CVPR First aid: renal pathology 2 Flashcards
Types of urinary incontinence
Stress incontinence
Urgency incontinence
Mixed incontinence
Overflow incontinence
Stress incontinence
Outlet incompetance (urethral hypermobility or intrinsic sphincteric deficiency) → leak with ↑ intra-abdominal pressure (eg, sneezing, lifting), ↑ risk with obesity, vaginal delivery, prostate surgery
(+) bladder stress test (directly observed leakage from urethra upon coughing or Valsalva maneuver)
Treatment of Stress incontinence
Pelvic floor muscle strengthening (Kegel exercises, weight loss, pessaries
Urgency incontinence
Overactive bladder (detrusor instability) → leak with urge to void immediately
Urgency incontinence associations
UTI
Treatment of Urgency incontinence
Kegel exercises
Bladder training (timed voiding, distraction or relaxation techniques)
Anti-muscarinics (eg, oxybutynin)
Mixed incontinence
Features of both stress and urgency incontinence
Overflow incontinence
Incomplete emptying (detrusor under activity or outlet obstruction) → leak with over-filling
Overflow incontinence associations
Polyuria (eg, diabetes)
bladder outlet obstruction (eg, BPH)
Neurogenic bladder (eg, MS)
↑ post-void residual (urinary retention on catheterization or ultrasound
Treatment of Overflow incontinence
Catheterization
Relieve obstruction (eg, α-blockers for BPH)
What is a urinary tract infection?
Inflammation of urinary bladder
Presents as suprpubic pain, dysuria, urinary frequency, urgency
Systemic signs (eg, high fever, chills) are usually absent
Risk Factors for UTI
Female
Sexual intercourse (“honeymoon cystitis”)
Indwelling catheter
Diabetes mellitus
Impaired bladder emptying
Causes of UTI
E Coli (most common)
Staphylococcus saprophyticus - seen in sexually active young women (E coli is still more common in this group)
Klebsiella
Proteus mirabilis - urine has ammonia scent
Lab findings of UTI
(+) leukocyte esterase
(+) nitrates (indicate gram (-) organisms)
Sterile Pyuria and (-) urine cultures suggest urethritis by Neisseria gonorrhoeae or Chlamydia trachomatis
UTI AKA
Urinary tract infection
