Bladder Disorders and Urinary Incontinence Flashcards
Hematuria:
- signs of glomerular bleeding
- what does the work up include?
Glomerlar bleeding signs:
- red cell casts
- dysmorphic RBC
- hematuria with proteinuria w/ a large % being albumin.
Work up: -Clean catch urine culture -urine cytology -CT urography* -US in pregos -cystoscopy (cystoscopy and CT urography are always done together)
Cystitis:
- pathogenesis
- MC pathogen
- presentation
- dx
- Tx for men and women
Pathogenesis:
-colonization of the vaginal introitus from fecal flora, ascension to the bladder via the urethra. if this ascends to the kidneys it becomes pyelonephritis
MC is e. Coli , others may include proteus and klebsiella
Presentation:
- dysuria
- frequency
- urgency
- suprapubic pain
- hematuria
- pyuria
Dx:
- UA***** (will see + leukocyte esterase/ +nitrites)
- ALL males should have a culture.
Tx: Women: -Nitrofurantoin -Bactrim -Fosfomycin -reserve FQ for severe cases such as pyelonephritis -phenozopyridine(anesthetic) MEN: -Bactrim -FQ
Pyelonephritis:
- pathogenesis?
- sx
- dx
- tx
pathogenesis: cystitis gone wrong.
Sx: chills, flank pain w/ CVA tenderness, nausea, vomiting
Dx:
- UA
- Urine culture and sensitivities
Tx:
Outpatient: FQ (Cipro or levo)** may also use bactrim or augmentin but not used often.
Inpatient: PO FQ + Aminoglycoside
Noninfectious Cystitis:
- sx
- cause
- work up
- tx
Sx: -dysuria
- frequency
- urgency
- suprapubic pain
- hematuria
- nocturia
- pressure in pelvis
Cause:
-bubble baths, feminine hygiene sprays, tampons, radiation, chemo, tomatoes, artificial sweeteners, caffeine and chocolate.
Work up:
- UA
- UC
- Sometimes cystoscopy
Tx:
- avoid irritants
- voiding routine*
- Kegels
Nongonococcal Urethritis in males:
- cause
- Manifestations
- dx
- tx
Cause: chlamydia
Manifestations:
- urethritis:asymptomatic/ symptomatic
- epididymitis: swollen, red, hot testicle
- prostatitis
Dx: NAAT testing
Tx:
rocephin and azithromycin
Gonorrhea in Males:
- manifestations
- dx
- tx
Manifestations:
- urethritis: symptomatic
- epididymitis: less than 35YO
Dx: NAAT
Tx:
- Rocephin and Azithro
- make sure to treat the partner, no sex until infection cleared, educate on safe sex, test for HIV
Overactive Bladder:
- pathophys
- presentation
- SE of medications used for tx
- MOA of medications
- tx
Pathophys: detrusor muscle contracts before bladder is filled. (irregularly at smaller volumes of urine)
-may be 2ndry to DM, stroke, spinal dz
Presentation:
- urgency
- frequency
- nocturia
SE:
-anticholinergic SE, dry mouth, constipation, blurred visiion
MOA:
-increase bladder capacity
-block basal release of ach during bladder filling
(relaxes detrusor muscle so it doesnt spams)
Tx:
- antimuscarinics such as:
- -oxybutynin (Ditropan)
- -Tolterodine (Detrol)
- -Solifenacin (Vesicare)
- Mirabegron (Mybetriq)
- SE is HTN, dry mouth, incomplete bladder emptying.
Urinary Incontinence:
-related causes of morbidity
Morbidity:
- perineal candida infection
- cellulitis/pressure ulcers
- UTI/Urospesis
- Falls/Fxs
- sleep deprivation
- psychological: poor self esteem, social withdrawal, depression, sexual dysfunction
Incontinence:
-causes
Causes: DIAPPERS -Delirium -Infection -Atrophic Vaginitis -Pharmacologic; sedatives, diuretics, anticholinergics -Psychological: depression -Excessive urine production -Restricted mobility -Stool impaction
Urge Incontinence:
- etiology
- presentation
etiology:
- uninhibited bladder contractions
- detrusor over activity
- bladder abnormalities or idiopathic
Presentation:
-sudden urge to void preceded or accompanied by leakage of urine
Stress incontinence:
-etiology
Etiology: leakage of urine with increased intra-abdominal pressure in the absence of bladder contraction (such as coughing/sneezing)
- may be d/t urethral hypermobility or intrinsic sphincter deficiency
- prostate surgery MC in men
Mixed Incontinence:
-what two types of incontinence?
