Dysuria and Urinary Frequency Flashcards
characterised mainly by urethral and suprapubic
discomfort, indicates mucosal inflammation of the
lower genitourinary tract (i.e. the urethra, bladder
or prostate).
Dysuria
_________ difficult and painful micturition with
associated spasm
Strangury
________usually causes pain at the onset of
micturition
Urethritis
________usually causes pain at the end of
micturition
Cystitis
Suprapubic discomfort is a feature of ______
bladder infection (cystitis
_______(e.g. prostatic cancer) cause
severe dysuria, pneumaturia and foul-smelling
urine.
Vesicocolonic fistulas
Dysuria and frequency are most common in women
aged _______
15 to 44 years
Dysuria and discomfort is a common feature
of postmenopausal syndrome, due to __________ The urethra and lower bladder are oestrogen-dependent
atrophic urethritis.
Unexplained dysuria could be a pointer to
________
Chlamydia urethritis
________ is the most
common cause of dysuria in the adolescent age group
and is a relatively common cause of dysuria in family
practice, estimated at around 15%
Vaginitis
Small amounts of blood _________ can
produce macroscopic haematuria
(1 mL/1000 mL urine)
Microscopic haematuria includes the presence
of red blood cells (RBC) >8000 per mL of urine
_________ or >2000 per mL of
urine_________ representing the occasional
RBC on microscopic examination
(phase contrast microscopy)
light microscopy
Joggers and athletes engaged in very vigorous
exercise can develop_______
transient microscopic
haematuria.
What are the 2 types of microscopic hematuria
glomerular (from kidney parenchyma):
non-glomerular (urological):
Microscopic hematura:
common causes are IgA nephropathy and thin
membrane disease
glomerular
Microscopic hematura:
__________: the common
causes are bladder cancer, benign prostate
hyperplasia and urinary calculi
non-glomerular (urological)
Macroscopic haematuria occurs in 70% of people
with________ and 40% with__________
bladder cancer
kidney cancer
Massive haematuria is a feature of _______
radiation cystitis
______ can occur as a manifestation of nephritis
and may be a feature of bleeding in cancer of the
kidney or polycystic kidney.
Loin pain
It is worth noting that _________
secondary to prostatic enlargement located at the
bladder neck, may rupture when a man strains to
urinate.
large prostatic veins,
Urine microscopy:
— formed RBCs in true haematuria
— red cell casts indicate _______
— deformed (dysmorphic) red cells indicate glomerular bleeding
glomerular bleeding
this test, performed on a urine
sample, may be useful to detect malignancies
of the bladder and lower tract but is usually
negative with kidney cancer
Urinary cytology
What are the radiological techniques to assess urinary tract
— intravenous urography (IVU); intravenous
pyelogram (IVP)—the key investigation
— ultrasound (less sensitive at detecting LUT
abnormalities)
— CT scanning
— kidney angiography
— retrograde pyelography
In all patients, regardless of the IVU findings,
________is advisable
cystoscopy
________indicated if glomerular disease
is suspected, especially in the presence of
dysmorphic red cells on microscopic
examination.
Kidney biopsy:
________ is red urine caused by pigments
other than red blood cells that simply stain the
culture red
Pseudohaematuria
Causes of pseuohematuria
• anthocyanins in food (e.g. beetroot, berries)
• red-coloured confectionery
• porphyrins
• free haemoglobin (e.g. haemoglobinuria)
• myoglobin (red-black colour)
• drugs (e.g. pyridium, phenolphthalein—alkaline
urine)
________ is the passage of a
significant number of red cells in the urine during
or immediately after heavy exercise.
Exercise or sports haematuria
What is the theory of the cause of exercise hematuria?
largely caused by the posterior wall of the bladder
impacting repetitively on the base of the bladder
during running
Macroscopic haematuria is a common presenting ploy
of people with _________ and ___________simulating kidney colic.
Munchausen syndrome
pethidine
addicts
This is a benign granulomatous tumour about the
size of a pea in the distal urethra. Almost exclusive
to post-menopausal women, it is very tender and
bleeds easily.
