Genitourinary Exam 2 Cards Flashcards
Acute UTI
Usually 1 organism
Chronic UTI
may be 2+ organism
MCC of UTI
E. coli
CFU count indicative of a potential UTI
Over 100,000 cfu/mL is suggestive but NOT diagnostic
Bacteriuria
10^5 cfu/mL, 2 consecutive specimens in women - recommended not to screen in children and women
Unresolved bacteriuria - 3 etiologies
Failure to sterilize urinary tract during UTI tx
Noncompliance
resistance
Multiinfections
Persistent bacturia - 4 etiologies
Keeps coming back - prostate, catheter, stones, fistula
4 ways UTIs can spread
Ascending - MC, skin up urethra
Direct extension - From local infected tissue
Hematogenous - Staph from blood
Lymphatic - Rare from lymph
4 Risk factors for UTI
Abnormal voiding
Renal disease
Deficient mucosal lining
Abnormal pH or osmolality of urine
Male and female risk factors for UTI
Female - Short urethra and sex
Male - Prostatitis and foreskin
Etiology of acute cystitis
Nearly always bacterial - E. coli MC
Up the urethra
Rare in adult men
Clinical presentation of acute cystitis
Dysuria
Frequency/Urgency
Suprapubic pain
May see blood in urine
Labs for acute cystitis
WBCs - leukocyte esterase
Nitrites - Made by bacteria
Hematuria also possible
First Line Treatment for acute cystitis
NEW GUIDLINES COMING
5 days - nitrofurantoin
3 days - Bactrim (can just do TMP if sulfa allergic)
Single Dose - Fosfomycin
Second line treatment for acute cystitis
Augmentin 5-7 days
Cephalosporin - Podoxime, Dinir, Keflex
Third line for acute cystitis
FQ for 3 days
Soothing Adjunct therapy for acute cystitis - side effects and considerations
Phenazopyridine - sooths bladder
Discolored urine - interferes with UA dip!!
Only 2 days so we know if pain is gone
Toxic urine adjunct for acute cystitis
Methenamine - metabolizes to formaldehyde and ammonia in urine
Renal and liver failure CI
Interacts with Sulfa
2-3 days
Non pharm adjunct treatments for acute cystitis
Sitz bath - warm comfort bath
Fluid intake
Cranberry juice
Vaginal estrogen in post menopausal women
Non-pharm acute cystitis prevention
Voiding after sex
Hydration
Wiping from front to back
Breathable undergarments - cotton
D-mannose from cranberry juice
Diabetes med that can cause a UTI
SGLT-2 inhibitor - gliflozin
Frequent UTI
3+ in 12 months for women
Pharm for recurring cystitis
Any UTI drug low dose or PRN
Work ‘em up
Etiology of acute pyelonephritis
E. coli, Staph (blood), Kelbsiaella, Pseudomonas
Ascent up urethra
Less common than cystitis - usually follows
Clinical presentation of acute pyelonephritis
Fever, chills, NVD, flank pain, gross hematuria
Imaging for acute pyelonephritis
CT preferred - shows renal inflammation
US can show hydronephrosis
Fluid on a CT scan
Appears dark
Lab results from acute pyelonephritis
Positive urine culture
Leukocyte esterase and casts
Urine nitrite
Leukocytosis on CBC
Outpatient treatment for acute pyelonephritis
Can be out if healthy
Fluids and abx - or IV if you can
Initial IV abx for acute pyelonephritis
Rocephin, Ciprofloxacin, Gentamicin
Oral abx for acute pyelonephritis
Levaquin, Cipro, Bactrim, MAY use augmentin
2 CI drugs for acute pyelonephritis
Nitrofurantoin
Fosfomycin
Therapy duration for acute pyelonephritis outpatient
7 days -FQ 14 days non-FQ
Inpatient pharm for acute pyelonephritis
4 normal
3 for resistance
IV - Rocephin, Gent/Amp, FQ, pip and taz
IF
Suspicion of resistant - Carbapenem, Vanc, Cefepime
14 days
Complications fro pyelonephritis
Abcess
Nephron loss
Etiology of acute urethritis
4 MCC in order
Gonnorrhea = MC
Chlamydia
Mycoplasma genitalia
Trichomonas
Usually and STI - MC in men
Clinical presentation of acute urethritis
Pain with urination
Discharge (gon is more purulent)
May be asymptomatic
Labs for urethritis
Gram stain (G- is gon), now we usually use NAAt for Gon,Chly
UA - first stream sample
Pharm for gonorrhea
Ceftriaxone - 1 dose IM
Pharm for chlamydia
Doxy for 7 days (preferred)
Z-max - 1 dose IM
Clinical presentation of prostatitis
Heamturia - gross or microscopic
Irritative voiding symptoms
