Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Urology > Bladder Disorders & Urinary Incontinence > Flashcards

Bladder Disorders & Urinary Incontinence Flashcards

1
Q

Hematuria: Are there any clues in the H & P to suggest etiology?

A
  1. Gross vs. microscopic
  2. Glomerular [???] vs. nonglomerular
  3. Microscopic: transient vs. persistent
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Hematuria—nonglomerular

  1. Etiologies? 6
  2. Etiology if older than 40?
A
    • Fever,
    • vigorous exercise,
    • trauma,
    • nephrolithiasis,
    • infection,
    • prostatitis,
    • IgA nephropathy
    • Strep glomerulonephritis
  2. Bladder cancer
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Risk Factors for Malignancy

9

A
  1. Age > 35
  2. Smoking history (extent of exposure correlates w/ risk)
  3. Occupational exposure to chemicals/dyes—painter, printers
  4. History of gross hematuria
  5. History of chronic cystitis or irritative voiding symptoms
  6. History of pelvic irradiation
  7. Exposure to cyclophophamide
  8. History of chronic indwelling foreign body
  9. History of analgesic abuse (also associated increased risk of kidney cancer)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Hematuria—Work-up

6

A
  1. Urine culture—if positive treat and repeat UA
  2. Urine cytology: all w/ gross hematuria & those w/ risk factors
  3. Imaging—CT urography preferred**:
  4. US in pregnant women
  5. US, CT without contrast or MRI may be used
  6. Cystoscopy: obtaining urine for cytology just before in high risk patients
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Hematuria—Negative Work-up
1. In young and middle-age patients usually is? 2

  1. Patients at high risk for malignancy may need what? 2
  2. Signs of glomerular bleeding? 3
A
    • Mild glomerular disease (Monitor–???)
    • Predisposition to stone disease
    • Need annual UA
    • May need another work-up in 1-3 years
    • Red cell casts
    • Dysmorphic RBCs
    • Proteinuria with the hematuria with a large percentage being albumin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Pathogenesis of cystitis?

3

A
  1. Colonization of the vaginal introitus from fecal flora
  2. Ascension to the bladder via the urethra
  3. Can ascend to the kidneys causing pyelonephritis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

This route much more difficult in males—why?

A

Because of the length of the urethra

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q
  1. What is the most common pathogen in cystitis?

2. Others? 2

A
  1. E. coli
  2. Others:
    - Proteus
    - Klebsiella
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Clinical Presentation—UTI

5

A
  1. Dysuria
  2. Frequency
  3. Urgency
  4. Suprapubic pain
  5. Hematuria
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q
  1. Diagnostic tests for cystitis? 1
  2. What are we looking for?
  3. In women who the diagnosis is uncertain or resistance is a consideration what should be done?
  4. ALL males with cystitis should have what?
A
  1. UA is a must!
  2. Looking for positive leukocyte esterase and/or positive nitrites
  3. urine culture with sensitivities should be done
  4. ALL males with cystitis should have a culture
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Dx tests for pyleonephritis? 2

A
  1. UA

2. Urine culture and sensitivities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Women with Cystitis: This is Common!
1. What do we have to Rule out?

  1. Treatment? 5
A
  1. R/O vaginal source
  2. Treatment:
    - Nitrofurantoin (100 mg BID x 5 days)
    - Bactrim [Trimethoprim-Sulphamethoxazole] (1 DS BID x 3 days)
    - Fosfomycin 3 gms. X 1 dose
    - Reserve fluoroquinolones for other uses
    - Phenozopyridine (pyridium)**
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Men with Cystitis
1. Differential? 4

  1. Treatment? 3
A
  1. Differential:
    - Prostatitis
    - Urethritis secondary to STI
    - Urinary tract abnormality
    - Nephrolithiasis
  2. Treatment:
    - Trimethoprim-sulphamethoxazole (Bactrim)
    - Fluoroquinolone
    - Want to cover possible prostatitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Treatment for Pyelonephritis
1. OUtpatient? 3

  1. Inpatient? 3
A
  1. Outpatient:
    - Where fluoroquinolone resistance low use Cipro or levuoquin
    - Other: trimethoprim-sulphamethoxazole or
    - Augmentin
  2. Inpatient:
    - Oral fluoroquinolone
    - Plus aminoglycoside
    - Or extended spectrum cephalasporin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Noninfectious Cystitis

  1. How does it present?
  2. Most common in what population?
  3. Irritants? 6
A
  1. Symptoms similar to cystitis along with nocturia, Pressure in pelvis
  2. Epidemiology: women of childbearing years
  3. Irritants:
    - Bubble baths,
    - feminine hygiene sprays,
    - tampons,
    - spermicidal jellies
    - Radiation, chemo
    - Foods—tomatoes, artificial sweeteners, caffeine and chocolate
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Noninfectious Cystitis
1. Work up? 3

  1. Treatment? 3
A
  1. Work-up:
    - UA
    - Urine culture
    - Sometimes cystoscopy
  2. Treatment:
    - Avoiding irritants
    - Voiding routine**
    - Kegel’s
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Chlamydia—Male
1. It is the most common cause of what?

