GE System-Panre Flashcards
Acute prostatitis (Level 2)
Most common cause is acute bacterial prostatitis → pts are typically acutely ill
with combination of irritative &/or obstructive urinary symptoms, perineal or
pelvic pain
● Most often occurs in young & middle-aged ♂; associated with presence of acute
bacterial urinary tract infection (UTI)
MC organisms in Acute prostatitis (Level 2)
Most common organisms:
○ Escherichia coli , Proteus species
○ If associated with sexually transmitted infection (STI), most common
organisms include Neisseria gonorrhoeae & Chlamydia trachomatis
Acute prostatitis (Level 2) S/S
Fever, chills, malaise, dysuria, urgency, frequency, pelvic
or perineal pain, pain at tip of penis, cloudy urine, sensation of incomplete bladder
emptying, dribbling of urine’ Prostate is exquisitely tender, swollen & firm (prostate massage is
generally contraindicated)
○ Pts may have generalized urosepsis
Acute prostatitis (Level 2) DX
Clinical
○ Urinalysis → WBCs & bacteria
○ Urine gram stain & culture
Acute prostatitis (Level 2) TX
Nontoxic pt: Trimethoprim-sulfamethoxazole (TMP/SMX) or
fluoroquinolone (eg. ciprofloxacin), analgesics, bed rest, stool softeners,
hydration
○ Toxic pts: Hospitalize; intravenous fluoroquinolone, ± aminoglycoside (eg.
gentamicin)
○ Appropriate referral or consult
Bacterial cystitis (Level 2)
Bacterial infection & inflammation of the urinary bladder
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● Most commonly seen in ♀
Bacterial cystitis (Level 2) MC organism ?
Escherichia coli ( E. coli )
Bacterial cystitis (Level 2) Risk factors
Sexual intercourse, diaphragm & spermicide use, recent antibiotic use,
new sex partner within past year, structural or functional abnormalities of the
urinary tract, instrumentation of the urinary tract
Bacterial cystitis (Level 2) Uncomplicated vs complicated UTI
Uncomplicated: Premenopausal adult ♀ without structural or functional
abnormality of the urinary tract; ∅ pregnancy; ∅ significant comorbid
conditions
○ Complicated: Pregnancy, ♂ sex, structural or functional urinary tract
abnormality, poorly controlled diabetes mellitus, chronic kidney disease,
recent instrumentation of the urinary tract
Bacterial cystitis (Level 2) CM ?
Dysuria, urinary urgency & frequency, sensation of bladder
fullness, suprapubic pain & tenderness
Bacterial cystitis (Level 2) DX
Clinical
○ Dipstick urinalysis: Positive leukocyte esterase, ± blood, ± protein, ± nitrite
○ Microscopic urinalysis: >8-10 white blood cells/mL in a fresh, unspun urine
sample using hemocytometer chamber; bacteria, ± red blood cells
○ Urine culture is usually performed only for pts with complicated UTI
Bacterial cystitis (Level 2) TX?
First-line: Nitrofurantoin, TMP/SMX, or fosfomycin
○ Phenazopyridine for symptomatic dysuria: Turns urine reddish-orange
Benign prostatic hyperplasia (BPH) (Level 2)
Nonmalignant adenomatous overgrowth of the periurethral prostate gland →
varying degrees of bladder outlet obstruction
Benign prostatic hyperplasia (BPH) (Level 2) CM?
Weak stream, hesitancy, urinary urgency & frequency,
nocturia, sensation of incomplete bladder emptying, terminal dribbling, overflow or
urge incontinence
Benign prostatic hyperplasia (BPH) (Level 2) Dx?
Clinical: ↑ prostate gland size, rubbery consistency, loss of median furrow
○ Urinalysis
○ Prostate-specific antigen measurement for patients between 50-69 yo after
shared decision making discussion
Benign prostatic hyperplasia (BPH) (Level 2) TX ?
