Final Exam - Genitourinary Flashcards
Causes of functional urinary incontinence
- Delirium
- fecal impaction
- lack of manual dexterity
- decreased mobility
- taking the following medications: diuretics, hypnotics, alcohol, narcotics, decongestants
Causes of stress incontinence
due to history of vaginal deliveries, urine leakage with cough or sneezing
Work up for urinary incontinence
A urinalysis and urine culture and sensitivity should be done, measurements of serum electrolytes, blood urea nitrogen, creatinine, calcium (for polyuria in the absence of diuretics), and glucose.
Catheterization to assess post-void residual volume is important even on initial evaluation of the patient.
Overactive bladder
syndrome of symptoms that include urgency, frequency, and nocturia, all of which are associated with involuntary contractions of the detrusor muscle; more common in women
Urinary incontinence
The sudden intense urge to urinate and an involuntary loss of urine.
May or may not be a feature of overactive bladder, as about one-third of patients with OAB have urge incontinence, not all.
How to diagnose UTI
the subjective complaints of the patient and a clean-catch midstream urine sample showing the presence of bacteria, especially if more than 100,000 organisms/mL
Diagnosing a UTI in the elderly
altered mental status may be the sole manifestation of UTI and should create a high level of suspicion
What is the gold standard for diagnosing a UTI?
Urine culture is considered the gold standard with the greatest sensitivity for laboratory confirmation of UTI, urinalysis with microscopy is also helpful and provides rapid results in the primary care setting.
Pyridium
medication used for relief of pain, burning, urgency, and frequency from UTI.
Priapism
A prolonged erection of the penis, usually without sexual arousal
First line treatment for priapism
Phenylephrine (Neo-Synephrine) is the drug of choice for first-line treatment of low-flow priapism because the drug has almost pure alpha-agonist effects and minimal beta activity.
Phimosis
Is an unusually long foreskin or a foreskin that cannot be retracted over the glans penis during physical examination
It occurs in uncircumcised males and is normal in infancy.
In anyone older than infancy, refer to urologist
Hypospadias
Condition where the opening of the penis is on the underside of the organ.
More common in infants with a family history of hypospadias.
A circumcision should never be done on a newborn with hypospadias because the surgeon who ultimately corrects the hypospadias may need the prepuce to repair the defect.
Treatment for hypospadias
Surgical correction should be undertaken by the time the child enters the first grade.
Varicocele
Abnormal degree of venous dilation of the pampiniform plexus in the spermatic cord above the testes, which usually results in pain and engorgement of the testis.
Ascular engorgement of the internal spermatic vein.
Physical exam findings for varicocele
On exam, there will be soft and movable blood vessels underneath the scrotal skin upon palpation.
Palpation of varicose veins, described as a “bag of worms”, in the scrotum is a classic example of a varicocele, an abnormal tortuosity and dilation of the veins of the pampiniform plexus within the spermatic cord.
Undescended Testes and treatment
In boys with undescended testes, less than 1% have their testes descend after the first year.
Orchiopexy needs to be performed before age 6 to promote normal spermatogenesis and hormone production, prevent tumor formation, and leave the testis in a location where it can be easily palpated.
Benign Prostatic Hypertrophy
Nodular hyperplasia of the prostate. Begins enlarging after age 50
Treatment of BPH
5-alpha-reductase inhibitors include finasteride (Proscar) and dutasteride (Avodart)
After 6 months of therapy with finasteride (Proscar) for benign prostatic hyperplasia, the PSA should decrease by about 50%.
Testing can then be repeated annually. If the PSA has not decreased, you should suspect prostate cancer and proceed to evaluate for such.
Patient teaching after BPH surgery
Within 4 to 6 weeks after surgery, it is safe to resume a full sex life, including intercourse. Before this time, the spasmodic contractions that occur in the prostatic urethra at the time of ejaculation could trigger delayed bleeding.
After 6 weeks, the risk of delayed bleeding is very slight. However, if the area has not completely healed, there may be slight discomfort because of the spasms.
Erectile dysfunction determining the cause
Perform a medication history to determine if one of those could be causing the ED
The following medications have been shown to cause ED:
- antiandrogens
- antihypertensives such as beta blockers and central sympatholytics (reserpine)
- anticholinergics
- antidepressants
- antipsychotics
- central nervous system depressants
- drugs of abuse such as alcohol, tobacco, and heroin
Chronic bacterial prostatitis
Recurrent bacterial infection of the prostate and urinary tract, affects men aged 50 to 80.
Most common cause is E. Coli.
Young adult males in their 20s usually have acute prostatitis from gonorrhea or other bacterial infections.
Symptoms of chronic bacterial prostatitis
- bladder obstruction symptoms such as weak urine stream, hesitancy or dribbling, hematuria, hematospermia, and/or painful ejaculation.
What is acute bacterial prostatitis always associated with?
UTI and has a characteristically abrupt onset. Fever, chills, low back pain, tenesmus, and urinary complaints typical of UTI are common.
Exam for bacterial prostatitis
The rectal examination should be performed gently because vigorous manipulation of the prostate can result in septicemia. Therefore, prostatic massage is contraindicated.
Prostate cancer
Associated with human cytomegalovirus
A man with a first degree relative with prostate cancer is twice as likely to develop the disease.
Men with diets high in fat, particularly animal fat and smoking are also risk factors.
Prostate cancer symptoms
- bone pain
- weight loss
- anemia
- shortness of breath
- lymphedema
- lymphadenopathy
Treatment for prostate cancer
Goserelin acetate (Zoladex) and leuprolide acetate (Lupron) block the release of FSH and LH administered intramuscularly.
Also surgery.
