Genitourinary #1 Flashcards
Urge incontinence is due to _____ and is MC in ______
Detrusor muscle overactivity and is most common in older women
Management of urge incontinence
- Bladder training
- Diet (avoid spicy foods, chocolate, alcohol, and caffeine)
- Antimuscarinics: Tolterodine, Oxybutynin
- Mirabegron
- TCA
- Surgical: injection of Botox, bladder augmentation
Overflow incontinence is due to _____ and some common etiologies include…
Bladder detrusor muscle under activity
-Neurological disorders, autonomic dysfunction, BPH, prior pelvic floor surgery
How does overflow incontinence differ from the other types of incontinence?
-Loss of urine with no warning (as in urge) or triggers (as in stress)
What is the gold standard to diagnose a patient with overflow incontinence?
Post void residual > 200 mL
Treatment for overflow incontinence
- Intermittent or indwelling catheter first-line
- Cholinergics: Bethanechol (increases detrusor muscle activity)
What is the pathophysiology of stress incontinence?
-Leakage of urine that occurs once increased abdominal pressure > urethtral pressure
When does stress incontinence occur usually?
-Exertion, coughing, sneezing, laughing
Common etiologies of stress incontinence include
- Laxity of pelvic floor muscles (childbirth, surgery)
- Urethral hyper mobility
Treatment for stress incontinence
- Pelvic floor (Kegel) exercises
- Lifestyle modifications: weight loss, smoking cessation, drink small amounts of water throughout the day
- Pessaries
- Surgery: Midurethral sling (definitive)
Uterine Prolapse is when the uterus herniates into the vagina. Risk factors include weakness of pelvic support structures such as after childbirth. There are Grades 0-4 of this condition. Describe them.
Grade 0: no descent
Grade 1: uterus descent into the upper 2/3 of the vagina
Grade 2: the cervix approaches the introitus
Grade 3: the cervix is outside the introitus
Grade 4: entire uterus is outside the vagina
Treatment for uterine prolapse
- Mechanical: pessaries elevate and support uterus
- Surgical: Hysterectomy or ligament fixation
What is Peyronie Disease?
-Acquired localized fibrotic changes of the tunica albuginea leading to abnormal penile curvature
Treatment for Peyronie Disease
- Observation: if curvature is 30 degrees or less
- Medical: if curvature 30 degrees or more or associated with sexual dysfunction
What is vesicoureteral reflux?
-Retrograde passage of urine from the bladder into the upper urinary tract
MC clinical manifestation of VUR
-Febrile UTI
What is the initial diagnostic that is usually ordered for VUR and what is the diagnostic that is the imaging test of choice?
- Renal and bladder US (initial)
- Voiding cystourethrogram (diagnostic of choice)
Treatment for VCUG, for all grades
- Grades I-II: observation or ABX prophylaxis to reduce risk of recurrent UTI
- Grades III - IV: surgical correction
MCC of acute cystitis
-E. Coli
However, what is the most common cause of acute cystitis in sexually active women?
Staph Saprophyticus
What is the MCC of acute cystitis with indwelling catheters?
Enterococci
Symptoms of acute cystitis
- Dysuria, frequency, urgency
- Hematuria, Suprapubic pain and tenderness
Diagnostics for acute cystitis
- UA: Pyuria ( > 10 WBC’s/hpf)
- Urine Culture: definitive diagnosis. Clean catch specimen. Women > 1000 CFU/ml
Medical management of acute cystitis
- Nitrofurantoin or Bactrim (first line)
- Fluoroquinolones (if sulfa allergy) - Cipro, Levo, Moxi
What are some other adjunct treatment recommendations for patients with acute cystitis?
- Increased fluid intake
- Void after intercourse
- Hot Sitz baths
- Phenazopyridine is a bladder analgesic (turns urine orange color)
What are some examples of a complicated acute cystitis?
- Symptoms > 7 days
- Pregnancy
- Diabetics
- Elderly
- Males
- Indwelling Catheters
What are the treatment options for a complicated acute cystitis?
- Fluoroquinolones PO or IV
- Aminoglycosides (Gentamicin, Tobramycin)
What drug should be used for acute cystitis in pregnancy?
Amoxicillin or Augmentin
Pyelonephritis is an infection of
The upper genitourinary tract
MCC of pyelonephritis
-E. Coli
Symptoms of pyelonephritis
- Fever, chills, back or flank pain, N/v
- Urinary symptoms
-What are the hallmark symptoms of pyelonephritis though
- CVA tenderness
- Tachycardia
- Fever
For diagnostics for pyelonephritis, what should you order and what do you see?
- UA: Pyuria (WBC > 10/hpf), cloudy urine, hematuria
- -WBC casts!!!!
- Urine culture: Definitive diagnosis
Outpatient management for pyelonephritis
-Fluoroquinolones (Cipro, Levo, Moxi)
Inpatient management of pyelonephritis
- 3rd or 4th gen Cephalosporins
- Fluoroquinolones
- Aminoglycosides
- Penicillins
- —Any one of these for 2 weeks
If the patient is pregnant, what medication should be given for pyelonephritis?
-IV Ceftriaxone (Aztreonam if PCN allergy)
MCC of orchitis
-Viral (Mumps, Echovirus)
Treatment for orchitis
-Symptomatic first line, NSAIDs, bed rest, cool packs
Symptoms of orchitis
-Scrotal pain, swelling, tenderness, erythema
What is cryptorchidism?
Testicle that has not descended into the scrotum by four months of age
Risk factors for cryptorchidism
- Prematurity
- Low birth weight
- Maternal obesity or DM
Treatment for cryptorchidism
- Orchiopexy at 4-6 months of age and DEFINITELY before 2 years old
- Observation if < 6 months of age can be done
What is the major complication of cryptorchidism?
Increased risk for testicular cancer, decreased fertility, Testicular torsion, inguinal hernia
MC causes of urethritis
- Chlamydia: purulent or mucopurulent discharge
- Gonorrhea: abrupt onset of symptoms, opaque/yellow thick discharge
Clinical symptoms of urethritis
- Urethral discharge and penile or vaginal pruritus
- Dysuria
- Abdominal pain and abnormal vaginal bleeding
Diagnostic for urethritis
NAAT: Most sensitive
Treatment for urethritis
- Ceftriaxone + Azithromycin (Gonorrhea)
- Azithromycin or Doxy (Chlamydia)
What is enuresis defined as?
Any urinary incontinence while sleeping in children 5 years of age or older
What is the difference in primary and secondary enuresis?
- Primary: absence of any period of nighttime dryness (MC type)
- Secondary: enuresis after a dry period of at least 6 months. Occurs after stressful event (divorce, death, etc.)
Treatment for enuresis
- Behavioral, bladder training
- Enuresis alarm: most effective long term therapy
- Desmopressin/DDAVP: synthetic ADH which reduces urination
- Imipramine: TCA used in refractory cases