5-α-reductase inhibitors (eg. finasteride)
○ α-blockers (eg. terazosin)
○ Appropriate referral as needed for further work-up & treatment
Bladder cancer (Level 1)
Carcinoma of transitional epithelium (most common type)
● High recurrence rate (70% in 5 yrs)
● 4 th most common CA in men (♂:♀=3:1)
Median age at diagnosis: 65 yo
Bladder cancer (Level 1) Risk factors
Smoking: #1 most common and most important
○ Aromatic amines (eg. aniline dyes),
○ Analgesic abuse
○ Chronic irritation (eg. chronic catheterization)
Bladder cancer (Level 1) CM
Painless gross or microscopic hematuria → most common
(classic presentation in 80-90%)
○ Also may have dysuria, urgency, frequency
Bladder cancer Dx:
Clinical
○ Urinalysis
Bladder cancer tx
Appropriate referral: cystoscopy with biopsy
Hydrocele
Fluid collection within the tunica vaginalis or processus vaginalis of the scrotum
○ Most commonly seen in boys (rare in girls)
Hydrocele Types ?
types:
○ Communicating (most common): Residual communication of the processus
vaginalis with the peritoneum → peritoneal fluid accumulation
■ Usually seen between ages: newborns~1-2 yo
○ Noncommunicating: Usually occurs in older children
■ May be idiopathic or associated with epididymitis, orchitis,
testicular torsion or tumo
Hydrocele CM?
Communicating hydroceles: Size may fluctuate throughout the day (larger
during the day, smaller at night) or with straining or crying
■ Often reducible with application of pressure
○ Noncommunicating hydroceles: Size is constant & non-reducible
○ Testis may palpable posterior to the fluid collection
○ Positive transillumination (homogeneous glow without internal shadows
Hydrocele DX?
Clinical
○ If indicated, ultrasound study (eg. inability to palpate testis, internal
shadows on transillumination)
Hydrocele TX?
Observation until 1-2 yo; possibly surgery
Varicocele
Dilation of the pampiniform venous plexus & internal spermatic vein; ~85-95%
occur on the left side
● Associated with ♂ infertility
○ ~35% of subfertile or infertile ♂ have varicocele, but only 10-15% of ♂
with varicoceles have fertility problems
Varicocele CM
Usually asymptomatic & may be discovered in a man
seeking evaluation for infertility;
○ Some patients have achy scrotal pain or heaviness especially with standing
Varicocele red flags?
Sudden onset, isolated right-sided, not reducible in supine
position
Varicocele Dx?
Clinical
○ If indicated, high-resolution color-flow Doppler ultrasonography (eg.
equivocal clinical examination, red flags
Varicocele Tx?
Usually observation & symptomatic treatment (eg. OTC analgesics);
appropriate urologic referral for adolescents or adults with significant pain or
discomfort; fertility work-up as indicated
Erectile dysfunction (ED) (Level 2)
Inability to either attain or sustain an erection satisfactory for sexual performance
Erectile dysfunction (ED) (Level 2) Primary ED?
Primary ED: ♂ who has never been able to attain or sustain an erection →
almost always due to psychological factors (eg. guilt, fear of intimacy,
depression, anxiety) or obvious anatomic abnormality
Erectile dysfunction (ED) (Level 2) 2nd Ed?
Usually acquired later in life in ♂ who have previously been
able to attain or sustain an erection and common due to:
■ Vascular disease: Atherosclerosis, HTN, DM, smoking
■ Neurologic disease: Diabetic neuropathy, stroke, multiple sclerosis,
autonomic neuropathies, spinal cord injury, complications of pelvic
(eg. prostate) surgery
■ Others: Drug effect (eg. β-blockers, alcohol), prolonged bicycle
riding, testosterone deficiency
■ Psychological factors: Performance anxiety, stress, depression
Erectile dysfunction (ED) (Level 2) CM?
