GU Emergencies Flashcards
Sx’s of acute urinary retention
can’t pee, decreased stream, “dribble”, severe pain in lower abdomen
what is acute urinary retention?
painful inability to void
pathophysiology of acute urinary retention? (HINT: 3 factors)
increased urethral resistance
-bladder outlet obstruction
lower bladder pressure
-impaired bladder contractility
interruption of sensory and motor innervations of the bladder
what factors can trigger acute urinary retention?
Prostatitis, Narcotics, diphenhydramine (anticholinergics), Pseudoephedrine, Oxybutynin/Detrol, ETOH ingestion, anesthesia (paralyzes bladder)
how does prostatitis trigger acute urinary retention?
increases bladder outlet obstruction (M/C)
how do narcotics trigger acute urinary retention?
reduce bladder contractility
how does diphenhydramine trigger acute urinary retention? who does it cause retention in?
it’s an anticholinergic -> reduces contractility
-causes retention in older people
how does Pseudoephedrine trigger acute urinary retention?
it’s a sympathomimetic which stimulates Alpha-receptors in prostate
how does Oxybutynin/Detrol trigger acute urinary retention?
anticholinergic meds for tx of overactive bladder or bladder spasms
-can flip someone into retention
most common cause of acute urinary retention in men?
BPH
causes of acute urinary retention in women?
pelvic prolapse, urethral stricture, urethral diverticulum, post-surgery, pelvic masses that stop contractility of the bladder
causes of acute urinary retention in both men and women?
clot retention (clot off urethra), herpes zoster virus can cause the bladder to not contract
what is the initial management of acute urinary retention?
Urethral catheterization (Foley catheter) - to drain bladder
Supra Pubic Catheter (for pts that had trauma to the urethra)
what is late management of acute urinary retention?
treat the underlying cause (do this after drain the bladder)
what labs do you want to get for acute urinary retention?
UA and Cx - want to check Cr, electrolytes, see if there’s an infection
what are the indications for treatment for BPH?
incomplete bladder emptying, acute urinary retention, CRI
what is the FIRST LINE medical tx for BPH?
Alpha-1 blockers
-Terazosin, Doxazosin, Tamsulosin (M/C), Alfuzosin
what is the MOA of alpha-1 blockers?
-relax the muscle of the prostate and bladder neck -> increased urinary outflow
when do alpha-1 blockers begin to work?
quickly, within 72hrs
what is the M/C side effect of alpha-1 blockers?
orthostatic hypotension
which alpha-1 blockers are more likely to lower BP (cause orthostatic hypotension)? when are they taken?
Terazosin and Doxazosin are more likely to lower BP
Taken at Bedtime
when can you NOT take terazosin or doxazosin?
do not take terazosin or doxazosin with meds for ED like sildenafil, vardenafil, tadalafil, or avanafil
Tamsulosin and Alfuzosin don’t interact with ED meds
Tamsulosin has a higher incidence of what?
ejaculatory dysfunction
do Tamsulosin 0.4mg and Alfusozin need to be pirated up?
NO!!!
what are other meds to use to treat BPH?
5-Alpha-reductase inhibitors
Finasteride (M/C), Dutasteride
MOA of 5-Alpha-reductase inhibitors?
androgen inhibitors -> suppress growth of prostate and can cause it to shrink
how long does it take for Finasteride or Dutasteride to work?
6 months -> no indication to start in the AUR phase
side effects of Finasteride or Dutasteride? what can they cause? side effects resolve when?
decreased sex drive, difficult with erection or ejaculation, or sx’s of depression
- can cause pts to stop taking the meds
- side effects resolve when the med is stopped
what levels decrease by 50% in men who take Finasteride or Dutasteride? why is this important to remember?
PSA levels decrease by 50%
-important to remember if you have PSA testing to screen for prostate cancer
complication of acute urinary retention?
Post-Obstructive Diuresis
what is the criteria for Post-Obstructive Diuresis?
> 200ml/hr for 3 consecutive hrs or 3L/24hrs of urine drained
-if >1000cc in bladder and increased Cr, monitor for post-obstructive diuresis
pts with post-obstructive diuresis need to be kept as what?
need to be kept inpatient to monitor for urine output and electrolytes
tx for post-obstructive diuresis?
IVF at 75% of the cc/hr rate of diuresis
probably keep Foley in for 10-14 days
all men in urinary retention need what follow-up?
a Urology follow-up
what trial should AUR pts get?
a voiding trial in 3-7 days
sx’s of nephrolithiasis?
writhing in pain - can’t sit still
unremarkable abdominal exam
pain refers to genitals