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CPR II Exam 3 > Incontinence, Prostate Cancer, and BPH (Tyler) > Flashcards

Incontinence, Prostate Cancer, and BPH (Tyler) Flashcards

1
Q

Acute Dysuria

A

<1 week

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2
Q

Internal Dysuria

A

dysuria that is localized to the internal genital structures

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3
Q

External Dysuria

A

Dysuria that is localized to the external genital structures and occurs as urine exits the body

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4
Q

Urgency

A

A sudden, compelling need to urinate that is often accompanied by bladder discomfort and inability to void more than a minimal quantity of urine

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5
Q

Frequency

A

urinating more frequent than usual without increase in total urine volume due to decrease bladder capacity to hold urine

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6
Q

Nocturia

A

waking up to urinate 2 or more times during the night

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7
Q

Voiding symptoms

A 
symptoms that occur at time of urination including slow/intermittent urine stream and difficulty initiating urination (hesitancy) 
prolonged termination (dribbling)
and dysuria
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8
Q

Storage symptoms

A

symptoms that occur during bladder storage and filling

including urgency, frequency, nocturia, and incontinence

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9
Q

UTI

A

infection of urethra, bladder, prostate, or kidney

lower UTI implies infection of urethra/bladder

upper UTI implies kidney

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10
Q

complicated UTI

A

uti in individual with functional or structural abnormalities of the urinary tract.

higher risk of treatment failure

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11
Q

Nocturnal Polyuria age related and social related

A

Fluid intake
Late afternoon and evening intake
Caffeine
Alcohol

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12
Q

Nocturnal Polyuria peripheral edema

A

Venous insufficiency

CHF

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13
Q

Nocturnal Polyuria Medications

A 
Gabapentin
Pregabalin
Thiazolidinediones
NSAIDs
Pyridine Calcium Blockers
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14
Q

Stress Incontinence

A

leakage of Urine on coughing/sneezing/standings

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15
Q

Urge incontinence

A

urgency and inability to delay urination

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16
Q

Overflow incontinence

A

variable presentation

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17
Q

Transient causes of incontinence

A

DIAPPERS

Delerium
Infection
Atrophic urethritis/vaginitis
Pharmaceuticals
Psychological factors (depression with psychomotor retardation)
Excess urinary output
Restricted mobility
Stool impaction
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18
Q

pharmacology in transient incontinence

A

Potent diuretics

Anticholinergics

Psychotropics

Opioid analgesics

α-Blockers (in women)

α-Agonists (in men)

Calcium channel blockers

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19
Q

established causes of incontinence

A

Detrusor overactivity
urethral incompetence
detrusor underactivity

20
Q

Detrusor overactivity

A

urge incontinence

Uninhibited bladder contractions that cause leakage

Most common cause of established geriatric incontinence, accounting for two-thirds of cases; usually idiopathic

Detrusor hyperactivity with incomplete contractions (DHIC) is a subtype of urge incontinence that can present with urgency with incomplete bladder emptying

21
Q

Urethral incompetence

A

stress incontinence

Urethral obstruction

Common in older men but rare in older women

May be due to prostatic enlargement, urethral stricture, bladder neck contracture, or prostatic cancer in men

Cystoceles or other anatomic problems can be causes in women

22
Q

Detrusor underactivity

A

overflow incontinence

least common cause of incontinence

may be idiopathic or due to sacral lower motor nerve dysfunction

23
Q

signs and symptoms of atrophic urethritis and vaginitis

A

Vaginal mucosal friability

Erosions

Telangiectasia

Petechiae

Erythema

24
Q

signs and symptoms of detrusor overactivity

A

(urge incontinence)

complaint of urinary leakage after onset of an intense urge to urinate that can’t be forestalled

standing full bladder stress test may result in second delay in release of urine

25
Q

signs and symptoms of urethral incompetence

A

stress incontinence

Urinary loss occurs with laughing, coughing, or lifting heavy objects

Most commonly seen in women but can be seen following prostatectomy in men

A standing full bladder stress test (asking the patient to cough while standing) should result in immediate release of urine

26
Q

signs and symptoms of urethral obstruction

A

Common symptoms include dribbling, urge incontinence, and overflow incontinence

Detrusor overactivity (which coexists in two-thirds of cases) may cause symptoms of urgency

27
Q

signs and symptoms of detrusor underactivity

A

overflow incontinence

Urinary frequency, nocturia, and frequent leakage of small amounts

An elevated postvoid residual (generally over 450 mL) distinguishes detrusor underactivity from detrusor overactivity and stress incontinence, but only urodynamic testing differentiates it from urethral obstruction in men

28
Q

Laboratory tests for incontinence

A

Review medications

Check urinalysis, urine culture

Consider tests for hyperglycemia, hypercalcemia, diabetes insipidus

29
Q

imagine for incontinence

A

US can determine postvoid residual

in older men for whom surgery is planned urodynamic confirmation of obstruction is strongly advised

30
Q

diagnostic procedures for incontinence

A

To test for stress incontinence, have the patient relax her perineum and cough vigorously (a single cough) while standing with a full bladder

1Instantaneous leakage indicates stress incontinence if urinary retention has been excluded by postvoid residual determination using ultrasound

A delay of several seconds or persistent leakage suggests the problem is caused by an uninhibited bladder contraction induced by coughing

Because detrusor overactivity may be due to bladder stones or tumor, the abrupt onset of otherwise unexplained urge incontinence—especially if accompanied by perineal or suprapubic discomfort or sterile hematuria—should be investigated by cystoscopy and cytologic examination of the urine

31
Q

LUTS suggestive for BPH

A

urinary frequency—urination eight or more times a day

urinary urgency—the inability to delay urination

trouble starting a urine stream

a weak or an interrupted urine stream

dribbling at the end of urination

nocturia—frequent urination during periods of sleep

urinary retention

urinary incontinence- the accidental loss of urine

pain after ejaculation or during urination

urine that has an unusual color or smell

32
Q

symptoms from BPH most often come from

A

blocked urethra

bladder that is overworked from trying to pass urine through the blockage

33
Q

AUA scoring 0-5

A 
0 not at all
1 less than 1 time in 5
2 less than half the time
3 about half the time
4 more than half the time
5 almost always
34
Q

AUA questions

A

Over the past month how often….

had the sensation of failing to empty bladder

had to urinate wi/in 2 hours of finishing

have you found you stopped and started again several times

have you found it difficult to postpone urination

have a weak urinary stream

had to push or strain to begin urination

most typically get up to urinate from the time you went to bed at night

35
Q

AUA symptoms scale

A

0-7 mild
8-19 moderate
>35 severe

36
Q

symptoms due to BPH often coexist with

A

symptoms over overactive bladder

37
Q

most common pharm for overactive bladder is

A

anticholinergics

38
Q

TULIP

A

Transurethral US guided laser induced prostatectomy

39
Q

Prostate cancer risk increase

A

2.5 fold if one first degree relative is affected

5 fold if more than one

40
Q

amount of prostate cancers that are hereditary

A

5-10%

41
Q

what percent of early onset prostate cancer are hereditary

A

40%

42
Q

when should you test someone above the age of 75 for PSA

A

higher than median PSA measured before age of 70

43
Q

most men with screen detected prostate cancer Tx

A

don’t treat, observe

44
Q

if a man needs treatment for his prostate cancer how do you treat?

A

you don’t send him to urology

45
Q

are DRE and PSA recommended for routine screening

A

negative

46
Q

DRE is considered when

A

in high risk patients and does not actually impact decision making

47
Q

if PSA is 4-7

A

refer to urology if symptom score is moderate to severe

CPR II Exam 3 (13 decks)

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