GU Flashcards
What is stress incontinence?
Leakage of urine with activities causing increased intra-abdominal pressure (coughing, laughing, sneezing, etc.)
What are 2 diagnostic tests for stress incontinence?
Cough stress test (pos if urine leak w/cough)
Cotton swab test (pos if angle change is > 30*)
What is the treatment for stress incontinence?
Conservative: avoid excess fluids, scheduled voiding, pelvic floor rehab
Meds: non are FDA approved; can try phenylpropanolamine or duloxetine
Surgery: intravesicular balloon, sling procedure, urethropexy
What is urge incontinence?
Sudden urge to urinate w/subsequent leakage, leakage of urine prior to reaching toilet, or bladder contraction stimulated by senses (running water, cold weather, arriving home, etc.)
What is the treatment for urge incontinence?
Conservative: avoid excess fluid, scheduled voiding, pelvic floor rehab
Meds: Antimuscarinics (darifenacin or solifenacin, tolterodine or fesoterodine, oxybutynin) topical vaginal estrogen (mirabegron) (not FDA approved)
Surgery: neuromodulation, botox A injection
In terms of treatment, if someone presents with mixed incontinence, how do you treat it?
Focus on addressing the predominant symptoms
What is overflow incontinence?
Urinary dribbling, leakage of urine without preceding urge, weak urinary stream, sensation of incomplete bladder emptying
What diagnostic test can be performed for overflow incontinence?
Pelvic ultrasound w/post-void residual volume (pos if > 200mL remains in bladder)
What is the treatment for overflow incontinence?
Conservative: intermittent cath, indwelling cath
Meds: alpha-adrenergic antagonists (terazosin or tamsulosin)
Surgery: suprapubic cath
When does functional incontinence occur?
In pts with normal urinary tracts, but have cognitive or physical barriers to toileting (dementia, severe depression, physical disability, etc.)
What is enuresis?
Incontinence while sleeping after the age that bedwetting is common (> 7 yo)
What is the treatment for enuresis?
Avoid caffeine later in the evening
Avoid fluids just before bed
Bed moisture alarms
What is the most common formulation of nephrolithiasis (kidney stone)?
Calcium oxalate
What are signs/symptoms of nephrolithiasis?
Stone in kidney: asymptomatic
Stone in ureter: restlessness, frequent/painful urination, flank pain that radiates to groin on affected side, hematuria
What is the test of choice for nephrolithiasis if the pt has hematuria?
Renal CT without contrast
What is the treatment for nephrolithiasis?
Pain management (NSAIDs or opioids)
Increase fluid intake
Dilation of ureters w/tamsulosin (flomax) (take before bed)
When would nephrolithiasis require surgery/admission to the hospital?
Surgery: stone is > 6mm or delayed passage (nephrolithotomy, rigid & flexible ureteroscopy, shockwave lithotripsy)
Admit: obstructed/infected upper urinary tract, intractable vomiting or pain, anuria or deteriorating renal function, hx of kidney transplant/solitary kidney w/obstructing stone
What are the formulations of stones based on urine pH level?
pH > 8: calcium and phosphate
pH < 6: uric acid or crystine
What size of a kidney stone is likely to pass on its on, and when should you refer to urology?
< 4mm will pass on its own
Refer to urology if stone is > 6mm or stone is < 6mm but has not passed in 4 weeks
Where in the urinary tract are stones more/less likely to pass from?
Proximal ureter: less likely to pass
Distal ureter: more likely to pass
What causes 90% of acute bacterial prostatitis?
E. coli
What are signs/symptoms of acute bacterial prostatitis?
Fever/chills
Fatigue
Myalgias
Dysuria
Urinary frequency
Urinary hesitancy
Suprapubic/pelvic/perineum pain
Recent hx of UTI, prostate biopsy, prostate manipulation
What test should be performed when working up a pt for acute bacterial prostatitis who is < or = to 35 yo or has high-risk sexual activity?
Gonorrhea/chlamydia
What is the treatment for acute bacterial prostatitis?
Mild-mod: Bactrim or Cipro x 6 weeks
Severe: Ampicillin 2g IV q6 hrs + Gentamicin 5mg/kg QD until afebrile, once afebrile/stable Bactrim or Cipro x 6 weeks
