119pnych bez recepty i lek\u00f3w zio\u0142owych)

Wykluczenie chor\u00f3b alternatywnych
\u2013 U&E\/ eGFR, je\u015bli podejrzewasz upo\u015bledzenie czynno\u015bci nerek
- Cukier we krwi na czczo
\u2013 Pe\u0142na morfologia krwi
\u2013 Badanie moczu metod\u0105 zanurzeniow\u0105
\u2013 Wynik IPSS (pacjent musi wype\u0142ni\u0107 sekcj\u0119 \u201eJako\u015b\u0107 \u017cycia\u201d)
\u2013 Charakterystyka g\u0142o\u015bno\u015bci cz\u0119stotliwo\u015bci w celu rozr\u00f3\u017cnienia typu LUTS
\u2013 badanie PSA

Om\u00f3wienie badania PSA, je\u015bli jest to wskazane i pe\u0142na konsultacja z pacjentem przed jego wykonaniem. Po leczeniu potwierdzonego ZUM od\u0142\u00f3\u017c badanie PSA na co najmniej miesi\u0105c.

Przegl\u0105d dwutygodniowy<\/strong>
\u2013 Przegl\u0105d dochodze\u0144
\u2013 Przejrzyj wykres wolumenu cz\u0119stotliwo\u015bci
\u00a0
Przewa\u017caj\u0105ce LUTS w pami\u0119ci masowej<\/strong>
\u2013 Objawy
- Cz\u0119stotliwo\u015b\u0107
- Pilna sprawa
- Rozwa\u017ca\u0107
\u2013 Nadzorowany trening p\u0119cherza
\u2013 Leki antycholinergiczne
\u2013 Produkty zabezpieczaj\u0105ce, np. podk\u0142adki lub urz\u0105dzenia zbieraj\u0105ce
\u2013 Zewn\u0119trzne urz\u0105dzenia zbieraj\u0105ce (aparaty p\u0142aszczowe, pisuary ci\u015bnieniowe \u0142onowe)
\u2013 Cewnikowanie sta\u0142e
\u2013 Skierowanie do \u015brodowiskowego zespo\u0142u ds. wstrzemi\u0119\u017aliwo\u015bci
\u00a0
Pustka \u2013 dominuj\u0105cy LUTS<\/strong>
Objawy
\u2013 Wahanie
\u2013 S\u0142aby przep\u0142yw

Rozwa\u017ca\u0107
\u2013 Bloker alfa
\u2013 Inhibitor 5-alfa reduktazy +\/- alfa bloker (przegl\u0105d za 3-6 miesi\u0119cy) je\u015bli
\u2013 Prostata >30g (powi\u0119kszona)
LUB<\/strong>
\u2013 PSA >1,4mg\/ml
\u00a0
W przypadku utrzymuj\u0105cych si\u0119 objaw\u00f3w przechowywania<\/strong>
Rozwa\u017ca\u0107
\u2013 Alfa bloker + antycholinergiczny
\u2013 Okresowe cewnikowanie p\u0119cherza moczowego
\u2013 W przypadku cewnikowania pacjenta nale\u017cy monitorowa\u0107 wydalanie moczu
\u2013 Je\u015bli ilo\u015b\u0107 wydalanego moczu wynosi > lub r\u00f3wna 200 ml\/h, pacjent b\u0119dzie musia\u0142 zosta\u0107 przyj\u0119ty w celu do\u017cylnego wspomagania p\u0142ynami
\u00a0
W przypadku pacjent\u00f3w z innymi zidentyfikowanymi przyczynami, np. uropati\u0105 zaporow\u0105<\/strong>
Przejd\u017a do urologii
\u00a0
Recenzja za 4-6 tygodni<\/strong>
\u2013 Poprawa objaw\u00f3w \u2013 Kontynuuj leczenie
\u2013 Brak poprawy objaw\u00f3w. \u2013 Om\u00f3w mo\u017cliwe opcje chirurgiczne i ryzyko zwi\u0105zane z operacj\u0105

Je\u015bli tak, skontaktuj si\u0119 z urologi\u0105
\u2013 Pacjent wyra\u017ca zgod\u0119 i wyra\u017ca zgod\u0119 na operacj\u0119
\u2013 Uci\u0105\u017cliwy LUTS, kt\u00f3ry nie reaguje na konserwatywne leczenie lub leki
\u2013 Retencja trwa
\u2013 LUTS s\u0105 powik\u0142ane nawracaj\u0105cym lub uporczywym ZUM
<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n
Data przegl\u0105du ARP 67: 2026 r<\/td><\/tr><\/tbody><\/table><\/figure>","protected":false},"excerpt":{"rendered":"

Category Threshold Criteria Lower urinary tract symptoms (LUTS) refer to a group of clinical symptoms involving the bladder, urinary sphincter, urethra, and, in men, the prostate.  LUTS are a common problem. 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