COMMON COMPLAINTS: Dysuria and Urinary Symptoms

Question 1

Kind of incontinence you get when bladder emptyin is impaired resulting in intravesical hydrostatic pressure overcoming internal and external urinary sphincter closing

Answer 1

overflow incontinence

Question 2

incontinence triggerd by increaae in intraabsominal pressure like lifting, sneezing, or valsalva.

Answer 2

stress incontinence

Question 3

Results from urethral hypermobility caused by pelvic floor weakness, prolapse, or intrinsice spincter deficiency

Answer 3

stress incontinence

Question 4

incontinence caused by detrusor mm instability

Answer 4

urge incontinence

Question 5

6 yo w/ nighttime bed wetting despite being toilet trained for the past 2 years. No other abnormalities, fasting blood glucose 82. What is the most likely diagnosis?

Answer 5

Enuresis

Urinalysis is normally done to look for diabetic ketoacidosis, diabetes insidpidus, and UTIs. Do a thurough PE and Hx but monosymptomatic nocturnal enuresis resolves spontaneously.

Question 6

Incomplete voiding and nocturia in a 72 yo man should raise concern for…

Answer 6

BPH

Question 7

Oxybutinin, MOA

Answer 7

antimuscarinic, it acts as a competitive antagonist of acetylcholine at post ganglionic muscarinic receptors resulting in relaxation of bladder smooth muscle deminishing the frequency of unihibited contractions of the detrusor mm, decreasing urinary URGENCY and frequency

Question 8

RIsks w/oxybutinin

Answer 8

Constipation

Question 9

DM1 pt w/difficulty initating urinary stream, cough stress test is + and residual post void volume is 800ml

Answer 9

This pt likely has Overflow Incontinence secondary to neurogenic bladder from DM neuropathy

Overflow incontinence occurs when bladder emptying is impaired resulting in intravesical hydrostatic pressure overcoming internal and external urinary sphincter clising pressures thereby causes a leakage of urine

Question 10

82 yo male presenting for 8 month hx of progressive urinary frequency and decreased urinary stream. What is a very likely culprit?

Answer 10

BPH, BPH can present as dribbling and incontinence. Chronic outlet obstruction can lead to bladder diverticula formation or lead to hydronephrosis. Pts can present w/AKI.

Question 11

If you suspect BPH, what is the first test you will want to help dx?

Answer 11

Measurement of postvoid residual volume

Question 12

Treatment of urinary symptoms due to BPH

Answer 12

alpha blockers (tamsulosin), 5a-reductase inhibitors (finasteride), or surgery.