Urethral caruncle
Main Sx of Urethral caruncle
The main symptom is haematuria
Dx of Urethral caruncle
may require cystoscopy and biopsy for diagnosis
Tx of Urethral caruncle
Treatment includes warm salt baths and oestrogen
creams
Bladder cancer is the seventh most common
malignancy, with 90% being_______
transitional cell
carcinomas
Most important RF for bladder CA
Smoking is the most
common association.
Gold standard for dx of bladder CA
IVU is the gold standard
The common bladder carcinoma in situ is treated with
_____________. This 6-week
course and follow-up if necessary leads to
60–75% remission
intravesical BCG immunotherapy
Other intravesical agents used include various
cytotoxics (___________
e.g. mitomycin C)
_________ means kidney inflammation
involving the glomeruli
Glomerulonephritis
____________: oedema + hypertension
+ haematuria
nephritic syndrome
_______ oedema + hypoalbuminaemia
+ proteinuria
nephrotic syndrome:
The main causes of glomerulonephritis–nephritic
syndrome are
• IgA nephropathy (commonest) • thin glomerular basement membrane disease (has an AD genetic link) • post-streptococcal glomerulonephritis • systemic vasculitis
Typically presents as haematuria in a young male
adult at the time of or within 1–2 days of a mucosal
infection (usually throat, influenza or URTI) and
persists for several days
IgA nephropathy
Typically seen in children (>5 years), especially in
Indigenous communities following GABHS throat
infection or impetigo. Presents after a gap of 7–10
days or so.
Acute post-streptococcal
glomerulonephritis
SSx of PSGN
- Haematuria: discoloured urine (‘Coke’ urine)
- Peri-orbital oedema (may be legs, scrotum)
- Rapid weight gain (from _________)
- Scanty urine output (oliguria)
- ________→ may be complications
oedema
Hypertension
What is the usual course of PSGN
- Oliguria ______ days
- Oedema and hypertension ______days
- Invariably resolves
- _________prognosis
2
2–4
Good long-term
Dx of PSGN
• GABHS antigens
• Blood urea, creatinine, C 3&4 (complement),
ASOT, DNase B
Tx of PSGN
- Strict fluid balance chart
- Daily weighing
- Penicillin (if GABHS + ve)
- Fluid restriction
- Low protein, high carbohydrate, low salt diet
- Antihypertensives and diuretics (as necessary)
discoloured urine + peri- orbital
oedema + oliguria _________
post-streptococcal
glomerulonephritis
Proteinuria is an important and common sign of
kidney disease. The protein can originate from the
____________
glomeruli, the tubules or the LUT
The amount of protein in the urine is normally less
than_______
100 mg/24 hours
Greater than__________mg/24 hours is abnormal for
children and adults
300
Proteinuria_________/24 hours indicates a serious
underlying disorder.
> 1 g
Routine dipstick testing will only detect levels
greater than __________hours and thus has
limitations
300 mg/24
In diabetics, microalbuminuria is predictive of
nephropathy and an indication for ______
early blood
pressure treatment
If proteinuria is confirmed on repeated dipstick
testing it should be measured more accurately
by measuring _______ with a
24-hour urine or the ________
which is preferred
daily albumin excretion
albumin creatinine ratio (ACR),
Nephrotic range proteinuria __________
is due to one or other form of glomerulonephritis in
over 90% of patients.
