14. UTIs and BPH Flashcards
Why are UTI more common in women
shorter length of the female urethra
why are UTI more common in post menopausal women
causes alteration in the normal vaginal bacterial flora that normally competes with the pathological bacteria
What actually is a UTI
infection in the bladder causing cystitis (inflammation of the bladder)
can spread up to the kidneys causing pyelonephritis
What is the main source of infection for UTI
usually from faeces where the normal intestinal bacteria such as E.coli
name some risk factors for UTI
o catheterisation o menopause o sexual intercourse o pregnancy o urinary tract malformation o urinary stones
What are the common presentation with someone with lower urinary tract infection
- Dysuria (pain, stinging or burning when passing urine)
- Suprapubic pain or discomfort
- Frequency
- Urgency
- Incontinence
- Confusion is commonly the only symptom in older more frail patients
What are the symptoms of someone with pyelonephritis
- Fever is a more prominent feature than lower urinary tract infections.
- Loin, suprapubic or back pain. This may be bilateral or unilateral.
- Looking and feeling generally unwell
- Vomiting
- Loss of appetite
- Haematuria
- Renal angle tenderness on examination
When you dip someone’s urine who has a UTI what could you find
nitrites (gram negative bacteria breakdown nitrates)
leukocytes
If nitrities or leukocytes are present then what should you do
send off an MSU sample to the lab for culture and sensitivity testing
what is the common cause of UTI
E coli
This is a gram-negative, anaerobic, rod-shaped bacteria that is part of the normal lower intestinal microbiome. It is found in faeces and can easily spread to the bladder.
Name some other causes of UTI except E.coli
- Klebsiella pneumoniae (gram-negative anaerobic rod)
- Enterococcus
- Pseudomonas aeruginosa
- Staphylococcus saprophyticus
- Candida albicans (fungal)
Management of UTI:
how many days treatment for a simple lower urinary tract infection in women
3 days
5-10 dayys
7 days
3 days
Management of UTI:
how many days treatment for women that are immunosuppressed, have abnormal anatomy or impaired kidney function
3 days
5-10 dayys
7 days
5-10 days
Management of UTI:
how many days treatment for men, pregnant women or catheter related UTIs
3 days
5-10 dayys
7 days
7 days
What are the main initial antibiotic used to treat. UTI
nitrofurantoin
Trimethoprim
Alternatives are
Piyymecillinam
Amoxicillin
Cefalexin
UTI in pregnancy increase the risk of what
pyelonephritis
premature rupture of membrane
pre term labour
How many days of antibiotics should be given to women who are pregnant
7 days even with asymptomatic bacteriuria
what is the first line antibiotic for UTI in pregnant women
nitrofurantoin
what is the second line antibiotic for UTI in pregnant women
Cefalexin or amoxicillin
Which antibiotic is avoided in the third trimester as it is linked with haemolytic anaemia in the newborn
nitrofurantoin
which antibiotic is generally considered safe in pregnancy but avoided in the first trimester or if they are on another medication that. affect folic acid
trimethoprim
What are the guidelines for treatment of pyelonephritis
first line antibiotic for 7-10 days
Cefalexin
Co-amoxiclav
Trimethoprim
Ciprofloxacin
Patients with pyelonephritis and pyrexia usually require what kind of treatment in hospital
24-48 hours of IV gentamicin or temocillin followed by 10 day course of oral antibiotics
What is BPH
benign prostatic hyperplasia
very common in men of increasing age
caused by hyperplasia of the stromal and epithelial cells of the prostate
how do patients with BPH usually present
- Hesitancy
- Urgency
- Frequency
- Intermittency
- Straining to void
- Terminal dribbling
- Incomplete emptying
How do you assess for BPH
urine dipstick to exclude infection of major differential
PSA done prior to rectal examination can help with assessing potential for prostate cancer
Rectal exam to asses prostate size and characteristics
What is the management of BPH
reassurance and monitoring if manageable symptoms
Medications
- alpha blockers such as tamsulosin 400 mcg
- 5-alpha reductase inhibitors which block testosterone and actually help reduce the size of the prostate Finasteride
name the 2 drugs used to treat BPH
tamulosin (alpha blocker)
Finasteride (5-alpha reductase inhibitor)
Name the surgical options for someone with BPH
transurethral resection of the prostate (TURP)
transurethral electrovapurisation of the prostate (TUVP)
holmium lase enucleation of the prostate (HoLEP)
open prostatectomy via abdominal or perineal incision
what does a transurethral resection of the prostate (TURP) involve
Accessing the prostate through the urethra and ‘shaving’ off prostate tissue from inside using diathermy
Aims to create a wider space for urine to flow through, thereby improving symptoms
what are the major complications with TURP
mnemonic is FIRES
f- failure to resolve symptoms I- incontinence R- retrograde ejectulation E- erectile dysfunction Strictures
when assessing for BPH what scoring system to used to assess for symptoms
international prostate symptom score (I-PSS) Score out of 35 1-7 mild 8-19 moderate above 20 is severe
What percentage chance is there of not detecting prostate abnormalities by rectal exam
1 in 5
To investigate for BPH the patient would have a trans-rectal ultrasound (TRUS) guided biopsy. What medication is the patient required to have and why
antibiotic beforehand to prevent infection
note there is still 2% to getting an infection
what is a transrectal ultrasound
lie on your side fully awake
urologist passes a narrow ultrasound probe into back passage
take 12 biopsies through a long narrow needle that passes through the probe itself
how is the prostate cancer graded
based on the biopsies
graded from 3-5 based on how quickly they are likely to grow or how aggressive the cells look
Gleason Grade
work out the 2 most common ones and that gives a score ranging from 6 (3+3) to 10 (5+5)
If you have prostate cancer then you stay under active surveillance with PSA tests for what period of time
every 3 months for the first year
Before commencing someone on Gentamicin what blood test do you need to do
eGFR as the dose is based on the renal function
What is the risk of having a robot assisted radical prostatectomy
10-20% risk of some degree of incontinence
50% risk of some kind of erectile dysfunction
Patients with an overactive bladder usually benefit from what kind of treatment
an anticholinergic
patients with a history of bladder outflow obstruction, what is the best management for patients with moderate symptoms
an alpha adrenoceptor blocker- tamsulosin