Establish the presence or absence of erections:
■ Either nocturnally &/or upon awakening (psychogenic ED usually do
have these erections; organic ED often does not)
○ Examination for penile fibrous bands or plaques (eg. Peyronie disease),
testicular atrophy, rectal tone, perianal sensation, bulbocavernosus reflex,
peripheral pulses
ED DX?
Clinical: Screening for mental health (eg. depression), sexual health (eg.
satisfaction with relationship), underlying disorders (eg. DM)
○ Measure morning testosterone level: If ↓, measure prolactin & luteinizing
hormone
○ Additional laboratory testing as guided by signs & Sx
ED Tx?
Phosphodiesterase-5 inhibitors (eg. sildenafil)
■ Contraindication: Concomitant use of nitrates
○ Vacuum erection & constriction devices
○ Appropriate referral: Intraurethral or intracavernosal prostaglandin E1,
surgical implants
○ Treatment directed at any other underlying cause
Peyronie Disease
Curvature of penis from scar tissue (plaque) accumulation in tunica albuginea
● Risk factors: penile trauma, autoimmune dz, Dupuytren dz
● S/Sx: penile curvature, painful erections, erectile dysfunction, difficulty or inability to
have sexual intercourse
● PE: curvature noted on erection, palpable fibrosis, ‘hour-glass’ deformity (indentation of
shaft at plaque site)
● Labs: U/S for plaque delineation & presence of Ca++
● Tx: observation for minimal pain &/or mild curvature (<30°); otherwise, urology referral
Fecal incontinence (Level 1)
Impaired ability to control the passage of gas or stool
Fecal incontinence (Level 1) Etiologies?
Childbirth-related injury (most common), trauma to anal muscles (eg.
anal surgery), age-related loss of anal muscles strength, neurologic injury or
disease (eg. spinal cord injury, severe dementia, stroke), inflammatory diseases (eg.
ulcerative colitis), rectal tumor or prolapse
Fecal incontinence (Level 1) CM?
Range from difficulty controlling gas to inability to control
liquid & formed stools, sense of urgency
Fecal incontinence (Level 1) Dx?
Clinical
○ Evaluate sphincter function, perianal sensation on physical examination
Fecal incontinence (Level 1) TX?
Non-surgical: Bowel pattern management for enhanced predictability,
adequate fluid & dietary bulk intake, possibly constipating medications (eg.
loperamide), perianal muscle strengthening & biofeedback
○ Appropriate referral for additional work-up & treatment including surgery
Stones under what MM would be passed with no problem?
5mm
Nephrolithiasis:
Kidney stone
Urolithiasis
Stone in the genitourinary tract
Nephrolithiasis/urolithiasis (Level 2)
Precipitation of crystals in the urinary tract that can cause acute occlusion to the
passage of urine
● Most stones are calcium oxalate
Nephrolithiasis/urolithiasis (Level 2) CM?
May be asymptomatic or patients may present after
passing gravel or stone
○ ‘Classic presentation’: Nausea, vomiting, mild~excruciating pain that waxes
& wanes in severity, and develops in waves or paroxysms; stone location
often determines pain location:
■ Upper ureter or renal pelvis: Flank pain or tenderness
■ Lower ureter: Pain radiates to ipsilateral testis or labium
Nephrolithiasis/urolithiasis (Level 2) Dx?
Clinical
○ Urinalysis: Most patients will have gross or microscopic hematuria
○ CT scan of abdomen & pelvis without contrast: Preferred imaging study for
identifying stone & hydronephrosis
Nephrolithiasis/urolithiasis (Level 2) Tx?