(>3 g/24 hours)
_________ is the presence of significant
proteinuria after the patient has been standing
but is absent from specimens obtained following recumbency for several hours, such as an early
morning specimen
Orthostatic proteinuria
The presence of protein in the urine is a sensitive
marker of ___________ so regular screening
for microalbuminuria in diabetics is regarded as
an important predictor of nephropathy and other
possible complications of diabetes
diabetic nephropathy,
The use of ________at the microalbuminuria stage may slow
the development of overt nephropathy
ACE
inhibitors
Gold standard of overt nephropathy
The gold
standard is a 24-hour collection
While proteinuria is usually simply a marker of
kidney disease, heavy proteinuria in excess of
3 g/24 hours may have severe clinical consequences,
including
oedema, intravascular volume depletion,
venous thromboembolism, hyperlipidaemia and
malnutrition
_________is the
commonest cause of the nephrotic syndrome in
childhood and accounts for about 30% of adult
nephrotic syndrome
Minimal change glomerulonephritis
Tx of MCD
steroid
proteinuria + generalised oedema
+ hypoalbuminaemia
nephrotic syndrome
Dx of NS
- Proteinuria________ g/day (3–4 on dipstick)
- Hypoalbuminaemia _______ g/L
- Hypercholesterolaemia ______ mmol/L
> 3
<30
> 4.5
BP of NS
N
Causes of NS in 2/3 of cases
2 in 3 (approx.):
— idiopathic nephrotic syndrome (based on
kidney biopsy)
— minimal change disease (commonest)
— focal glomerular sclerosis
— membranous nephropathy
— membranoproliferative glomerulonephritis
Medical Tx of NS
- Diuretics
- Prednisolone
- Phenoxymethylpenicillin
- Aspirin
Loss of urine secondary to
factors extrinsic to the urinary tract
Functional incontinence
(or bed-wetting) Involuntary urine
loss during sleep
Nocturnal enuresis
The commonest cause of urge incontinence; synonymous
with an irritable or unstable bladder; characterised
by involuntary bladder contractions, resulting in a
sudden urge to urinate
Overactive bladder (detrusor instability
Escape of urine following poor bladder emptying.
Overflow incontinence
An urgent desire to void followed by involuntary loss of urine
Urge incontinence
The involuntary loss of urine during the day or night
Urinary incontinence
Includes urinary difficulties, detrusor instability and overflow incontinence
Voiding dysfunction
What is the cause?
Simple stress incontinence (with cough/sneeze
Sphincter incompetence
What is the cause?
Urge incontinence Giggle incontinence Stress and urge incontinence Enuresis Complex stress incontinence (with exercise)
Unstable bladder, with or without sphincter weakness
What is the cause?
Quiet dribble incontinence
Sphincter incompetence and unstable bladder or overflow
What is the cause?
Continuous leakage
Fistula, ectopic ureter, patulous urethra
What is the cause?
Reflex incontinence
Neuropathic bladder
The basic requirements for continence are:
- adequate central and peripheral nervous function
- an intact urinary tract
- a compliant stable bladder
- a competent urethral sphincter
- efficient bladder emptying
The most common contributing factor to urinary incontinence is:
weakness of the pelvic floor muscles
Drugs that cause Bladder relaxants → overflow incontinence
- anticholinergic agents
* tricyclic antidepressants
Drugs that cause Bladder stimulants → urge incontinence
- cholinergic agents
* caffeine
Sedatives that cause urge incontinence
- antidepressants
- antihistamines
- antipsychotics
- hypnotics
- tranquillisers
These may be worth a trial for bladder instability or
voiding dysfunction
- solifenacin 5–10 mg (o) daily
- propantheline 15 mg (o) bd or tds
- oxybutynin 2.5–5 mg (o) bd or tds
- tolterodine 2 mg (o) bd
- imipramine 10–75 mg (o) nocte
The main complaint is of ‘heaviness’
in the vagina and a sensation of ‘something coming
down’. Relevant symptoms that are of considerable
distress for the patient and, depending on the type of
prolapse, include voiding difficulties, urinary stress
incontinence, faecal incontinence, incomplete rectal
emptying and recurrent cystitis
Uterovaginal prolapse
Classification of prolapse:
• ________—bladder descends into vagina
• ________—urethra bulges into vagina
• ________—rectum protrudes into vagina
• ___________—loop of small intestine bulges into
vagina (usually posterior wall)
__________—uterus and cervix descend toward
vaginal introitus:
Cystocele
Urethrocele
Rectocele
Enterocele
Uterine
What are the degrees of prolapse?
— first degree—__________
— second degree—__________
— third degree (procidentia)—_______
cervix remains in vagina
cervix protrudes on
coughing/straining
uterus lies outside vagina
Management of prolapse
Pessaries are an option for those who are poor
anaesthetic risks, too frail for surgery, don’t want
surgery, are young and have not completed their
family or are awaiting surgery.
Ring pessaries
The pessary needs to be cleaned or changed every
_________
4–6 months
