11.1 () Dysuria, frequency and bladder spasm Flashcards
Name 5 medical conditions that can cause irritative voiding symptoms
V - urinary clots
I - UTI
N - cancer of bladder or prostate
D - kidney stones
I - radiation, chemotherapy, opioids
C
A
T - surgery, foley catheter, other trauma
E
N
P
Dysuria:
- What does it feel like?
- What are other accompanying symptoms
Burning, tinging or stinging of urethre and meatus associated with voiding
Accompanied by frequency, urgency, suprapubic pain
What common medication can help dysuria?
What is the dose?
What is a common side effect?
What are contraindications?
Pyridium (phenazopyridine hydrochloride)
200mg up to TID with or after meals x 2 days
Reddish orange discoloration of urine
CI: renal insufficiency or glucose 6 phosphate dehydrogenase (G6PD) deficiency
Bladder spasm and overactive bladder - initial approach
History, physical
Urinalysis and cuture
PVR to assess for urinary retention
Asymptomatic bacteriuria is more common in what 3 groups?
Women <60yo
Diabetics
Elderly
What are normal limits of PVR?
50-100ml of urine
What 5 classes of medications can cause urinary retention?
Anti cholinergic (TCA, atropine)
Opioid
Benzo
Anti-D
Anti-H
Anti-5HT3
Initial conservative (non-med) options for overactive bladder:
Name 2 broad categories and examples (min 2 each)
Behavioural education/modification:
- Timed voiding q 4-6 hours
- Double voiding
- Urge suppression
- Fluid intake management
- Pelvic floor muscle training
Interventional:
- Intermittent catheter
- Indwelling catheter (foley or suprapubic)
What common GI condition can contribute to urinary retention?
Constipation
How to treat overactive bladder that fails conservative tx - 3 classes of medications (1 examples each)
B&O supps
Anticholinergic: (DOB)
Tolterodine (detrol)
Oxybutynin
Buscopan
Beta 3 adrenoreceptor agonist:
Mirabegron (myrbetriq)
Alpha blocker in men:
flomax
FS: BABA
Who should not use anticholinergic meds (name 3)
Narrow angle glaucoma
Impaired gastric emptying
Urinary retention
Patient already on other anticholinergic meds
What is the mechanism of action of mirabegron?
Beta 3 adreno-receptor agonist:
Inhibition of afferent bladder nerves –> relaxing detrusor muscle
4 SEs of mirabegron?
High BP
Cardiac arrhytmia
Angio edema
Urinary retention*
UTI*
Dry mouth
Dizziness *
Constipation*
Mechanism of action of B&O supps?
Belladona has atropine and scopolamine that induce smooth muscle relaxation of bladder
Opium acts as narcotic analgesic
Failing conservative management and PO meds for overactive bladder
- Name 3 non-invasive procedures
- Name 1 invasive procedure
Intra-detrusor injection of botox A
Percutaneous tibial nerve stimulation
Sacral neuromodulation
Urinary diversion (ileal conduit)