Hydration (oral if possible; intravenous if unable)
○ Pain control: NSAIDs &/or opiates
○ Admit patients that cannot tolerate oral intake, or if they have fever &/or
uncontrollable pain
○ Possible administration of α-blocker (eg. tamsulosin) or Ca ++ -channel
blocker (eg. nifedipine) for facilitating stone passage
○ Have patient strain urine for several days & bring stone in for analysis
■ Most stones with diameter ≤ 5 mm pass spontaneously
○ Urology consult for urosepsis, acute kidney injury, anuria or intractable
pain, nausea or vomiting
■ Also for stone ≥10 mm or failure to pass stone with conservative
therapy
Struvite stones
(magnesium ammonium phosphate)
■ Form in patients with upper UTI due to urease-producing organisms
(eg. Proteus , Klebsiella ) → usually do not present with classic Sx/S;
instead, patients have recurrent UTI, mild flank pain or hematuria;
urine pH >7.0
Orchitis (Level 2)
Inflammation of the testes
Orchitis (Level 2) Etiologies?
Etiologies: Most common is viral (eg. mumps)
○ Can be bacterial secondary to epididymitis
Orchitis (Level 2) CM
Constitutional Sx (eg. fever, malaise), scrotal and
testicular pain, tenderness & swelling; overlying scrotum may be taut, shiny &
erythematous
○ In mumps orchitis (unilateral or bilateral) testicular pain & swelling usually
occurs 4-7 days following parotid swelling
Orchitis (Level 2) Dx
Clinical
○ Serum immunofluorescence antibody testing for mumps
○ Color Doppler ultrasonography if Dx is unclear
Orchitis (Level 2) TX
Supportive: Bed rest, NSAIDs, support of testes, ice packs
○ Mumps: Susceptible contacts should be vaccinated
■ Mumps is a reportable disease
○ Directed at any underlying cause (eg. antibiotics for epididymitis)
○ Urology consult or follow-up
Paraphimosis
Clinical condition occurring across the age-spectrum in either uncircumcised or
partially circumcised ♂ where the retracted foreskin becomes trapped behind the
glans penis & cannot be returned to its normal anatomic position
● If the foreskin remains retracted for an extended period of time, venous &
lymphatic obstruction can occur → edema & arterial occlusion to the glans penis
(urologic emergency!)
Paraphimosis most common cause
Most common cause: Iatrogenic where foreskin is inadvertently left in the
retracted position by patient or provider (eg. following urethral catheterization)
Paraphimosis CM
Pain, swelling & entrapment of foreskin in coronal sulcus
Paraphimosis Dx?
Dx: Clinical
Paraphimosis TX ?
Manual reduction, possibly surgery; urology consult or referral
Phimosis
Clinical condition occurring across the age-spectrum in either uncircumcised or
partially circumcised ♂ where there is the inability to retract the foreskin
● Normal and physiologic in boys & usually resolves by age 5-7 yo
Phimosis CM?
Usually none unless there are pathologic complicationseg. balanitis, UTI, urinary outlet obstruction, STI or penile CA)
Phimosis Dx?
Clinical
Phimosis TX
Conservative measures (topical corticosteroids, manual foreskin stretching),
urology consult for possible circumcision; treat any associated underlying
pathology
Prostate cancer (Level
Adenocarcinoma of the prostate (most common
Prostate cancer is most common in ?
men >50 yo in US; median age at diagnosis is 72 yo; MC CA in Men
Prostate cancer’s RF?
African-American, family history
Prostate cancer CM are?
Clinical manifestations: Asymptomatic (most common)
○ Advanced disease → Hematuria, bladder outlet obstruction, bone pain,
pathologic Fx
Screening: Variable guidelines; discussion & shared decision-making
Prostate cancer is Dx ?
Clinical (digital rectal examination is often normal)
○ Possibly prostate-specific antigen
○ Transrectal ultrasound-guided needle biopsy, CT, bone scan
Prostate cancer TX?
Urology referral; active surveillance, surgery, radiation therapy, chemotherapy,
androgen deprivation therapy
Testicular cancer (Level 1)
Usually germ cell tumor of testis (95%) with the most common types being seminoma
& nonseminoma
Testicular cancer (Level 1) is MC solid CA in ?
