Approach to Hematuria, Dysuria, and Nocturia

Question 1

What is a complicated UTI?

Answer 1

a UTI in the setting of:

pregnancy

BPH

renal falure/transplant

males

immunosupression

often pylonphritis

etc

Question 2

what is an uncomplicated UTI?

Answer 2

acute cystitis or pyelonephritis in a non pregnant outpatient woman without other issues

(some references include pyelonephritis as complicated and I think Selby does as well)

Question 3

What is a recurrent UTI?

Answer 3

>2 UTIs in 6 moths or >3 infections in one year

Question 4

What is the likely etiology of UTIs?

most common pathogen?

Answer 4

uropathogenic bacteria colonizing GI, perineium, or vagina inoculate the urethra and ascend into the bladder

E. coli

Question 5

what are the common s/s of UTIs?

Answer 5

dysuria

frequency

urgency

Question 6

What are the common s/s of pyelonephritis?

Answer 6

fever/chills

flank pain

CVA tenderness

fatigue

n/v, anorexia

AMS in elderly

Question 7

What are some complictions of UTIs?

Answer 7

sepsis

AKI

perinephric abscess

emphysematous pyelonephritis

papillary necrosis

Question 8

What are the two most sensitive/specific findings for UTI on a urine dipstick?

Answer 8

LE and nitrites

sensitivity of 75%

specificity of 82%

Question 9

Which findings on a urinalysis with micro indicate a UTI?

Answer 9

hematuria

pyuria

WBC casts

bacteria

Question 10

a true UTI will have ___ value of colony forming units per ml on urine culture ?

Answer 10

>10^3 CFU

Question 11

Which imaging modality is often reserved for complicated UTIs?

Answer 11

CT ab/pelvis with and w/o IV contrast

Question 12

What is the treatment for uncomplicated cystitis?

Answer 12

nitrofurantoin

TMP-SFX

Fosfomycin

Question 13

If UTI is related to a catheter, what should be done ASAP?

Answer 13

remove the catheter

Question 14

What is acute prostatitis vs. chronic prostatitis?

Answer 14

acute bacterial prostatitis lasts less than 3 months while chronic bacterial prostatitis lasts longer than 3 months

Question 15

What is chronic pelvic pain syndrome?

What is asymptomatic prostatitis?

Answer 15

pain without infection of the prostate

infection of prostate without symptoms

Question 16

What is the likely pathogen for prostatitis?

Answer 16

E. coli (often from urethra, but can be introduced via procedures)

Question 17

What are the s/s of acute bacterial prostatitis?

Answer 17

acutely ill with constitutional symptoms and urinary symptoms

Question 18

What are the s/s of chronic bacterial prostatitis?

Answer 18

more subtle, low fevers, recurrent UTIs with same bacteria in urine

pain with ejaculation or blood in semen

Question 19

how is acute prostatitis diagnosed?

Answer 19

DRE

urinalysis and culture

consider GC/Chlamydia in high risk pts

Question 20

how is chronic prostatitis diagnosed?

Answer 20

DRE

urinalysis and culture

prostatic massage is diagnositic standard

Question 21

What is the treatment and duration for prostatitis?

Answer 21

Fluoroquinolones (primary tx)

can use TMP-SMX

tx for 4-6 weeks

Question 22

What is the cause of BPH?

Answer 22

results from increased number of stromal and glandular epithelial cells within the prostate

Question 23

What is the cause of Lower Urinary Tract Symptoms?

Answer 23

likely results from bladder outlet obstruction (BOO) from BPH and detrusor muscle overactivity secondary to BOO

Question 24

BPH can be asymptomatic, but when symptoms are present what is it called and what are the symptoms?

which symptoms tend to be more irritating?

Answer 24

LUTS

storage symptoms-frequency, urgency, incontinence

voiding symptoms-slow, intermittent, split, dribbling

storage symptoms

Question 25

how is BPH diagnosed?

Answer 25

based on h/p

may do DRE, urinalysis, BMPH, PSA, and post-void residual U/S

Question 26

how will a1 blockers help BPH?

Answer 26

block SNS contraction of prostatic smooth muscle

improvement in 1-2 weeks

-Zosin’s

Question 27

How does a 5A-reductase inhibitor help BPH?

Answer 27

decreases conversion of testosterone to dihydrotestosterone, thus shrinking the prostate

improvement in 6-12 months

-Steride

Question 28

How do anticholinergic agents help BPH?

Answer 28

help overactive bladder sx and decrease bladder contraction

Question 29

How do PDE5 inhibitors help BPH?

Answer 29

help with ED and LUTS

causes smooth muscle relaxation and ,au have antiproliferative effects in prostate and bladder SM. M.

Question 30

can BPH meds be combined?

Answer 30

sure

Question 31

What are some surgical treatments for BPH?

Answer 31

transurethral resection of prostate (TURP)

simple prostatectomy

Question 32

what are some ddx of nocturia

Answer 32

urinary incontinence

diuretics

BPH

UTIs

etc

Question 33

What is the liklihood of developing a second kidney stone after having a first episide?

Answer 33

15% at one year

35%-40% at 5yrs

50% at 10yrs

Question 34

How many kidney stones are calcium based?

Answer 34

79.1%

Question 35

What are some s/s of kidney stones

Answer 35

can be asymptomatic

usually symptomatic when causing obstruction

flank pain, hematuria, n/v

Question 36

what is the most common imaging modality?

Answer 36

non contrast CT ab/pelvis

Question 37

What stone cyrstal patterns can be seen on urine micro ?

Answer 37

cystine crystals-look like hexagons

struvite-looks like coffin lid/rectangles

Question 38

What is the medical management of kidney stones?

Answer 38

fluids

pain control

anti-emetics

explusives (alpha blockers, CCB

Question 39

what is the surgical therapy for kidney stones?

Answer 39

ESWL

ureteroscopy with basket stone extrusion

PUL or open neprholithotomy

fluids/meds