Approach to Hematuria, Dysuria, and Nocturia Flashcards
What is a complicated UTI?
a UTI in the setting of:
pregnancy
BPH
renal falure/transplant
males
immunosupression
often pylonphritis
etc
what is an uncomplicated UTI?
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)
What is a recurrent UTI?
>2 UTIs in 6 moths or >3 infections in one year
What is the likely etiology of UTIs?
most common pathogen?
uropathogenic bacteria colonizing GI, perineium, or vagina inoculate the urethra and ascend into the bladder
E. coli
what are the common s/s of UTIs?
dysuria
frequency
urgency
What are the common s/s of pyelonephritis?
fever/chills
flank pain
CVA tenderness
fatigue
n/v, anorexia
AMS in elderly
What are some complictions of UTIs?
sepsis
AKI
perinephric abscess
emphysematous pyelonephritis
papillary necrosis
What are the two most sensitive/specific findings for UTI on a urine dipstick?
LE and nitrites
sensitivity of 75%
specificity of 82%
Which findings on a urinalysis with micro indicate a UTI?
hematuria
pyuria
WBC casts
bacteria
a true UTI will have ___ value of colony forming units per ml on urine culture ?
>10^3 CFU
Which imaging modality is often reserved for complicated UTIs?
CT ab/pelvis with and w/o IV contrast
What is the treatment for uncomplicated cystitis?
nitrofurantoin
TMP-SFX
Fosfomycin
If UTI is related to a catheter, what should be done ASAP?
remove the catheter
What is acute prostatitis vs. chronic prostatitis?
acute bacterial prostatitis lasts less than 3 months while chronic bacterial prostatitis lasts longer than 3 months
What is chronic pelvic pain syndrome?
What is asymptomatic prostatitis?
pain without infection of the prostate
infection of prostate without symptoms
What is the likely pathogen for prostatitis?
E. coli (often from urethra, but can be introduced via procedures)
What are the s/s of acute bacterial prostatitis?
acutely ill with constitutional symptoms and urinary symptoms
What are the s/s of chronic bacterial prostatitis?
more subtle, low fevers, recurrent UTIs with same bacteria in urine
pain with ejaculation or blood in semen
how is acute prostatitis diagnosed?
DRE
urinalysis and culture
consider GC/Chlamydia in high risk pts
how is chronic prostatitis diagnosed?
DRE
urinalysis and culture
prostatic massage is diagnositic standard
What is the treatment and duration for prostatitis?
Fluoroquinolones (primary tx)
can use TMP-SMX
tx for 4-6 weeks
What is the cause of BPH?
results from increased number of stromal and glandular epithelial cells within the prostate
What is the cause of Lower Urinary Tract Symptoms?
likely results from bladder outlet obstruction (BOO) from BPH and detrusor muscle overactivity secondary to BOO
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?
LUTS
storage symptoms-frequency, urgency, incontinence
voiding symptoms-slow, intermittent, split, dribbling
storage symptoms
how is BPH diagnosed?
based on h/p
may do DRE, urinalysis, BMPH, PSA, and post-void residual U/S
how will a1 blockers help BPH?
block SNS contraction of prostatic smooth muscle
improvement in 1-2 weeks
-Zosin’s
How does a 5A-reductase inhibitor help BPH?
decreases conversion of testosterone to dihydrotestosterone, thus shrinking the prostate
improvement in 6-12 months
-Steride
How do anticholinergic agents help BPH?
help overactive bladder sx and decrease bladder contraction
How do PDE5 inhibitors help BPH?
help with ED and LUTS
causes smooth muscle relaxation and ,au have antiproliferative effects in prostate and bladder SM. M.
can BPH meds be combined?
sure
What are some surgical treatments for BPH?
transurethral resection of prostate (TURP)
simple prostatectomy
what are some ddx of nocturia
urinary incontinence
diuretics
BPH
UTIs
etc
What is the liklihood of developing a second kidney stone after having a first episide?
15% at one year
35%-40% at 5yrs
50% at 10yrs
How many kidney stones are calcium based?
79.1%
What are some s/s of kidney stones
can be asymptomatic
usually symptomatic when causing obstruction
flank pain, hematuria, n/v
what is the most common imaging modality?
non contrast CT ab/pelvis
What stone cyrstal patterns can be seen on urine micro ?
cystine crystals-look like hexagons
struvite-looks like coffin lid/rectangles
What is the medical management of kidney stones?
fluids
pain control
anti-emetics
explusives (alpha blockers, CCB
what is the surgical therapy for kidney stones?
ESWL
ureteroscopy with basket stone extrusion
PUL or open neprholithotomy
fluids/meds
