Chapter 29: Disorders of the Lower Urinary Tract

Question 1

Diagnostic Tests

Answer 1

• Urinalysis: for diagnosis of infection (tells pH, Ketones, bacteria, protein, and casts)
• Ultrasonography: Visualization of the Urinary System
• Fluroscopic voiding cystourethrography or radionuclide voiding cystography: used to identify refluxor urethral abnormalities
• Urodynamic testing: used for diagnosing voiding dysfunctions
• urine culture diagnoses UTI

Question 2

Post Void Residual

Answer 2

• residual urine: normally the adult bladder contains less than 50 to 100 ml following voiding
• if urine left in the bladder is over 100 ccs it is deemed urinary retention

Question 3

Incontinence

Answer 3

• report of any involuntary urine loss
• is never normal under any circumstances
• is not a normal part of aging

Question 4

Stress Incontinence

Answer 4

• occurs when urine is involuntarily lost with increases in intra-abdominal pressure
• precipitated by effort or exertion
• due to weakening of pelvic muscles or intrinsic urethral sphincter deficiency

Question 5

Urge Incontinence

Answer 5

• involuntary sudden leakage of urine along with or immediately following the sensation of a need to urinate (urgency)
• Due to an overactive detrusor muscle (muscle around bladder)
• may be idiopathic, due to bladder infection, radiation therapy, tumors or stones, or CNS damage

Question 6

Incontinence (overactive bladder syndrome and mixed incontinence)

Answer 6

• overactive bladder syndrome: urgency is associate with increased daytime frequency and nocturia, though not neccessarily with incontinence
• mixed incontinence: due to a combination of stress and urge incontinence

Question 7

Incontinence (neurologic bladder and Overflow incontinence)

Answer 7

• neurologic bladder: broad classification of voiding dysfunction in which the specific cause is a pathology that produces disruption of nervous communication governing micturition
• overflow incontinence: bladder becomes so full that it leaks urine or “overflows”
  (causes include obstruction of the urethra; underactive/inactive detrusor muscle)

Question 8

Incontinence (functional incontinence)

Answer 8

• related to physical or environmental limitations resulting in an inability to access a toilet in time

Question 9

Incontinence (Diagnosis)

Answer 9

• bladder diary, recording the time, frequency, and volume of micturtion as well as incidents of incontinence
• diagnostic tests include residual urine measurment, filling cystometry studies, and pressure flow studies during voiding

Question 10

Treatment of incontinence

Answer 10

• lifestyle changes which include weight loss, reducing caffeine intake, and avoiding constipation
• behavioral, pharmaceutical, and surgical options
• pelvic floor muscle training (for urge incontinence)
• bladder training
• medication including anticholinergic agents (oxybutynin), vaginal or oral estrogen, and alpha-adrenergic blockers (Prazosin)

Question 11

Enuresis

Answer 11

• intermittent incontinence while asleep
• inappropriate wetting of clothing or bedding
• typically refers to incontinence in children, particularly at night

Question 12

Cystis

Answer 12

• Inflammation of the bladder lining
• From infection, chemical irritants, stones, trauma
• Most cases have an infectious etiology and result from infection originating in the urethra
• Predisposing factors include female gender, increased age, catheterization, DM, bladder dysfunction, poor hygiene, and urinary stasis
• glucose in diabetics predisposes to bladder dysfunction

Question 13

Cystis (Manifestations & Symptoms)

Answer 13

• Manifestations: frequency, urgency, dysuria, suprapubic pain, and cloudy urine
• Symptoms in children include fever, irritability, poor feeding, vomiting, diarrhea, and ill appearance
• Symptoms in older adults may include lethargy, anorexia, confusion, and anxiety (confusion is first sign of infection)

Question 14

Management and Treatment of Cystis

Answer 14

• Most female patients treated based on symptoms
• Males/children/complicated cases may require urine culture and/or further assessment
• Antibiotics
• Symptomatic cystitis in elderly: managed with close drug monitoring to avoid toxicity; asymptomatic bacteriuria in elderly should not be treated

Question 15

Lower Urinary Tract Urolithiasis

Answer 15

• Stones forming anywhere in the urinary tract
• Most often caused by stones traveling to the ureters, bladder, or urethra from the kidney
• May also originate in the bladder or ureters
• Manifestations: associated with tissue irritation and obstruction
• Similar to nephrolithiasis in terms of risk factors and stone characteristics
• If infection present: treated with appropriate antimicrobials, based on culture and sensitivity tests
• For stones that do not pass spontaneously: endoscopic (transurethral) lithotripsy

Question 16

Ureterolithiasis

Answer 16

• Usually those that were able to pass through the junction of the renal pelvis and ureters
• Manifestations include ureteral colic, hematuria, tachycardia, tachypnea, diaphoresis, and N/V
• Treatment: alpha-adrenergic blockers, shock-wave lithotripsy, and ureteroscopy are first-line treatments; surgery may be needed

Question 17

Bladder (Vesical) Urolithiasis

Answer 17

• Due to stones traveling from ureters, but may form in bladder because of urinary stasis
• Manifestations: hesitancy, frequency, and dysuria; hematuria possible
• If infection: antimicrobial therapy based on culture and sensitivity
• Stones that don’t pass spontaneously may require endoscopic lithotripsy