disorder of the urinary tract Flashcards
what are some examples of renal disorders?
incontinence
benign prostatic hyperplasia- men
cystisis- women
what are the two types of incontinence?
stress and urge
how to manage stress incontinence?
- pelvic floor training
- duloxetine (women) - selective serotonin and noradrenaline reuptake inhibitor, relaxes the detrusor muscle, increases external sphincter activity
- topical vaginal estrogen therapy
what could be causes of stress incontinence?
back damage to pelvis floor muscle and ligaments
Damage to bladder neck
what is management of urge incontinence?
- pelvic floor muscle training
- reduction of excessive fluid intake
- topical vaginal estrogen (female)
- M3 muscarinic receptor antagonist (males), block transmission through parasympathetic nerves which activate the detrusor muscle - solifenacin
what are examples of absorbant material for incontinence ?
incontinence pads, pull-up pants, bedding
tampons for stress incontinence (not recommended by NICE)
what are appliances for incontinence
?
sheaths, drainage systems for men, urinals
what can desmopressin in children be used for?
reduces urinating during the night
what is BPH?
prostate is enlarged and puts pressure on the urethra
symptoms: hesitation of urination, urgency, sensation bladder is never empty, frequency having to go to toilet during the night
what is the mechanism of tamsulosin?
alpha1-adrenoceptor blocker
inhibits the contraction of prostatic and bladder neck smooth muscle
increases urine flow rate and reduces other symptoms (urgency, dribbling, incomplete emptying)
does not effect prostate size, growth rate
when can tamsulosin P medicine be supplied?
- age 45-75 with symptoms for >3 mths
- no symptoms of infection or blood in urine
- no diabetes, heart, liver or kidney disease
- no postural hypotension
- no previous prostate surgery
what is a side effect of tamsulosin?
may have dizziness, fatigue, sweating due to alpha-blockage (fall in BP) - lie down
may cause retrograde ejaculation due to weak sphincter at the base of the bladder
what are examples of 5 alpha- reductase inhibitors?
finasteride, dutasteride
used if very enlarged prostate
how does 5 alpha-reductase inhibitors work?
inhibit the metabolism of testosterone to dihydrotestosterone
- DHT is a more potent driver of prostate growth than testosterone
- ARIs reduce side of prostate and can improve urine flow in 6-12 months
- may be used in combination with an alpha -blocker (eg. tamsulosin + dutasteride)
what are herbal medication that can help with LUTS?
Saw palmetto fruit and nettle root
what are surgical procedure to manage LUTS?
Transurethral resection of the prostate
- removal of prostate tissue
- retrograde ejaculation results in 90% of men
what questions would get asked if someone presented with symptoms of cystisis?
- any pain when passing urine
- any lower back pain
- any problems passing urine
- any other symptoms
- any vaginal symptoms
when should you refer to gp for cystisis?
> 5-7 days, blood in urine, fever, back pain
- new sexual partner, rash, raised warts (sexually transmitted disease?)
- thirst, weight loss, nocturia (diabetes?)
-frequent recurrence (>3 times a year) - persistent symptoms in pregnancy
- related to drug therapy
- male, child or elderly
how to manage cystisis?
- mild cases usually resolve itself
- drink plenty fluids
- avoid delayed and empty bladder completely
- wash area with water and unperfumed soap
- paracetamol may be used for mild pain
what are alkalising agents for cystisis?
- potassium or sodium citrate mixture or powders
- may relieve burning sensation
- avoid in pregnancy, renal disease
what antibacterial agents would be used for infection?
trimethoprim 200mg twice a day for 3 days
nitrofurantoin - 50mg four times a day
