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Met3b > LUTS + UTI > Flashcards

LUTS + UTI Flashcards

1
Q

What are the risk factors for bacteriuria?

A
  1. Female, low oestrogen states (menopause), pregnancy
  2. Increasing age
  3. Diabetes
  4. In-dwelling catheters
  5. Stone disease
  6. Congenital malformation
  7. Voiding dysfunction
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2
Q

How can UTIs be categorised?

A
  1. Isolated UTI:
    - at least 6 months between infections
  2. Recurrent UTI:
    - >2 infections in 6 months or 3 within 12 months
    - Re-infection: infection by different organism
    - Persistence: infection by same organism from a focus in urinary tract
  3. Unresolved UTI:
    - Inadequate therapy
    - May be due to bacterial resistance
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3
Q

What are the symptoms of a lower UTI (cystitis)?

A
  1. Frequent, small-volume voids
  2. Urgency
  3. Suprapubic discomfort
  4. Dysuria
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4
Q

What investigations should be carried out for a lower UTI?

A
  1. Dipstick mid stream urine (presence of leukocytes ± nitrite)
  2. Urine microscopy
  3. AXR
  4. Renal USS
  5. Possibly IV/CT urogram (?structural abnormality)
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5
Q

How should a lower UTI be treated?

A
  1. uncomplicated: short course abx (e.g. trimethoprim)

2. complicated: 7-10 day course of augmentin + further investigation

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6
Q

What are the S+S of upper UTIs (pyelonephritis)?

A
  1. Flank/loin pain
  2. N+V
  3. Fevers + chill
  4. LUTS
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7
Q

What investigations should be carried out for an upper UTI?

A
  1. MSU: dipstick + send for culture
  2. Bloods: FBC, U+Es, blood cultures
  3. Imaging: AXR, renal USS, CT urogram
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8
Q

What bacteria usually cause upper UTIs?

A
  • 80% = E Coli
  • less common:
    (i) enterococci
    (ii) klebsiella
    (iii) proteus
    (iv) pseudomonas
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9
Q

How should an upper UTI be treated?

A
  1. Not systemically unwell: 10 days oral abx

2. Systemically unwell: admit for IV abx

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10
Q

What is a potential complication of pyelonephritis?

A 
Perinephric abscess (abscess in Gerota's fascia)
Microbiology: S aureis, E coli, Proteus
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11
Q

What is the treatment for a perinephric abscess?

A
  • drainage of collection (radiologically or formal open incision)
  • abx until resolution of infection
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12
Q

What microorganisms are associated with uncomplicated UTIs?

A
  1. E Coli (most common)
  2. Staph saprophytic
  3. Strep faecalis
  4. Proteus
  5. Klebsiella

uncomplicated = structurally and functionally normla urinary tract

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13
Q

What microorganisms are associated with complicated UTIs?

A
  1. E Coli (most common)
  2. Strep faecalis
  3. Staph aureus
  4. Staph epidermis
  5. Pseudomonas
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14
Q

What is 2nd line therapy for an uncomplicated lower UTI?

A

2nd line = required due to hypersensitivity reaction, side effects, failure of 1st line)
Treatment:
- urine culture sensitivty testing
- fluoroquinolone (ciprofloxacin 500mg BD or levofloxacin 250 mg OD)
- oral cephalosporins

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15
Q

What patients are at high risk of complicated lower UTIs?

A
  1. Males
  2. Recent urinary tract instrumentation
  3. Recent abx
  4. Diabetes
  5. immunosuppressed
  6. Obstruction
  7. Structural/functional abnormalities
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16
Q

What is the treatment for a complicated lower UTI? How is this different if the patient is immunocompromised?

A
  1. Empirical therapy: fluoroquinolone for 7-10 days

2. Immunocompromised: single-dose aminoglycoside (e.g. gentamicin 3-5mg/kg IVI or IMI)

17
Q

Define a recurrent UTI.

A

> 4 culture-proven UTIs in a year

18
Q

What investigations should be carried out for recurrent UTIs?

A
  1. MSU culture, urine microscopy
  2. Children: US to visulaise anatomical anomalies
  3. Men: referral to a urologist (those with haematuria shoudl be referred urgently)
  4. Women: urgent referral if recurrent UTIs associated with haematuria
    - CT scan imaging of choice for underlying pathology in women
19
Q

What are the different categories of LUTS? What symptoms fall into each category?

A
  1. Voiding:
    - weak/intermittent urinary stream
    - straining
    - hesitancy
    - terminal dribbling
    - incomplete emptying
  2. Storage:
    - urgency
    - frequency
    - incontinence
    - nocturia
  3. Post-micturition:
    - dribbling
20
Q

What are the non-medical management options of men experiencing storage symptoms as a result of BPH?

A
  • supervised bladder training
  • advice on fluid intake
  • lifestyle advice
  • containment products (if needed)
21
Q

What are the non-medical management options of men experiencing voiding symptoms as a result of BPH?

A
  • intermittent bladder catheterisation before indwelling urethral or suprapubic catheterisation
  • advise surgery is better than bladder training
22
Q

What drug treatments are commonly used in BPH?

A
  1. Moderate to severe LUTs (+ no RFs for progression): alpha blocker
  2. LUTS and prostate estimated to be >30g or PSA >1.4 ng/ml (high risk of progression): 5-alpha reductase inhibitor
  3. Bothersome moderate to severe LUTS + prostate ~>30g or PSA >1.4ng/ml: alpha blocker + 5-alpha reductase inhibitor
  4. Overactive bladder: anticholinergic
23
Q

What is the MOA of alpha blockers? What are the potential adverse effects?

A

MOA:

  • blockade of alpha1 adrenergic receptors in prostate, urethra, bladder neck and detrusor muscle
  • causes relaxation of smooth muscle
  • = improved urinary flow

Adverse effects:

  • postural hypotension
  • retrograde ejaculation
24
Q

What is the MOA of 5-alpha reductase inhibitors? What are the potential adverse effects?

A

MOA:

  • decrease in dihydrotestosterone synthesis
  • reduced androgenic drive of prostate
  • reduction in prostate volume = improved outflow

Adverse effect:
- impotence

  • Dutaseride = dual 5ARI
  • Finasteride = mono 5ARI
25
Q

How often must drug treatments for BPH be reviewed?

A
  1. Alpha blockers: at 4-6 weeks, then every 6-12 months
  2. 5-alpha reductase inhibitors: at 3-6 months, then every 6-12 months
  3. Anticholinergic: 4-6 weeks until stable, then every 6-12 months
26
Q

What is the management of acute urinary retention in men?

A
  1. catheterise

2. alpha blocker (400 micrograms) before removing catheter

27
Q

When in surgery indicated in BPH?

A
  1. Voiding symptoms are severe
  2. Drug treatment and conservative treatment have been unsuccessful/are not appropriate
  3. Storage symptoms that have not responded to conservation or drug management
28
Q

What is the surgical management of BPH causing voiding symptoms?

A
  1. Prostate <30g:
    - Transurethral incision of the prostate
  2. Prostate >30g:
    - Monopolar or bioplar transurethral resection of the prostate (TURP)
    - Monopolar transurethral vaporisation of the prostate (TUVP)
    - Holmium laser enucleation of the prostate (HoLEP)
    - Open prostatectomy
29
Q

What is the surgical management of BPH causing detrusor overactivity?

A
  • cystoplasty
  • bladder wall injection with botulinum toxin
  • implanted sacral nerve stimulation
30
Q

What is the surgical management of BPH causing stress urinary incontinence?

A
  • implantation of an artificial sphincter

- intramural injectables, implanted adjustable compression devices and male slings

Met3b (21 decks)

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