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UROLOGY > BLADDER DISORDERS / UNARINY INCONTINENCE > Flashcards

BLADDER DISORDERS / UNARINY INCONTINENCE Flashcards

1
Q

Does the hematuria represent glomerular or nonglomerular bleeding?

A

RBC casts = glomerular bleeding

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2
Q

glomerular bleeding

A

⦁ RBC casts
⦁ dysmorphic RBCs
⦁ proteinuria with the hematuria, with a large percentage being albumin

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3
Q

urine centrifuge

A

if sediment red = hematuria

if supernatant red = dipstick heme
⦁ dipstick heme negative = beets, phenazopyridine, porphyria, other
⦁ dipstick heme positive = myoglobin or hemoglobin
- if plasma color is clear = myoglobinuria
- if plasma color is red = hemoglobinuria

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4
Q

risk factors for malignancy

A

Age > 35
Smoking history (extent of exposure correlates w/ risk)
Occupational exposure to chemicals/dyes—painter, printers
History of gross hematuria
History of chronic cystitis or irritative voiding symptoms
History of pelvic irradiation
Exposure to cyclophosphamide
H/O urologic disorder BPH, nephrolithiasis, etc.
History of chronic indwelling foreign body
History of non-narcotic analgesic abuse (also associated increased risk of kidney cancer)

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5
Q

HEMATURIA WORKUP

A

Urine culture & UA in all pts with hematuria
Uriny cytology no longer needed

IMAGING = CT urography = preferred (contrast)
⦁ pregnant = US
⦁ can do US, CT without contrast, or MRI if dye from CT not tolerated

Cystoscopy

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6
Q

what imaging is preferred for hematuria

A

CT UROGRAPHY*** (same as CT IVP)

if pregnant = US
if can’t have dye = US, CT w/o contrast, or MRI

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7
Q

DO NOT SCREEN FOR HEMATURIA IN

A

ASYMPTOMATIC PATIENTS

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8
Q

In young & middle age-patients; usually hematuria is

A

mild glomerular disease

monitor GFR, creatinine, and BP***

are predisposed to stones

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9
Q

most common pathogen of UTI

A

E.coli

others
proteus & klebsiella

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10
Q

UTI PRESENTATION

A 
⦁	dysuria
⦁	frequency
⦁	urgency
⦁	suprapubic pain
⦁	hematuria
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11
Q

pyelonephritis presentation

A
  • symptoms of cystitis may or may not be present with pyelonephritis
  • chills
  • flank pain with costovertebral angle tenderness
  • Nausea & Vomiting
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12
Q

diagnostic tests for cystitis & pyelonephritis

A

CYSTITIS

  • UA is a MUST! - look for positive leukocytes and/or positive nitrites
  • if uncertain about diagnosis or resistance is possible = do urine culture
  • ALL MALES with cystitis = need a culture

FOR PYELONEPHRITIS

  • UA
  • urine culture & sensitivity
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13
Q

treatment for women with cystitis

A

⦁ Nitrofurantoin = 1st
⦁ Bactrim = 2nd
⦁ can give phenozopyridine (pyridium) - analgesic agent for dysuria- turns urine dark orange

-reserve fluoroquinolones for other uses in case resistance is built

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14
Q

treatment for men with cystitis

A

⦁ Bactrim
⦁ Fluoroquinolone
- want to cover possible prostatitis (also treat with either bactrim or cipro for acute or chronic)
- men = usually have longer lengths of abx

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15
Q

outpatient treatment of pyelonephritis

A

fluoroquinolones (cipro or levo) if resistance is low

others = Bactrim or augmentin

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16
Q

inpatient treatment of pyelonephritis

A

oral fluoroqinolone + aminoglycoside

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17
Q

non-infectious cystitis

A
  • similar symptoms to cystitis + nocturia & pressure in pelvis
  • in women of childbearing years

IRRITANTS = bubble baths, feminine hygiene sprays, tampons, spermicidal jellies, radiation, chemo, foods (tomatoes, artifical sweeteners, caffeine, chocolate)

WORK UP

  • UA
  • urine culture
  • sometimes cystoscopy

TREATMENT

  • avoid irritants
  • voiding routine**
  • kegel’s
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18
Q

Most common cause of nongonococcal urethritis

A

chlamydia

tx = azithro

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19
Q

overactive bladder

A

detrusor muscle contracts before bladder is filled

presentation =
Urgency
Frequency
Nocturia

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20
Q

tx of overactive bladder

A

ANTIMUSCARINICS (anticholinergics)
MOA = Block basal release of acetyl choline during bladder filling & increases bladder capacity

Oxybutynin (Ditropan)
Tolterodine (Detrol)
Solifenacin (Vesicare)—once a day
(others = 2-3x/day)

SE = dry eyes, constipation, dry mouth

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21
Q

pathophys of overactive bladder without incontinence

A

Detruser muscle contracts irregularly at smaller volumes of urine

Usually idiopathic

Can be secondary to DM, stroke, spinal disease

22
Q

new agent for overactive bladder

A

Mirabegron (Myrbetriq)
Beta 3-adrenoceptor agonist - relaxes detrusor muscle

SE
HTN**
Incomplete bladder emptying
Dry mouth

23
Q

do not give mirabegron to a pt with

A

uncontrolled HTN

24
Q

RISK FACTORS FOR INCONTINENCE

A 
⦁	Obesity
⦁	Functional impairment
⦁	Parity
⦁	Family history
⦁	Smoking
⦁	Age
⦁	Others: diabetes, stroke, depression, estrogen depletion, genitourinary surgery, radiation
⦁	Non-Hispanic white women higher rates than non-Hispanic Black and Hispanic women
25
Q