Most common solid CA in ♂ 15-35 yo; median age at diagnosis is 33 yo
Testicular cancer (Level 1) RF ?
Cryptorchidism
Testicular cancer (Level 1) CM?
Non-painful testicular mass (most common); ± dull, aching pain
Testicular cancer (Level 1) DX
Clinical
○ Ultrasonography
○ α-fetoprotein, β-hCG, lactate dehydrogenase
○ Chest x-ray, CT or MRI of abdomen & pelvis
Testicular cancer (Level 1) TX
Urology referral; surgery, radiation therapy, chemotherapy
Testicular torsion (Level 2)
Clinical condition characterized by a twisting of the testis along the axis of the
spermatic cord with resultant strangulation of its blood supply → surgical
emergency
● Occurs most commonly in neonates & postpubertal boys
Testicular torsion (Level 2) CM ?
Acute onset of scrotal pain & swelling, nausea, vomiting
○ Scrotal edema & induration, testis is tender, elevated & horizontal (bell
clapper deformity,
○ Cremasteric reflex is usually absent on affected side;
○ Prehn sign: Elevating the testicles relieves pain of epididymitis, but not pain caused by testicular torsion
Testicular torsion (Level 2) Dx?
Clinical → go directly to surgery!
○ Color Doppler ultrasonography if there is low suspicion of torsion or Dx is
unclear
Testicular torsion (Level 2) TX?
Attempt manual detorsion if surgical intervention is not immediately
available:
■ Classically, the testis usually rotates medially (inward or internally)
→ detorsion is performed by rotating the testicle laterally away
from the midline towards the thigh (outward or externally)
○ Emergent surgical consultation for surgical detorsion & fixation
Urethritis (Level 2)
Inflammation of the urethra
Urethritis (Level 2) Etiologies
Noninfectious: Chemical (eg. soaps), trauma (eg. intermittent
catheterization)
○ Infectious:
■ Gonococcal: Neisseria gonorrhoeae
■ Non-gonococcal: Chlamydia trachomatis & Mycoplasma genitalium
Urethritis (Level 2) CM
Noninfectious: ± erythema at the urethral meatus, ± clear urethral
discharge
○ Infectious: May be asymptomatic – particularly in ♀ (especially with
Chlamydia )
■ Dysuria (most common Sx), urethral pruritus, burning, &/or
discharge
Urethritis (Level 2) DX
Clinical ○ Noninfectious: Depends upon etiology ○ Infectious: ■ Gram stain of urethral swab specimen (sensitive & specific only for ♂) ■ Dipstick (specifically leukocyte esterase) & microscopic analysis of first-catch urine ■ NAATs
Urethritis (Level 2) TX is ?
Noninfectious: Treatment directed at cause
○ Infectious:
■ Gonococcal: Ceftriaxone & azithromycin
■ Nongonococcal: Azithromycin or doxycycline
Urinary incontinence (Level 2) ● Involuntary loss of urine ? RF?
Involuntary loss of urine; ♀ sex, ↑ age, obesity, ↑ parity (especially vaginal deliveries),
smoking
Urinary incontinence (Level 2) ● Involuntary loss of urine there are three types?
Urge, Stress, Overflow
Urinary incontinence (Level 2) ● Involuntary loss of urine Dx?
Clinical
○ For stress incontinence: Bladder stress test
○ Urinalysis; possibly BUN & creatinine
Urinary incontinence (Level 2) ● Involuntary loss of urine TX?