  1. Manifestations? 3
  2. Main symptoms? 2
A
  1. Most common cause of nongonococcal urethritis
  2. Manifestations:
    - Urethritis: symptomatic*/asymptomatic
    - Epididymitis
    - Prostatitis
  3. Symptoms—
    - dysuria,
    - thin watery sometimes scant discharge
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Chlamydia in Males
1. Dx?

  1. Tx?
A
  1. NAAT testing:
    -Some tests are expensive and don’t produce results quickly
    Xpert CT/NG assay is a NAAT provides testing in 90 minutes
  2. Treatment–1000mg of Azithromycin in one pill
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Gonorrhea in males:

  1. Presents how? 2
  2. Dx? 2
  3. Tx?
A
    • Urethritis—symptomatic
    • Epididymitis—age less than 35years
    • NAAT testing of urine or swab
    • GS showing PMNs with gram neg diplococci
  3. ceftriaxone 250 mg intramuscularly in a single dose
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Gonorrhea most common symptoms?

2

A
  1. Dysuria and

2. copious amounts of purulent discharge

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the difference between a normal bladder and an overactive bladder?

A
  1. Normal- detrusor muscle contracts with a full bladder

2. Overactive- Detrusors muscle contacts before bladder is filled

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Overactive bladder Without Incontinence
1. Presentation? 3

  1. PP? 1
  2. Causes? 4
A
  1. Presentation:
    - Urgency
    - Frequency
    - Nocturia
  2. Pathophysiology:
    - Detruser muscle contracts irregularly at smaller volumes of urine
  3. -Usually idiopathic
    Can be secondary to
    -DM,
    -stroke,
    -spinal disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Treatment of OAB

  1. Antimuscarinics SE? 5
  2. MOA? 2
  3. Agents? 3
A
  1. SE:
    - Dry mouth,
    - constipation,
    - blurry vision,
    - confusion,
    - drowsiness
  2. Mechanism:
    - Increase bladder capacity
    - Block basal release of acetyl choline during bladder filling
  3. Agents:
    - Oxbutynin (Ditropan)
    - Tolterodine (Detrol)
    - Solifenacin (Vesicare)—once a day
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Treatment of OA- New Agent?

A

Mirabegron (Myrbetriq)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Mirabegron (Myrbetriq)

  1. MOA?
  2. SE? 3
A
  1. Beta 3-adrenoceptor agonist
    - Can use alone or with other agents
  2. SE:
    - HTN**
    - Incomplete bladder emptying
    - Dry mouth
26
Q

Urinary Incontinence: types? 3

A
  1. Stress
  2. Urge
  3. Overflow
27
Q

Medical Morbidity of urinary incontinece?

6

A
  1. Perineal candida infection
  2. Cellulitis and pressure ulcers
  3. UTIs and urosepsis
  4. Falls & fractures from slipping on urine
  5. Sleep interruption and deprivation
  6. Psychologically: poor self esteem, social withdrawal, depression and sexual dysfunction
28
Q

Pathophysiology: Continence depends on what? 2

A
  1. Intact micturition physiology

2. Intact functional ability to toilet oneself

29
Q

Risk factors for urinary incontinece?

12

A
  1. Obesity
  2. Functional impairment
  3. Parity
  4. Family history
  5. Smoking
  6. Age
  7. diabetes,
  8. stroke,
  9. depression,
  10. estrogen depletion,
  11. genitourinary surgery,
  12. radiation

Non-Hispanic white women higher rates than non-Hispanic Black and Hispanic women

30
Q

Transient causes
of Urinary incontinence?
DIAPPERS

A

Delirium

Infection

Atrophic vaginitis

Pharmacoloic: sedatives, diuretics, anticholinergics

Psychological: depression

Excessive urine production (?)

Restricted mobility

Stool impaction

31
Q

Screening Tool for urinary incontience: Questions?

