GU Flashcards
Urinary tract infections (UTI’S)
Inflammation and infection involving the kidneys, ureters, bladder and/or urethra
Causes of UTI’s
Lower: cystitis, urethritis/dysuria frequency syndrome
Upper: Pyelonephritis, renal abscesses
E. Coli #1 cause in women
Proteus species most common in men
S/S of lower UTI’s
Dysuria is key symptom Frequency Nocturia Urgency Hematuria
Diagnostics of UTI
Urinalysis usually shows pyuria (>10WBC)
Presence of nitrate on dipstick (specific but not sensitive for bacteria)
Esterase detection on dipstick (very sensitive but not specific)
Management of lower UTI
3-day therapy maximizes benefits and minimizes drawbacks of treatment
Bactrim, Cipro, and augmentin
Pregnancy: amox, nitrofurantoin, cephalexin, for 7-10 days
Acute pyelonephritis s/s
Flank, low back pain or abdominal pain
Fever and chills often present and usually indicate upper UTI
N/V
Mental status changes in the elderly
Stress incontinence
Causes: muscles impairing urethral support (most common) and intrinsic sphincter deficiencies due to pelvic surgery
Findings of stress incontinence
Urine leakage from activities with increased pressure on bladder
Typically a small amount of urine
Urge incontinence causes
Detrusor overactivity by CNS abnormalities such as strokes Infections of the GU tract Urinary Stones Neoplasms Fecal impaction
Urge incontinence findings
Urgency, involuntary urinary loss, nocturia, frequency
Often referred to as “overactive bladder”
Typically a large amount of urine
Management of stress incontinence
Timed voids to prevent full bladder
Pessary
Surgery
Management of urge incontinence
Urge suppression/distraction
Quick pelvic contractions
Medication
Patient teaching for incontinence
Weight loss (good for urge incontinence) Fluid management Avoid caffeine Pelvic floor exercises Bladder control strategies (urge =freeze and squeeze, Stress= squeeze before you sneeze)
Muscarinic Receptor antagonists
Immediate release: Oxybutynin, Tolterodine, Trospium
Extended release: Darifenacin, fesoterodine, Dirtropan, Solifenacin, Detrol, Oxybutynin transdermal, oxybutynin gel
Varicocele
A collection of dilated veins around the spermatic cord
S/s of varicocele
Often asymptomatic
Scrotal pain
Scrotum looks like a “bag of worms”
Decreased fertility
Management of varicocele
NSAIDs
Surgical ligation, venous embolization
Tanner stage 1 in boys
Preadolescent testes, scrotum and penis
Tanner stage 2 in boys
Enlargement of scrotum and testes, scrotum roughens and reddens
Tanner stage 3 in boys
Penis elongates
Tanner stage 4 in boys
Penis enlarges in breadth and development of the glans; rugae appear
Tanner stage 5 in boys
Adult shape and appearance
Epididymitis
Acute inflammatory or infection of the scrotum, secondary to an inflamed epididymis
Commonly in men <35 yo w/ chlamydia as causative agent
When >35 yo likely a result of a bacterial ascension from the bladder or bacteria introduced during cauterization and/or surgery
S/s of epididymitis
Pain dysuria urgency/frequency low back/perineal pain Fever/chills malaise scrotal edema
PE for epididymitis
Enlarged, tender epididymitis
Urethral d/c
Positive Prehn’s sign= no pain relief w/ elevation of scrotum
Diagnostics for epididymitis
STD testing
Urine culture
scrotal US
Management of epididymitis
Adults under 35= ceftriaxone 250mg IM x1 + doxycycline 100mg BID x14 days OR Azithromycin 1 gm PO once
Adults over 35= Bactrim 1 tab BID x 10 days OR Cipro 250 mg BID x10 days
Ice(early), heat (late)
Acute Bacterial Prostatitis
Inflammatory infection of the prostate
Usually caused by gm- bacteria (E.coli)
Nonbacterial= mostly in young men, chlamydia, mycoplasma, gardnerella
S/S of ABP
Fever/chills low back pain dysuria urgency/frequency nocturia
PE of ABP
Edematous prostate, may be warm and tender/boggy to palpation
Diagnostics for ABP
Urine culture–+ for causative agent
Management of ABP
Abx= Bactrim, Levofloxacin, nofloxacin, ofloxacin
Sitz bath 3x daily for 30 min each
No sexual intercourse until acute phase resolves
Benign prostatic hypertrophy (BPH)
Progressive, benign hyperplasia of the prostate
By age of 50, 50% of men will exhibit signs
By 80, 80% of men
Most common cause of bladder obstruction in men over 50
S/s of BPH
Urgency/frequency
Nocturia
Dribbling
Retention
PE of BPH
Bladder distention
Prostate non-tender with either asymmetrical or symmetrical enlargement
Smooth, rubbery consistency with possible nodules
Diagnostics of BPH
U/A Uroflowmetry Abd US Serum Cr/BUN should be normal Prostate-specific antigen (PSA): >4ng/ml indicates disease DRE
Management of BPH
Alpha-blockers: Terazosin, prazosin, Tamsulosin to relax muscles of the bladder and prostate
5-alpha-reductase ihibitors: Finasteride and dutasteride to shrink large prostates
Saw palmetto–effective for some
Prostate cancer
Malignant neoplasm of the prostate gland
2nd most common cancer among men
S/s of prostate cancer
Usually asymptomatic
May appear to be BPH in early stages
In advanced stages= bone pain from metastises, uremia secondary to obstruction may occur
PE of prostate cancer
Adenopathy
Bladder distention
Prostate palpates harder than normal with obscure boundaries, and nodules may be present
Prostate-specific antigens (PSA)
Values >4ng/ml=abnormal
The higher the PSA—the more likely the diagnosis of cancer
Approx 40% of pts with prostate cancer with present with normal PSA values!
Erectile Dysfunction
Inability to sustain an erection capable of intercourse
Major causes of ED
Stress– psychosocial issues, performance anxiety
Athertosclerosis
Diabetes
Recreational drugs
Meds- diuretics, antihypertensives, H2 blockers, antidepressants, anti-anxiety agents, anti-epileptics, antihistamines, NSAIDS, muscle relaxants, Parkinsons meds
Management of ED
Fix underlying cause
Check T level
Phosphodiesterase inhibitors: Sildenafil, vardenifil, tadalafil, avanafil (careful with use of nitrates!)
What ED drugs can last up to 36 hours and works within 15 minutes?
Tadalafil and Avanafil
Which ED drugs work in 30 minutes and last 4 hours?
Sildenafil and Vardenafil
UTI’s in the older adult
Most common clinical illness over 65
E. coli
Enterococci
Typically have atypical findings such as incontinence, fecal impaction, lethargy, decreased appetite, dehydration, confusion
Renal changes in the older adult
Diminished renal blood flow
Kidneys decrease in size
GFR diminishes
Reduced hormonal response to vasopressin
Bladder tone, elasticity and capacity are reduced
Decreased drug clearance
How do you determine renal function in the elderly?
Creatinine clearance
Cockcroft-Gault Equation:
Males: Cr.Cl= 140 minus age in years x kg
/ 72 x creatinine
Females: multiply the calculated value by 85% (0.85)
What is the normal Cr cl values in adults?
Males: < 40= 107-139 mL/min or 1.8 to 2.3 mL/sec
Females <40= 87-107 mL/min or 1.5-1.8 mL/sec
*Cr cl values usually decrease as one ages (6.5 mL/min for every 10 years after the age of 20)