Lifestyle modifications:
■ Weight loss for overweight/obese patients, ↓ caffeine &/or
alcohol consumption, smoking cessation
○ Pelvic floor muscle (Kegel) exercises
■ First-line for ♀ with stress incontinence
○ Bladder training: Timed voiding with progressive ↑ time between
urination
■ First-line for ♀ with urge incontinence
○ Pharmacotherapy:
■ Topical vaginal estrogen: Useful for stress or urge incontinence in
postmenopausal women with vaginal atrophy
■ Anticholinergic agents (eg. oxybutynin): Useful for urge
incontinence &/or overactive bladder
○ Urology referral for further work-up & treatment
Urge Urinary incontinence?
Associated with detrusor muscle hyperactivity (AKA: overactive
bladder)
■ Sudden & urgent need to void → uncontrollable leakage of urine
■ Nocturia
Stress Urinary incontinence ?
Postmenopausal urethral atrophy
■ Loss of urethral support due to damage of pelvic support
structures (eg. multiple childbirths)
■ Activities that ↑ intra-abdominal pressure (eg. coughing,
sneezing, laughing, bearing down) → leakage of urine
Overflow Urinary incontinence?
Overly full bladder due to poor bladder contraction &/or urethral
obstruction (eg. BPH)
■ Incomplete bladder emptying after passing urine followed by
continuous dribbling of urine, weak or intermittent stream,
hesitancy, frequency, nocturia
Penile Cancer
Squamous cell carcinoma (most common); ~50% occur on glans & ~20% on prepuce; rare
dz in US
Penile Cancer RF? Etiology?
uncircumcised penis (neonatal [but not adult] circumcision is protective); HIV/HPV infection, balanitis, >55 yo; Etiology: ? phimosis, smegma, virus (eg. HPV), trauma
Penile Cancer S/S? PE?
S/Sx: itching or burning under foreskin (most common), lesion that does not heal
● PE: wide range – ulceration (most common), hyperemic area, induration, papule, flat or
exophytic; inguinal lymphadenopathy
Penile Cancer Labs?
biopsy for dx; MRI, U/S, CT for staging
Penile Cancer TX?
urology referral; possibly chemo-tx, surgery
Peyronie Disease RF?
penile trauma (penile fracture-vigorous sexual activity which breaks tunica albuginea), autoimmune dz, Dupuytren dz
Peyronie Disease S/s? PE?
penile curvature, painful erections, erectile dysfunction, difficulty or inability to
have sexual intercourse; curvature noted on erection, palpable fibrosis, ‘hour-glass’ deformity (indentation of
shaft at plaque site)
Peyronie Disease Labs?
U/S for plaque delineation & presence of Ca++
Peyronie Disease TX?
observation for minimal pain &/or mild curvature (<30°); otherwise, urology referral
Urethral Prolapse (Urethrocele)?
Circumferential protrusion of distal urethra thru external urethral meatus – most
commonly seen in prepubertal girls & postmenopausal women
Urethral Prolapse (Urethrocele) s/Sx?
Prepubertal: usually Ø sx, ± blood on
diaper / underwear; hematuria uncommon
o Postmenopausal: vaginal bleeding with
voiding
Urethral Prolapse (Urethrocele) PE?
doughnut-shaped bulging mucosa protruding from anterior vaginal wall with centrally
located urethral meatus; tender, ulcerated & friable mucosa
Urethral Prolapse (Urethrocele) Tx?
sitz baths & topical estrogen; urology referral for urinary obstruction, thrombosis,
infection or strangulation
Urethral Stricture
Narrowing of urethra caused by injury (eg. pelvic Fx), instrumentation (eg. prostate
surgery), infection, or tumor → varying degrees of urine flow obstruction; most common
in ♂; Think complications of foley/catherter, STI
Urethral Stricture s/Sx?
weak urinary stream (hallmark sx), incomplete bladder emptying, splaying of urine
stream, dysuria, urgency, frequency, straining; recurrent UTI, acute urinary retention
Urethral Stricture PE?
cystourethroscopy, urethrography
Urethral Stricture TX?