4

A
  1. In the past three months: have you leaked urine?
  2. Which precipitants led to leakage?
  3. Which precipitant caused leakage most often?
  4. Do you ever wear pads, tissue or cloth in your underwear to catch urine?
32
Q

Urge Incontinence
1. Etiologies? 3

  1. Presentation? 4
A
  1. Etiology:
    - Uninhibited bladder contractions
    - Detrusor over activity
    - May be due to bladder abnormalities or idiopathic
  2. Presentation
    - Sudden urge to void
    - Preceded or accompanied by leakage of urine
    - More common in older women
    - Also seen in men
33
Q
  1. Stress Incontinence is what?
  2. It is important to know what about the timing of the incontinence?
  3. Occurs in what age?
  4. Due to? 2
  5. What is the most common cause in men?
A
  1. Leakage of urine with increased intra-abdominal pressure in the absence of a bladder contraction:
  2. It is important to determine if leakage occurs coincident or several seconds after a cough++
  3. Occurs in younger women
  4. Due to:
    - Urethral hypermobility
    - Intrinsic sphincter deficiency
  5. Prostate surgery most common cause in men**
34
Q

Mixed Incontinence

  1. Most common type in who?
  2. What is it?
A
  1. Most common type in women

2. Patients vary in predominance and/or bother of urge or stress leakage

35
Q

Incomplete Emptying (Overflow Incontinence)

  1. Preferred term?
  2. What is it?
  3. Due to? 2
A
  1. Preferred term is: incomplete bladder emptying
  2. Continuous leakage or dribbling of urine
  3. Due to:
    - Detruser underactivity
    - Bladder outlet obstruction
36
Q

Detrusor underactivity is due to what?

4

A
  1. Low estrogen
  2. Aging
  3. Peripheral neuropathy (due to DM, B12 etc)
  4. Damage to the spinal detrusor efferents (MS)
37
Q

Nocturia: Possible etiologies? 5

A
  1. CHF—fluid redistribution form pedal edema
  2. Late evening beverages
  3. Sleep apnea
  4. Sleep disturbances—chronic pain, depression
  5. Detrusor overactivity
38
Q

Diagnostic Tool: Nocturia?

A

Bladder diary:

  • Record time & volume of every continent and incontinent void over 42 to 78 hours
  • Other pertinents include: activity, Caffeine intake, hours of sleep, episodes of nocturia etc.
39
Q

Physical exam for incontience?

4

A
  1. Neurologic conditions
  2. In women thorough genital exam:
    3, In males exam of the prostate
  3. Older persons: cognitive & functional status, including mobility, manual dexterity, depression screening looking for “functional incontinence”
40
Q

Physical exam for incontience: What should we check for in women in the genital exam?
2

A
  1. Check for cystocele/rectocele, atrophy

2. Have the patient cough looking for leakage of urine (standing!)*

41
Q

Post-Void Residual

  1. What is it?
  2. What is considered adequate emtying?
A
    • Have patient void until they feel they have emptied their bladder completely
    • Then do bladder ultrasound or clean cath
  2. PVR
42
Q

Labs for incontience?

7

A
  1. Renal function
  2. Serum calcium, and
  3. Serum glucose
  4. UA
  5. Those with increased post-void residual—B12, etc.
  6. PSA for men if indicated
  7. Urine cytology if there is hematuria or pelvic pain
43
Q

Lifestyle treatment of incontinence? 5

A
  1. Weight loss
  2. Adequate, but not excessive fluid intake (2 L)
  3. Avoid caffeinated beverages and alcohol
  4. Minimize evening fluid intake for nocturia
  5. Smoking cessation
44
Q

Treatment: Behavioral therapy: for urge, stress and mixed?

4

A
  1. Bladder training: (Frequent voluntary voiding and relaxation techniques for urge incontinence)
  2. Pelvic muscle exercises: Kegels
  3. Biofeedback
  4. Pessiaries for organ prolapse or stress incontinence
45
Q

Pharmacotherapy: Used for urge & mixed if behavioral alone is not successful?

