Hematuria, Nocturia and Dysuria

Question 1

What are some Ddx for hematuria from the upper urinary tract?

Answer 1

Renal malignancy, renal cysts, urinary stones, glomerulonephritis, UTI (pyelonephritis, cystitis)

Question 2

What are some Ddx for hematuria from the lower urinary tract?

Answer 2

Bladder cancer, bladder stone, hemorrhagic cystitis (cyclophosphamide), BPH, prostate cancer, urethritis, urethral trauma (urinary catheter, etc)

Question 3

What is an uncomplicated UTI?

Answer 3

acute cystitis or pyelonephritis in a non-pregnant out pt woman without any anatomic abnormalities or urinary instrumentation

Question 4

What is a complicated UTI?

Answer 4

all other urinary infections are considered complicated; essentially these are UTIs associated with factors increasing colonization and decreasing efficacy of therapy such as pregnancy, urinary retention or obstruction, renal failure or transplant, males, anatomic abnormalities, catheters, immunocompromised pt

Question 5

What is a recurrent UTI?

Answer 5

Greater than or equal to 2 infections in 6 months or greater than or equal to 3 infections in one year

Question 6

What is asymptomatic bacteriuria?

Answer 6

bacteriuria present on urine culture but no clinical UTI sx present in pt

Question 7

What is catheter associated UTI (CA-UTI)?

Answer 7

UTI associated with placement of urinary catheter or within 48 hours of removal

Question 8

What is the pathogenesis for UTIs?

Answer 8

uropathogenic bacteria colonizing the GI tract, perineum or vagina inoculate the urethra and ascend into the bladder

Question 9

What are common gram negative bacilli that cause UTI?

Answer 9

E coli (75%), Klebsiella, proteus, psuedomonas

Question 10

What are common gram positive cocci that cause UTIs?

Answer 10

Enteroccocus, staph saprophyticus, group B strep

Question 11

What are some Ddx for UTIs?

Answer 11

Vaginitis (candida vulvovaginitis, bacterial vaginosis, trichomonas, etc), urethritis (chlamydia, gonorrhea, trichomonas, herpes simplex, etc), pelvic inflammatory disease (chlamydia, gonorrhea, etc), cystitis, pyelonephritis, prostatitis, epididymitis, interstitial cystitis (irritative voiding sx but no evidence of infection)

Question 12

What is acute bacterial prostatitis?

Answer 12

acute infection of the prostate gland

Question 13

What is chronic bacterial prostatitis?

Answer 13

chronic infection of the prostate gland (>3 mo)

Question 14

What is chronic pelvic pain syndrome?

Answer 14

chronic pelvic pain with no detectable infection of the prostate gland

Question 15

What is asymptomatic prostatitis?

Answer 15

infection present in prostate gland but pt is asymptomatic

Question 16

What is the pathogenesis for prostatitis?

Answer 16

Bacteria in the urethra will migrate via the prostatic ducts in the prostate gland; there can also be direct bacterial entry into the prostate from transrectal prostate biopsy

Question 17

What are the common bacteria that cause prostatitis?

Answer 17

Gram negative include E coli, Klebsiella, proteus and pseudomonas; gram positive include enterococcus and normal skin flora

Question 18

BPH results from what?

Answer 18

from an increased total number of stromal and glandular epithelial cells within the prostate

Question 19

Lower urinary tract sx result likely from what?

Answer 19

bladder outlet obstruction (BOO) from BPH and detrusor muscle overactivity secondary to BOO

Question 20

What are some Ddx for nocturia?

Answer 20

Urinary incontinence, diuretics, BPH, UTIs, primary polydipsia, polyuria (DI or DM), sleep apnea, fluid intake before bed

Question 21

What is the likelihood of a second kidney stone occurring after the first one?

Answer 21

15% at 1 year, 35-40% at 5 years and 50% at 10 years

Question 22

What is the MC type of kidney stone?

Answer 22

calcium stones