Acute urinary retention → emergent transurethral or suprapubic catheter placement
o Urology referral (dilation, urethrotomy, urethroplasty)
Vesicoureteral Reflux
Retrograde flow of urine from bladder into upper urinary tract
o 1°: incompetent ureterovesical junction (most common)
o 2°: ↑ voiding pressure in bladder (obstruction, neurologic
Vesicoureteral Reflux Most common?
Most commonly seen in children; + family or sibling Hx; may be associated with antenatal
or postnatal hydronephrosis
Vesicoureteral Reflux s/S?
usually Ø s/sx unless associated with UTI ± fever
Vesicoureteral Reflux Labs?
voiding cystourethrogram (best initial study), U/A, urine culture, creatinine, electrolytes, contrast renal-bladder U/S
Vesicoureteral Reflux Tx?
urology referral – tx depends upon age & severity; may include prophylactic
antibiotics, correcting voiding dysfunction & follow-up radiographic studies
Genitourinary Trauma
Blunt or penetrating injury to bladder, urethra or external genitalia (lower GU tract), or
kidneys & ureters (upper GU tract)
o Kidney injury»_space;> bladder, urethra»_space; ureters; Always be careful during PE examination do not want to make conditions worse
Genitourinary Trauma External Genitalia?
S/Sx: penile, scrotal or vulvar ecchymosis, swelling; hematocele
o Dx: penile Fx, testicular rupture or torsion
Genitourinary Trauma urethra & bladder?
S/Sx: suprapubic pain, blood at urethral meatus, gross or microscopic hematuria,
inability to void, absent or ‘high-riding’ prostate on digital rectal exam; vaginal
laceration; scrotal, vulvar, perineal ecchymosis or hematoma
o Dx: associated with pelvic Fx (eg. bulbomembranous junction of posterior urethra)
Genitourinary Trauma Kidney’s urethra & bladder?
S/Sx: flank or abdominal bruising, pain & tenderness; posterior rib Fx, gross or
microscopic hematuria
o Dx: renal or ureteral lacerations or avulsions
Genitourinary Trauma Kidney’s & ureters?
S/Sx: flank or abdominal bruising, pain & tenderness; posterior rib Fx, gross or
microscopic hematuria
o Dx: renal or ureteral lacerations or avulsions
Genitourinary Trauma Common labs:
U/A, CXR, AP pelvis; testicular U/S (torsion), retrograde urethrogram
(urethral injury), retrograde cystogram (bladder injury), abdominopelvic CT scan with
contrast (renal/ureter injury)
Genitourinary Trauma TX:
ABCs, treat life-threatening & other associated injuries
o Bladder catheter: caution with suspected urethra injury
o Urgent or emergent urology consultation
Bladder Prolapse
Bulging of bladder into upper anterior vaginal wall → descends toward or thru vaginal
opening
Bladder Prolapse RF?
Risk Factors: multiple pregnancies, ↑ BMI, straining with constipation, repeated heavy
lifting, chronic cough, previous surgery (eg. hysterectomy), other pelvic organ prolapse;
most common in older
Bladder Prolapse Etiology?
injury to levator ani muscle &/or pudendal nerves (eg. childbirth) → ↓ pelvic
floor support
Bladder Prolapse s/S?
see or feel a vaginal bulge (most common), urinary frequency, urgency,
incontinence or sense of incomplete voiding, back or pelvic pain, dyspareunia
Bladder Prolapse Pe?
PE: prolapse may be ↑ by having pt Valsalva during pelvic exam
Bladder Prolapse TX?
Tx:
o Weight management, avoiding constipation & heavy lifting, smoking cessation
o Pelvic floor muscle training (Kegel exercises)
o Mechanical support (eg. pessary)
o Estrogen replacement Tx
o Surgery
Bladder Prolapse Complications?
urinary retention, incontinence, recurring UTIs
This procedure measures the pressure in the bladder and the urethra simultaneously and is the best study for confirming the suspected diagnosis of stress incontinence.
Urethrocystometry