A
  1. Anticholinergics w/ antimuscarinic activity

2. Oxybutynin (Ditropan): IR, ER, Patch

46
Q

Anticholinergics w/ antimuscarinic activity

  1. MOA?
  2. Which drugs? 2
  3. SE? 5
  4. CI?

Oxybutynin (Ditropan): IR, ER, Patch

  1. MOA?
  2. Advantage?
A

Anticholinergics w/ antimuscarinic activity

  1. Increase bladder capacity
    • Tolterodine (Detrol LA),
    • Solifenacin (Vesicare)
  3. SE:
    - dry mouth,
    - blurred vision,
    - constipation,
    - drowsiness,
    - decreased cognitive function
  4. CI: Narrow angle glaucoma

Oxybutynin (Ditropan): IR, ER, Patch
5. Direct antispasmodic effect on detrusor muscle

  1. Less SE although dry mouth still prominent
47
Q

New Pharmacotherapy: Miragebron (Myratriq)

  1. Causes what?
  2. Helps which incontinence types?
  3. SE? 8
  4. Not reccommended for who?
A
  1. Causes bladder relaxation
  2. Help urge and mixed incontinence
  3. SE:
    - HTN,
    - tachycardia,
    - urinary retention (infection),
    - inflammation of the nasal passages,
    - dry mouth,
    - constipation,
    - abdominal pain, and
    - memory problems
  4. NOT recommended for patients with uncontrolled HTN
48
Q
  1. Surgical Therapy for what kind of incontinence?
  2. How successful?
  3. Which type of approaches?
  4. Vaginal includes? 3
A
  1. Used for stress incontinence
  2. High rate of success
  3. Abdominal or vaginal approaches
  4. Vaginal include:
    - Midurethral sling
    - Bladder neck sling
    - Submucosal injection of urethral bulking agents
49
Q

Surgery Using Mesh

  1. Explain this?
  2. Mesh related complications? 7
A
  1. Synthetic mesh kits were frequently used for repair of stress incontinence and pelvic floor prolapse
  2. Mesh related complications:
    - Mesh exposure (erosion)
    - Dyspareunia
    - Infection
    - Urinary problems
    - Bleeding
    - Organ perforation
    - Deaths associated w/ bowel perforation or hemorrhage
50
Q

The selected procedure for SUI is a what?

A

mesh midurethral sling

51
Q

Incontinence: When to Refer Immediately

5

A
  1. Incontinence w/ abdominal and/or pelvic pain
  2. Hematuria in the absence of UTI
  3. Suspected fistula
  4. Complex neurological conditions
  5. Abnormal findings
52
Q

Elective Referral for incontinence?

5

A
  1. Persistent symptoms after adequate therapeutic trial
  2. Uncertainty in diagnosis
  3. Significantly elevated PVR that does not resolve after treatment of possible precipitants
  4. Prior pelvic surgery or pelvic irradiation
  5. Desiring surgical therapy for stress incontinence
53
Q

Interstitial Cystitis (IC)

  1. AKA?
  2. Usually dx in what demographic of people? 2
A
  1. Also known as—bladder pain syndrome (BPS)
  2. Epidemiology:
    - Usually diagnosed in the 4th decade or later
    - Female to male ratio—5:1
54
Q

IC/BPS Presentation

  1. Presistant feature?
  2. Progression?
  3. May have other urinary symptoms? 3
A
  1. Persistent feature: pain or “unpleasant” sensation with filling of the bladder—relieved with bladder voiding
  2. Gradual onset w/ worsening symptoms
  3. May have other urinary symptoms:
    - Urinary frequency
    - Urgency
    - Nocturia
55
Q

Diagnosis for Interstitial Cystitis (IC)?

4

A

Thorough PE:

  1. Patient usually has a tender suprapubic area
  2. May have other pain conditions such as dyspareunia, irritable bowel, vulvodynia
  3. UA and
  4. culture to r/o cancer and infection
56
Q

Definition of IC/BPS

A

“An unpleasant sensation (pain, pressure, discomfort) perceived to be related to the urinary bladder, associated with lower urinary tract symptoms of more than 6 weeks duration, in the absence of infection or other identifiable causes.”

57
Q

IC Management—1st Line

3

A
  1. Patient education noting reasonable expectations about pain relief and chronicity of condition
  2. Psychosocial support
  3. Self-care and behavior modification
58
Q

IC Management—2nd Line

  1. Used for which pts?
  2. Meds? 3

REFERRAL

A
  1. PT—for those patients w/ pelvic muscle pain
  2. Meds:
    - Amitriptyline–TCA
    - Pentosan polysulfate sodium (PPS) [Elmiron]
    - Hydroxyzine–Antihistamine
59
Q

Pentosan polysulfate sodium (PPS) [Elmiron] MOA?

A
  • It concentrates in the bladder

- Proposed mechanism is reconstitutes deficient protective glycosaminoglycan layer over the urothelium

60
Q

Always rule out cancer when what is present?

Always ask appropriate patients about symptoms of incontinence

A

painless hematuria

Urology (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions