LUTS Flashcards
how many voids per night constitutes nocturia?
There is no set number
Nocturnal polyuria
What percentage of the total urine volume needs to be produced at night to dx nocturnal polyuria?
> 33%
What is the cause of nocturnal polyuria?
decreased arginine vasopressin over time
how much urine output is needed to dx polyuria?
> 3L per day
how does OSA cause nocturia?
Does aldosterone increase or decrease
decreased O2 perfusion leads to right sided heart dysfunction
this increased atrial natriuretic peptide which leads to decreased aldosterone
this increased urine production via water and salt excretion from vessels
DDAVP monitoring regimen
DDAVP dose
hyperosmolar urine induces hyponatremia
check BMP after 1 week, then 1 month, then 3-6 months afterwards
dose: 25mcg and 55mcg
Contraindications to DDAVP
sodium < 135mE/L
glucocorticoid use
loop diuretics
kidney disease
acute fluid wasting illness like GI bug
AUA definition of chronic urinary retetion
PVR >200cc for at least 6 months on two difference occasions.
if >300cc at least 2x, need renal sono and creatinine
DDX for urinary retention
spinal cord disease
cauda equina syndrome
MS (25% of patient needed CIC)
tumor/mass effect
fowlers
DM
age
POP
post-surgical
medication
DSD
Obstructive vs neurogenic causes
What is Fowlers syndrome?
painless retention due to decreased bladder sensation and failure of urethral relaxation
urethral diverticulum DDX
skenes
malignancy
ectopic ureterocele
leiyomyoma
Gartners duct cyst
risk factors for urethral diverticulum
AA race (OR 3.0)
UTIs
pelvic trauma/instrumentation
Process for urethral diverticulum development
repeat infections in urethra and paraurethral glands causing abscess/dilation and attaches to urethra
steps for urethral diverticulum removal
-urethroscopy
-foley
-u shaped or straight incision
shell diverticulum with sharp dissection and cut at the base when urethra is entered
-secure mucosal edges with 4-0
urethral diverticulum
risk factors for failure of repair
smoker
immunosuppressed
infection
large or complex fistula
urethral diverticulum
complications and rates
fistula 2-8%
Incontinence (de novo): 15%
stricture
how often does microhematuria workup come back negative?
60%
Hematuria DDX
-bladder cancer
-Renal disease-stones, failure
-trauma/instrumentation
-hx of pelvic surgery/mesh
-endometriosis
-Menses
-strenuous exercise
-schistosomaisis from somalia, middle east, east asia
-AVM
-chemo/rad cystitis
Patient <50
<25 rbc/hpf
nonsmoking
what is her chance of malignancy?
0.25%
What imaging should you select for hematuria work up?
Pt is over 50
CT urogram is the first choice
Non-contrast CT is okay for stones
US if CT is contraindicated
IVP if stone/mass is suspected
What is the success rate of a primary VVF repair?
What is the success rate of a secondary repair?
90%
80-90%
When should you repair a VVF?
<72 hours from inciting event
OR
after 12 weeks to allow for inflammation to subside
What is her risk of urinary tract malignancy?
<50 years old
never smoker
no gross hematuria
UA showed <25 RBC/hpf
0.5%
What is the AUGS and ACOG recommendation for microhematuria work up for low risk women age 35-50?
> 25 RBC/Hpf
What is the rate of urologic malignancy in women with any degree of hematuria?
<1%
what percentage of malignancy is thought to be iatrogenic due to CT radiation exposure?
up to 2 %
how do you counsel your patients regarding hematuria work up?
-History-smoking, chemical exposure, gross hematuria, menstruation, rectal bleeding, prior pelvic surgery
-physical-signs of blood source, UA, GSM
-shared decision making - she low risk
-discuss that rate of urologic cancer in women with any amount of hematuria is <1%
-explain what the work up would entail
Per AUA guidelines, at what age should all AMH work ups include CT urogram?
60 and older
Per AUA guidelines, below what age can you just repeat UA in 6 months?
<50
which patients would you treat asymptomatic bacteruria?
pregnancy
GU tract abnormality
planned surgery
transplant patient
