LUTS

Question 1

how many voids per night constitutes nocturia?

Answer 1

There is no set number

Question 2

Nocturnal polyuria

What percentage of the total urine volume needs to be produced at night to dx nocturnal polyuria?

Answer 2

> 33%

Question 3

What is the cause of nocturnal polyuria?

Answer 3

decreased arginine vasopressin over time

Question 4

how much urine output is needed to dx polyuria?

Answer 4

> 3L per day

Question 5

how does OSA cause naocturia?

Answer 5

decreased O2 perfusion leads to right sided heart dysfunction

this increased atrial natriuretic peptide which leads to decreased aldosterone and vasodilation

this increased urine production via water and salt excretion from vessels

Question 6

DDAVP monitoring regimen

DDAVP dose

Answer 6

hyperosmolar urine induces hyponatremia

check BMP after 1 week, then 1 month, then 3-6 months afterwards

dose: 25mcg and 55mcg

Question 7

Contraindications to DDAVP

Answer 7

sodium < 135mE/L
glucocorticoid use
loop diuretics
kidney disease
acute fluid wasting illness like GI bug

Question 8

AUA definition of chronic urinary retetion

Answer 8

PVR >200cc for at least 6 months on two difference occasions.

if >300cc at least 2x, need renal sono and creatinine

Question 9

DDX for urinary retention

Answer 9

spinal cord disease
cauda equina syndrome
MS (25% of patient needed CIC)

tumor/mass effect
fowlers

DM
age
POP
post-surgical
medication
DSD

Question 10

What is Fowlers syndrome?

Answer 10

painless retention due to decreased bladder sensation and failure of urethral relaxation

Question 11

urethral diverticulum DDX

Answer 11

skenes
malignancy
ectopic ureterocele
leiyomyoma

Question 12

risk factors for urethral diverticulum

Answer 12

AA race (OR 3.0)
UTIs
pelvic trauma/instrumentation

Question 13

Process for urethral diverticulum development

Answer 13

repeat infections in urethra and paraurethral glands causing abscess/dilation and attaches to urethra

Question 14

steps for urethral diverticulum removal

Answer 14

-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

Question 15

urethral diverticulum

risk factors for failure of repair

Answer 15

smoker
immunosuppressed
infection
large or complex fistula

Question 16

urethral diverticulum

complications and rates

Answer 16

fistula 2-8%
Incontinence (de novo): 15%
stricture

Question 17

how often does microhematuria workup come back negative?

Answer 17

60%

Question 18

Hematuria DDX

Answer 18

-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

Question 19

Patient <50
<25 rbc/hpf
nonsmoking

what is her chance of malignancy?

Answer 19

0.25%

Question 20

What imaging should you select for hematuria work up?

Answer 20

CT urogram is the first choice
Non-contrast CT is okay for stones
US if CT is contraindicated
IVP if stone/mass is suspected

Question 21

What is the success rate of a primary VVF repair?

What is the success rate of a secondary repair?

Answer 21

90%

80-90%

Question 22

When should you repair a VVF?

Answer 22

<72 hours from inciting event
OR
after 12 weeks to allow for inflammation to subside