GU #1 Flashcards
Urge Incontinence
-Pathophysiology
-Symptoms
-MC in…
-Management
-Detrusor muscle overactivity. Stimulated by muscarinic acetylcholine receptors.
-Urgency, frequency, nocturne. Inability to make it to the bathroom on time.
-MC in older women.
-Treatment
-Bladder training (voiding diary, decreased fluids, avoid spicy foods, citrus, chocolate, alcohol, caffeine. Kegel exercises).
-Antimuscarinics: Tolterodine, Oxybutynin
-Mirebegron: causes bladder relaxation
-TCA’s (Imipramine): anticholinergic effect
-Surgical: Botox, bladder augmentation
Overflow Incontinence
-Pathophysiology
-Etiologies
-Symptoms
-Diagnostic (what is definitive)
-Management
–Atony
–BPH
-Bladder detrusor muscle under activity (impaired contractility) to bladder outlet obstruction.
-MC in neurological disorders or autonomic dysfunction (DM, MS, spinal injuries, peripheral neuropathy with B12 deficiency), BPH, bladder outlet obstruction, pelvic organ prolapse.
-Loss of urine without warning, leakage, dribbling, incomplete emptying, weak stream, hesitancy, frequency, nocturne. Leakage with changes in position.
-Post void residual > 200ml
-Atony: Intermittent or indwelling catheter first line. Cholinergics (Bethanechol) increase detrusor muscle activity.
-BPH: Alpha-blockers for symptom relief.
Stress Incontinence
-Pathophysiology
-Etiologies
-Symptoms
-Management
-Involuntary leakage of urine once increased abdominal pressure > urethral pressure (exertion, coughing, laughing, sneezing)
-Laxity of pelvic floor muscles (childbirth, surgery, postmenopausal estrogen loss). Urethral hyper mobility.
-Urine leakage at times of increased pressure.
-Kegel exercises initially, lifestyle modifications (weight loss, no smoking, drink smaller liquids, pads), pessaries, surgery (midurethral sling - more rapid and definitive).
Uterine Prolapse
-Uterine herniation into the vagina
-Risk Factors (MC after…)
-Symptoms
-Grades 0-4
-Treatment
-RF: Weakness of pelvic floor structures. MC after childbirth. Obesity, multiple vaginal births, heavy lifting, loss of estrogen (post menopause)
-Vaginal fullness, falling out sensation, low back/abdominal pain, urgency, frequency, stress incontinence.
-Grade 0: no descent
-Grade 1: uterus descent into upper 2/3 of vagina
-Grade 2: cervix approaches introitus
-Grade 3: cervix outside introitus
-Grade 4: entire uterus outside the vagina.
-Treatment: pessaries, estrogen treatment. Surgical = hysterectomy or sacrospinous ligament fixation to spare uterus.
Peyronie Disease
-What is it?
-Pathophysiology
-Symptoms
-Management
-Fibrotic changes of tunica albuginea leading to abnormal penile curvature.
-Unknown pathophysiology by contributing factors include penile trauma, tissue ischemia, and excessive collagen.
-Penile pain, curvature, induration, shortening, sexual dysfunction.
-Urologist referral. Observe if mild curvature (30 degrees or less). Surgical treatment if > 30 degrees. Oral Pentoxifylline if within 3 months of onset. Intralesional IJ with collagenase if > 3 months.
Vesicoureteral Reflux
-What is it?
-Types (Primary vs. Secondary)
-Symptoms
-Diagnostics
-Management
-Retrograde passage of urine from the bladder into the upper urinary tract.
-Primary (MC type): due to incompetent UVJ.
-Secondary: due to abnormally high voiding pressure in the bladder that leads to failure of the closure of the UVJ.
-Symptoms: prenatal = hydronephrosis on prenatal US. Postnatal = febrile UTI.
-Diagnostics
–Renal and bladder US initially
–Voiding cystourethrogram DOC
-Management
–Grades I and II: Observation and ABX Prophylaxis (Bactrim, Nitrofurantoin)
–Grades III and IV: Surgical correction
Acute Cystitis #1
-Pathophysiology (what is it)
-Risk Factors
-Etiologies
-Symptoms
-Ascending infection of the lower urinary tract from the urethra
-RF: Women, pregnancy, elderly, DM, postmenopausal, infants
-E. Coli MC, Staph saprophyticus 2nd MC in sexually active women, Enterococci with indwelling catheters
-Dysuria, frequency, urgency, hematuria, suprapubic pain, tenderness
Acute Cystitis #2
-What makes it complicated?