CAUSES OF INCONTINENCE = DIAPPERS

A 
⦁	Delirium
⦁	Infection
⦁	Atrophic vaginitis
⦁	Pharm: sedatives, diuretics, anticholinergics
⦁	Psychological: depression
⦁	Excessive urine production
⦁	Restricted mobility
⦁	Stool impaction
26
Q

detrusor over-activity = __________ incontinence

A

urge

27
Q

URGE INCONTINENCE

A

Uninhibited bladder contractions
Detrusor over activity
May be due to bladder abnormalities or idiopathic

Presentation
Sudden urge to void
Preceded or accompanied by leakage of urine
More common in older women
Also seen in men
28
Q

Leakage of urine with increased intra-abdominal pressure in the absence of a bladder contraction:

A

STRESS INCONTINENCE

It is important to determine if leakage occurs coincident or several seconds after a cough++

Occurs in younger women

Due to:
Urethral hypermobility
Intrinsic sphincter deficiency

29
Q

due to Intrinsic sphincter deficiency

A

stress incontinence

30
Q

= MOST COMMON CAUSE OF STRESS INCONTINENCE IN MEN

A

PROSTATE SURGERY

31
Q

Most common type of incontinence in women

A

MIXED INCONTINENCE

32
Q

INCOMPLETE BLADDER EMPTYING = OVERFLOW INCONTINENCE

A
  • continuous leakage/dribbling of urine

due to detrusor underactivity (occurs with low estrogen, aging, peripheral neuropathy - DM, MS) or bladder outlet obstruction (BPH / stones)

33
Q

detrusor underactivity

A

incomplete bladder emptying = overflow incontinence

34
Q

possible etiologies of nocturia

A
  • possible etiologies
    ⦁ CHF—fluid redistribution form pedal edema
    ⦁ Late evening beverages
    ⦁ Sleep apnea****
    ⦁ Sleep disturbances—chronic pain, depression
    ⦁ Detrusor overactivity
35
Q

PVR for incontinence

A

Have patient void until they feel they have emptied their bladder completely

Then do bladder ultrasound or clean cath

PVR < 1/3 the total voided volume is considered adequate emptying

36
Q

labs for incontinence

A

Renal function
Serum calcium, and glucose
UA
Those with increased post-void residual—B12, etc.
PSA for men if indicated
Urine cytology if there is hematuria or pelvic pain

37
Q

lifestyle & behavioral treatment

A

Lifestyle:
Weight loss
Adequate, but not excessive fluid intake (2 L)
Avoid caffeinated beverages and alcohol
Minimize evening fluid intake for nocturia
Smoking cessation

Behavioral therapy: for urge, stress and mixed:
Bladder training:
- Frequent voluntary voiding
- Relaxation techniques for urge incontinence
Pelvic muscle exercises: Kegels
Biofeedback
Pessaries for organ prolapse or stress incontinence

38
Q

rx therapy for incontinence = for urge & mixed

A

Anticholinergics w/ antimuscarinic activity
Increase bladder capacity

Tolterodine (Detrol LA), Solifenacin (Vesicare)

SE: dry mouth, blurred vision, constipation, drowsiness, decreased cognitive function

CI: Narrow angle glaucoma

39
Q

CI to anticholinergics with antimuscarinic activity = increase bladder capacity and relaxes the bladder

A

narrow angle glaucoma

40
Q

which anticholinergic med for incontinence has Less SE although dry mouth still prominent

A

oxybutynin (Ditropan) = ER & Patch

Direct antispasmodic effect on detrusor muscle

41
Q

newer agent for incontinence

A

Miragebron (Myratriq)

Causes bladder relaxation…..? works on alpha receptors, which are in the internal sphincter -
Help urge and mixed incontinence
SE: HTN, tachycardia, urinary retention (infection), inflammation of the nasal passages, dry mouth, constipation, abdominal pain, and memory problems
NOT recommended for patients with uncontrolled HTN

42
Q

Mirabegron = NOT recommended for patients with uncontrolled

A

HTN

43
Q

surgery = used for ________ incontinence

A

stress

44
Q

The selected procedure for SUI (stress urinary incontinence)

A

mesh midurethral sling

45
Q

when to refer immediately for incontinence

A 
Incontinence w/ abdominal and/or pelvic pain
Hematuria in the absence of UTI
Suspected fistula
Complex neurological conditions
Abnormal findings
46
Q

INTERSTITIAL CYSTITIS

A

also known as BPS = Bladder Pain Syndrome

  • usually presents in 4th decade or later
  • much more common in women
47
Q

Persistent feature: pain or “unpleasant” sensation with filling of the bladder—relieved with bladder voiding

A

interstitial cystitis

Gradual onset w/ worsening symptoms

May have other urinary symptoms:
Urinary frequency
Urgency
Nocturia

48
Q

DIAGNOSIS OF INTERSTITIAL CYSTITIS

A
  • thorough PE - pt usually has a tender suprapubic area
  • may have other pain conditions, such as dyspareunia, irritable bowel, vulvodynia
  • do UA & culture to r/o cancer and infection
49
Q

TREATMENT OF INTERSTITIAL CYSTITIS

A

1st line = Management; patient education about pain relief & chronicity of condition; psychosocial support. self-care & behavioral modification
- very difficult to manage; basically a chronic pain condition

2nd line = PT - for those pts with pelvic muscle pain
- Meds
⦁ Amitryptiline
⦁ PPS (Elmiron) = Pentosan polysulfate sodium = concentrates in the bladder and has a protective layer over urothelium
⦁ Hydroxyzine = antihistamine - makes you sleepy

50
Q

MEDS THERAPY FOR INTERSTITIAL CYSTITIS

A

amitryptiline
PPS
hydroxyzine

UROLOGY (12 decks)

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