What is the MC type of incontinence in women?
Mixed incontinence is urge &/or stress leakage.
MC type of incontinence in women is mixed.
Overflow incontnence:
- aka
- what is this?
- cause
aka: incomplete emptying
What is this: continuous leakage or dribbling of urine
cause:
- detruser underactivity:
- -low estrogen
- -aging
- -peripheral neuropathy
- -damage to spinal detrusor efferents (MS)
- -bladder outlet obstruction (BPH)
Nocturia:
-causes
Causes:
- CHF
- late evening beverages
- sleep apnea**
- sleep disturbances (chronic pain, depression)
- detrusor overactivity
Incontinence:
-dx tools
Dx:
-bladder diary (record time and volume of every incontinent and continent void over 42-78hrs, include activity, caffeine, sleep)
- CV, Resp, Neuro, genital, prostate exams.
- Post void residual (PVR less than 1/3 total voided volume is considered adequate voding)
- Labs: renal function, serum calcium and glucose, UA, PSA for men, B12, urine cytology if hematuria or pelvic pain
Incontinence:
- tx
- -CI?
Tx:
- lifestyle changes:
- -weight loss
- -adequate fluid intake
- -avoid caffeinated beverages and alcohol
- -minimize evening fluid for nocturia
- smoking cessation
- behavioral therapy for urge, stress, mixed:
- -bladder training
- -pelvic muscle exercises: Kegals
- -biofeedback
- -pessiaries for organ prolapse or stress incontinence.
Pharmacotherapy: (urge and mixed)
- anticholinergics w/ antimuscarinic activity:
- -oxybutinin (antispasmodic)
- -tolterodine or solifenacin
**CI with narrow angle glaucoma – anticholinergic effects.
-Miragebron (Myratriq)
Surgical therapy:
- used for stress incontinence:
- -midurethral sling
- -bladder neck sling
- -submucosal injection of urethral bulking agents (not used often)
Which one of the incontinence medications is not recommeded in patients with uncontrolled HTN? What are the SE of this medication?
Miragebron (Myratriq)
-HTN, tachycardia, urinary retention, inflammation of nasal passages, dry mouth, constipation, abd pain, memory problems.
incontinence:
- when to refer immediately
- when to elective referral
Immediate:
- incontinence w/
- -abd/pelvic pain
- -hematuria w/o UTI
- -suspected fistula
- -complex neurologic conditions
Elective:
- incontinence w/:
- -persistent sx after adequat therapeutic trial
- -uncertain dx
- -elevated PVR taht does not resolve after tx
- -prior pelvic surgery or radiation
- -desiring surgical therapy for stress incontinence
Intersitial Cystitis:
- aka
- presentation
- dx
- tx
aka: bladder pain syndrome
Presentation:
- persistant pain or unpleasant sensation with filling of the bladder that is relieved with voiding*
- gradual onset with worsening sx
- urinary frequency, urgency, nocturia
dx:
- PE: tender suprapubic area
- -dyspareunia, irritable bowel, vulvodynia
- UA/UC to r/o cancer and infection
* these unpleasant sensation associated with lower urinary tract sx of more than 6wks duration in the absence of infection or identifiable causes
Tx: 1ST LINE MANAGEMENT -educate expectations about pain relief and chronicity of condition -psychosocial support -self-care
2nd LINE MANAGEMENT:
- PT
- Meds:
- -amitriptyline
- -Pentosan polysulfate sodium (Elmiron)
- -Hydroxyzine (1st generation antihistamine)
