Hematuria, dysuria, and nocturia Flashcards
what makes a uti uncomplicated?
if it is in a non-pregnant outpatient woman without any anatomic abnormalities or urinary instrumentation
what are some examples of factors that are associated with complicated UTIs?
pregnancy, urinary retention/obstruction, renal failure, renal transplant, and males
how is a recurrent UTI defined?
2 or more infection in 6 months or 3 or more infections in one year
what is asymptomatic bacteriuria?
bacteriuria present on urine culture but no clinical UTI symptoms present in the patient
what is catheter-associated UTI (CA-UTI)?
uti associated with placement of urinary catheter or within 48 hours of removal
what are the gram negative organisms associated with UTIs?
E. coli, Klebsiella pneumonia, proteus mirabilis, pseudomonas aeruginosa
what are the gram positive organisms associated with UTIs?
enterococcus species, staphylococcus saprophyticus, and group B streptococcus
what is the classic presentation of UTIs?
irritative voiding symptoms, suprapubic abdominal pain, gross/microscopic hematuria
what are the irritative voiding symptoms?
dysuria, urinary frequency, urinary urgency
what is the classic presentation of pyelonephritis?
patients will have the irritative voiding symptoms as well as: fever/chills/rigors, flank pain, CVA tenderness, fatigue, nausea/vomiting, and anorexia; AMS is a common presentation in older adults
what are 5 complications associated with UTIs?
sepsis/septic shock, acute kidney injury, perinephric abscess, emphysematous pyelonephritis, and papillary necrosis
how does interstitial cystitis present?
with irritative voiding symptoms but there is no evidence of infection
What things can urine dipstick detect?
leukocyte estrase, nitrites, blood, and color
what does presence of LE or nitrites typically mean?
there is a sensitivity of 75% and specificity of 82% for UTI
what does urinalysis with microscopy detect?
hematuria, pyuria, WBC casts, bacteria present
what do urine cultures with sensitivities show?
true UTIs have more than 10^5 CFU (colony-forming units/ml)
when might you use imaging to diagnose a UTI?
it is typically reserved for patients with acute complicated UTIs and/or possible pyelonephritis
what imaging modality do you use for UTIs?
CT abdomen/pelvis with and without IV contrast
what do CT scans in the setting of UTIs evaluate for?
calculi, obstruction, pyelonephritis findings
what are the pyelonephritis findings that can be seen on CT scans?
perinephric abscesses, perinephric stranding, areas of decreased contrast enhancement, and emphysematous pyelonephritis
What are the 4 different types of prostatitis?
acute bacterial prostatitis, chronic bacterial prostatitis, chronic pelvic pain syndrome, asymptomatic prostatitis
how is chronic bacterial prostatitis defined?
chronic infection of prostate gland (greater than 3 months)
what is chronic pelvic pain syndrome?
chronic pelvic pain with no detectable infection of prostate gland
who is most likely to get prostatitis?
young and middle-aged men
what are the risk factors for prostatitis?
functional or anatomical anomalies (urethral stricture), urinary tract instrumentation, UTIs, diabetes, smoking, HIV
what gram negative bacilli are most likely to causes prostatitis?
e. coli, klebsiella pneumonia, proteus mirabilis, pseudomonas aeruginosa
what gram positive cocci are most likely to cause prostatitis?
enterococcus species and normal skin flora
what is the clinical presentation of acute bacterial prostatitis?
acutely ill appearing, fevers, chills, malaise, n/v, signs of sepsis, irritative voiding symptoms, obstructive symptoms, suprapubic or perineal pain (“it hurts when I sit down”)
what is the clinical presentation of chronic bacterial prostatitis?
subtle signs, symptoms of recurrent UTIs, obstructive symptoms, suprapubic or perianal pain, pain with ejaculation or blood in semen
how do you make the diagnosis of acute prostatitis?
clinical diagnosis based on history and exam; digital rectal exam, urinalysis and culture
what else should you consider testing for in patients with possible prostatitis?
consider testing for gonorrhea and chlamydia in high risk patients
how do you make the diagnosis of chronic prostatitis?
digital rectal exam, urinalysis and culture, diagnostic standard is prostatic massage
how might the digital rectal exam on a patient with acute prostatitis differ from a digital rectal exam done on a patient with chronic prostatitis?
the DRE on a patient with chronic prostatitis is often normal on exam
how long should a patient with prostatitis be treated for?
duration of antibiotics is 4-6 weeks
what are 5 complications associated with prostatitis?
bacteremia and sepsis, epididymitis, prostatic abscess, chronic prostatitis, chronic pelvic pain
what are the risk factors for BPH?
age, metabolic syndrome, obesity, genetic susceptibility, excessive coffee or caffeine intake
BPH results from what?
increased total number of stromal and glandular epithelial cells within the prostate
what is LUTS and what does it result from?
lower urinary tract symptoms; results from both: bladder outlet obstruction (BOO) from BPH and detrusor muscle overactivity secondary to BOO
what do you have when BPH becomes symptomatic?
it becomes LUTS
what are the symptoms associated with LUTS?
storage symptoms (urinary frequency, urgency, nocturia, and urinary incontinence) and voiding symptoms
which set of symptoms in LUTS is usually more bothersome for most men?
the storage symptoms
how do you make the diagnosis of BPH?
typically a clinical diagnosis based on history and PE; DRE, UA, BMP, prostate specific antigen, or post-void residual US
what might the findings of a DRE be in a patient with BPH?
typically reveals an enlarged but non-tender prostate
how do you treat mild symptoms of BPH?
mild symptoms do not require treatment
how do you treat more severe cases of BPH?
surgical treatment: Transurethral resection of prostate (TURP) or a simple prostatectomy
what are the complications associated with BPH?
acute urinary retention, UTIs, bladder stones, formation of bladder diverticuli, acute or chronic kidney failure due to hydronephrosis
what is the lay term for nephrolithiasis?
kidney stones
what is the likelihood of forming a second stone?
it increases with time
most kidney stones have a composition of what?
calcium oxalate (79.1%)
kidney stones could be caused by acquired metabolic defects secondary to diseases such as what?
distal RTAs, primary or enteric hyperoxaluria, medullary sponge kidney, or horseshoe kidney
when kidney stones cause symptoms it is usually because of what? what are the symptoms?
urinary obstruction; severe flank pain that radiates to the groin, hematuria, gravel passage or visualized stone passage, n/v
what are the complications of nephrolithiasis?
hydronephrosis, AKI or CKD, recurrent urinary infections if stones become infected
how do you make the diagnosis of nephrolithiasis?
non-contrast CT of abdomen and pelvis, KUB x-ray, renal and bladder US, urinalysis with microscopy, strain urine
what is an example of a surgical treatment used for nephrolithiasis?
extracorporeal shock wave lithotripsy (ESWL)