-Diagnostics (What is seen on UA, what is definitive)
-Management of Uncomplicated?
-Management of Complicated?
-Complicated = symptoms > 7 days, pregnancy, diabetics, immunosuppression, indwelling catheter, elderly, males.
-UA = Pyuria (>10 WBCs/hpf), hematuria, nitrites, cloudy, increased pH with proteus.
-Urine Culture = Definitive. Need a clean catch specimen. If epithelial (squamous cells) = contamination.
-Uncomplicated Tx: Nitrofurantoin or Bactrim (first line). Fluoroquinolones (2nd line, or if sulfa allergy)
–Adjunct: increase fluids, void after intercourse, Hot Sitz baths. Phenazopyridine is a bladder analgesic, used for less than 48 hours, turns the urine orange.
-Complicated Tx: Fluoroquinolones PO or IV, Aminoglycosides x 7-10 or 14 days.
For Cystitis during pregnancy, what medications can be used?
Amoxicillin, Augmentin, Cephalexin, Nitrofurantoin, Fosfomycin.
For Asymptomatic Bacteriuria, when should you give treatment?
-Pregnancy, patients with chronic indwelling catheters ONLY
Pyelonephritis
-What is it?
-Pathophysiology
-Etiologies
-RF
-Symptoms and Exam Findings
-Diagnostics (UA, what is hallmark, definitive)
-Outpatient MgMt
-Inpatient MgMt
-Pregnancy Treatment
-Infection of upper genitourinary tract
-Ascending infection from lower urinary tract
-E. Coli MC etiology
-RF: DM, history of recurrent UTIs or kidney stones, pregnancy
-Fever, chills, back/flank pain, nausea, vomiting, dysuria, urgency, frequency, CVA tenderness, fever, tachycardia
-UA = Pyruria (>10 WBCs/hpf), cloudy urine, hematuria. WBC casts HALLMARK. Urine culture = definitive.
-Outpatient = Fluoroquinolones (first line)
-Inpatient = Cephalosporins, Fluoroquinolones, Aminoglycosides, or extended PCNs for 2 weeks
-Pregnancy = IV Ceftriaxone (first line). Aztreonam if PCN allergic.
Urethritis
-Two MCC
-Symptoms of both
-Diagnostics (most sensitive, others)
-Management
-Chlamydia Trachomatis. Pruritus, hematuria, purulent or mucopurulent discharge.
-Gonoccocal Urethritis: abrupt onset of symptoms, opaque/yellow/white/clear thick discharge, pruritus.
-Symptoms: urethral discharge and penile or vaginal pruritus. Dysuria. Abdominal pain or abnormal vaginal bleeding.
-NAAT most sensitive.
-Gram stain (2 or more WBCs/hpf). No organisms seen is suggestive of NGU. Gram negative diplococci = Gonorrhea.
-UA = positive leukocyte esterase or > 10 WBC/hpf
-Management
–Treat both Gonorrhea and Chlamydia due to co-infection.
–Gonorrhea = Ceftriaxone 250mg IM PLUS Azithromycin 1g x 1 dose
–Chlamydia = Azithromycin or Doxycycline 100mg BID x 10 days
What bacteria shape is N. Gonorrhea?
Gram Negative Diplococci
Orchitis
-Etiologies
-Symptoms
-Management
-Viral MC (Mumps***, Echovirus, Rubella)
-Scrotal pain, swelling, tenderness. Scrotal erythema and tenderness.
-Symptomatic management: NSAIDs, bed rest, scrotal support, cool packs.
Cryptorchidism
-What is it?
-MC on which side?
-Increased risk?
-Symptoms
-Diagnostics
-Management
-Complications
-Testicle that has not descended into the scrotum by 4 months of age
-MC on the right side
-Prematurity, low birth weight, maternal obesity or diabetes
-Empty, small, poorly rugated scrotum. Inguinal fullness.
-Physical exam, scrotal US
-Orchiopexy as early as 4-6 months of age and DEFINITELY by 2 years of age. Observation if < 6 months of age.
-Increased risk of testicular cancer