Indication that might mean prostate cancer
Gross hematuria
Dysuria
May be painful, may just be uncomfortable
Nocturia
abnormal if several times per night
Urine hesitancy
Don’t start urinating right away
4 types of incontinence
Overflow
Urge
Stress
Total
Acute bacterial prostatitis etiology
Ascent up urethra
Risk factors for UTI
Trauma
Dehydration
MCC -E. coli may need to consider STIs
Presentation of bacterial prostatitis
Fever, chills, mailaise
Irritative voiding
Pain can be perineal, sacral, suprapubic
Prostate tenderness and warmth
DRI in bacterial prostatis
Too much massage can cause sepsis
Labs for bacterial prostatitis
Leukocytosis
Pyuria and bacturia
+ culture
Imaging for bacterial prostatitis
Check for abcess CT or US if no respnse to therapy
Pharm therapy for bacterial prostatitis
IV
Nosocomial
Oral
ABX therapy based on C/S
Start FQ+Aminoglycoside - IV
Carb, Ceph, Aminoglycoside - Nosocomial
Bactrim, Cipro - Oral
Therapy length for bacterial prostatitis
4 weeks
Etiology of chronic bacterial prostatitis
More often E. coli
May skip to chronic before acute
Clinical pres of chronic bacterial prostatitis
Say they have bladder infectio - Men
Dull pain suprapubic
May have a mildly tender boggy prostate - may be normal
Labs for chronic bacterial prostatitis
Only positive upon prostate palpation followed by urination
Lipid laden macrophages
May see prostate stones on imaging
Pharm treatment for chronic bacterial prostatitis
FQ or Bactrim for 6 weeks - may need 12 weeks
Side effects of FQs
C. diff, CNS toxicity, Tendon rupture
Nonbacterial prostatitis/Chronic pelvic syndrome
Pelvic pain - unclear if prostate is cause
Clinical presentation of nonbacterial prostatitis
May report auto immune
No softness of the prostate
Negative cultures and imaging
Pharm Treatment for nonbacterial antibiotics
FQ or erythromycin for 6 weeks
Alpha blocker for urinary symptoms (tamsulozin, silodosin, alfuzosin are specific) can be more than 6 weeks
Adjunct pharm for chronic pelvic pain syndrome
5 alpha reductase inhibitors
NSAID
Qcertain can help
Percent of men who have BPH
80% of men over 80
50% of men 51-60
8% of men 31-40
Not all have symptoms
Risk factors for BPH - Lifestyle, ethnicity, drugs
Black ethnicity
Beta blocker use/Heart disease
Sedentary
Smoking/alcohol reduces
2 problems a large prostate can cause
Mechanical obstruction - narrow lumen
Dynamic obstruction - alpha 1 receptor stimulation
Clinical presentation of BPH
Obstructive voiding
Double voiding (twice in 2 hours)
Strain to urinate
Dribbling
MAY have irritative voiding
AUA score
Evaluates likelihood for BPH
Physical exam for BPH
Not rock hard
Smooth firm elastic enlargement
Neuro and abd exam
Labs for BPH
Normal UA
Check PSA - may not be cancer
Only biopsy if cancer concern
BPH treatment
Watchful waiting (0-7 score) - may regress
Best alpha blocker type for BPH
Alpha 1 a
3 Non selective alpha blockers for BPH
Prazosin, Doxazosin, Terazosin
Selective alpha blockers for BPH
Silodosin, Tamsulosin, Alfuzoson
Side effects for alpha 1a blockers
Dizziness, Orthostatic hypotension, Floppy iris syndrome, rhinitis, retrograde ejaculation
Drug interactions of alpha blockers for BPH
PDE-5 inhibitor
5 alpha reductase inhibitors for BPH
Block testosterone but take time
Reduce PSA and risk of prostate cancer
Finasteride and Dutasteride
Side effects of 5 alpha reductase inhibitors
Low sex drive, fatigue, ED
First line for BPH
Alpha blocker and 5 alpha reductase inhibitor
PDE-5 inhibitor for BPH
Tadalafil (Cialis) adjunct for ED and BPH
Herbals for BPH
Saw Palmetto - not first line
More invasive surgeries for BPH
TURP - Trans Urethral Resection - risk of retrograde ejaculation or incontinence. Removes prostate tissue from inside the urethra
Transurethral resection syndrome
Hypervolemic, hyponatremic state from irrigation solution used in the surgery
Altered mental status, confusion, N/D
Transurethral incision of the prostate
Cut muscle around bladder neck - less invasive than TURP
Open prostectomy
When prostate is too larger for endoscopic removal - many complications