{"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\/ro\/llr-lower-urinary-tract-symptoms-luts\/","title":{"rendered":"Simptome ale tractului urinar inferior LLR (LUTS)"},"content":{"rendered":"

Categoria<\/strong><\/p>\n\n\n\n

Criterii de prag<\/p>\n\n\n\n

Simptomele tractului urinar inferior (LUTS) se refer\u0103 la un grup de clinice simptome<\/a> implic\u00e2nd vezica urinara<\/a>, sfincterul urinar<\/a>, uretra<\/a>, iar, la b\u0103rba\u021bi, cel prostata<\/a>. <\/p>\n\n\n\n

LUTS sunt o problem\u0103 comun\u0103. Calea permite efectuarea investiga\u021biilor complete necesare \u00een asisten\u021ba medical\u0103 primar\u0103 pentru a se asigura c\u0103 cei care au nevoie de evaluarea spitalului sunt v\u0103zu\u021bi rapid, investiga\u021bi am\u0103nun\u021bit \u0219i apoi, ori de c\u00e2te ori este posibil, transfera\u021bi \u00eenapoi la Asisten\u021ba Primar\u0103, unde majoritatea LUTS pot fi gestionate \u00een siguran\u021b\u0103.<\/p>\n\n\n\n

Eligibilitate<\/strong><\/p>\n\n\n\n

LLR ICB va finan\u021ba trimiterea de \u00eengrijire secundar\u0103 pentru simptomele tractului urinar inferior dac\u0103 urm\u0103toarea evaluare a fost f\u0103cut\u0103 \u00een asisten\u021ba primar\u0103<\/strong>
\u00a0
Pacien\u021bii trebuie s\u0103 fie \u00eendruma\u021bi prin calea 2 WW dac\u0103 au<\/strong>
\u2013 PSA legat de v\u00e2rst\u0103 crescut\u0103
\u2013 O prostat\u0103 neregulat\u0103 dur\u0103
\u2013 hematurie semnificativ\u0103
\u00a0
Pacien\u021bi cu unul sau mai multe simptome:<\/strong>
- Frecven\u021b\u0103
\u2013 Nocturie
\u2013 Dificultate la urinare
\u2013 Dribling
\u00a0
Consulta\u021bie ini\u021bial\u0103<\/strong>
Istorie
\u2013 Probleme medicale, emo\u021bionale, fizice, psihologice, sexuale \u0219i sociale
- Revizuirea tuturor medicamentelor curente (inclusiv medicamentele f\u0103r\u0103 prescrip\u021bie medical\u0103 \u0219i pe baz\u0103 de plante)

Excluderea morbidit\u0103\u021bilor alternative
\u2013 U&E\/eGFR dac\u0103 b\u0103nui\u021bi insuficien\u021b\u0103 renal\u0103
\u2013 Glicemia a jeun
\u2013 Hemoleucograma complet\u0103
\u2013 Test de urin\u0103 cu baghet\u0103
\u2013 scor IPSS (pacientul trebuie s\u0103 completeze sec\u021biunea \u201eCalitatea vie\u021bii\u201d)
\u2013 \u00cenc\u0103rcarea volumului de frecven\u021b\u0103 pentru a diferen\u021bia tipul de LUTS
\u2013 testul PSA

Discu\u021bia testului PSA dac\u0103 este cazul \u0219i consultarea complet\u0103 efectuat\u0103 cu pacientul \u00eenainte de a \u00eentreprinde. Am\u00e2na\u021bi testul PSA cu cel pu\u021bin o lun\u0103 dup\u0103 tratamentul ITU dovedit.

Recenzie de dou\u0103 s\u0103pt\u0103m\u00e2ni<\/strong>
\u2013 Revizui\u021bi investiga\u021biile
\u2013 Revizui\u021bi diagrama volumului frecven\u021bei
\u00a0
Stocare predominant LUTS<\/strong>
- Simptome
- Frecven\u021b\u0103
\u2013 Urgen\u021b\u0103
- Considera
\u2013 Antrenamentul vezicii urinare supravegheat
\u2013 Medicamente anticolinergice
\u2013 Produse de izolare, de exemplu, tampoane sau dispozitive de colectare
\u2013 Dispozitive de colectare externe (aparate cu teaca, pisoare cu presiune pubiana)
\u2013 cateterism permanent
\u2013 Trimiterea c\u0103tre echipa de continence comunitar\u0103
\u00a0
Voiding \u2013 LUTS predominant<\/strong>
Simptome
\u2014 Ezitare
\u2013 Flux slab

Considera
\u2013 Blocant alfa
\u2013 inhibitor 5-alfa reductaz\u0103 +\/- alfa blocant (revizuire \u00een 3-6 luni) dac\u0103
- Prostata > 30g (m\u0103rit\u0103)
SAU<\/strong>
- PSA > 1,4 mg\/ml
\u00a0
Pentru simptome persistente de depozitare<\/strong>
Considera
\u2013 Alfa-blocant + anticolinergic
\u2013 cateterizare intermitent\u0103 a vezicii urinare
\u2013 \u00cen cazul \u00een care pacientul este cateterizat, trebuie s\u0103 se monitorizeze urina
\u2013 Dac\u0103 cantitatea de urin\u0103 este > sau egal\u0103 cu 200 ml\/or\u0103, pacientul va trebui internat pentru suport de lichide IV
\u00a0
Pentru pacientul cu alte cauze subiacente identificate, adic\u0103 uropatie obstructiv\u0103<\/strong>
Consulta\u021bi urologie
\u00a0
Revizuire in 4-6 saptamani<\/strong>
\u2013 Ameliorarea simptomelor \u2013 Continuarea tratamentului
\u2013 Nicio ameliorare a simptomelor \u2013 Discuta\u021bi posibilele op\u021biuni chirurgicale \u0219i riscurile asociate interven\u021biei chirurgicale

Consulta\u021bi Urologie dac\u0103
\u2013 Pacientul este de acord \u0219i \u00ee\u0219i exprim\u0103 preferin\u021ba pentru interven\u021bie chirurgical\u0103
\u2013 LUTS deranjant care nu r\u0103spunde la managementul conservator sau la medicamente
\u2013 Re\u021binerea continu\u0103
\u2013 LUTS sunt complicate de UTI recurente sau persistente
<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n
Data revizuirii ARP 67: 2026<\/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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