Patho - Disorders of the Lower Urinary Tract

Question 1

voiding function etiologies

Answer 1

-Disorders of lower urinary tract
-Nervous system pathologies
-Access to toileting facilities
-Aging
-Immobility
-Medications—diuretics
-Obesity
-Estrogen depletion
-Pregnancy
-Environmental barriers
-Pelvic muscle weakness

Question 2

incontinence

Answer 2

Any involuntary urine loss
-Never normal in any circumstances & not a normal part of aging

Question 3

stress incontinence

Answer 3

Due to increase in intra-abdominal pressure
-Precipitated by effort or exertion
-D/t weakened pelvic muscles or intrinsic urethral sphincter deficiency

Question 4

urge incontinence

Answer 4

-Sudden urine leakage along with or immediately following sensation of need to urinate (urgency)
-D/t overactive detrusor muscle
-May be idiopathic, d/t bladder infxn, radiation tx, tumors, stones, or CNS damage

Question 5

mixed continence

Answer 5

due to a combination of stress & urge incontinence

Question 6

Overactive bladder syndrome

Answer 6

Frequent/sudden urge to urinate, can be accompanied by urinary incontinence

Question 7

Overflow incontinence

Answer 7

bladder so full that leaks urine (overflows). Causes include obstruction of urethra & underactive/inactive detrusor muscle.

Question 8

Neurogenic bladder

Answer 8

broad classification of voiding dysfunction; any pathology that disrupts CNS communication that causes urination

Question 9

Functional incontinence

Answer 9

r/t physical or environmental limitations resulting in an inability to access a toilet in time

Question 10

treatment for voiding dysfunction

Answer 10

1. Lifestyle changes: wt loss, reduce caffeine intake & avoid constipation
2. Behavioral, pharmaceutical & surgical options
3. Pelvic floor muscle training (for stress incontinence)
4. Bladder training
5. Rxs: anticholinergic agents, vaginal or oral estrogen & alpha-adrenergic blockers

Question 11

what is enuresis?

Answer 11

Intermittent incontinence while asleep
-Inappropriate wetting of clothing or bedding

Question 12

enuresis pathogenesis

Answer 12

-Deficiency in ADH (vasopressin)
-Nocturnal overactivity of detrusor -muscle
-Immature or abnormal arousal mechanisms
-Familial pattern

Question 13

enuresis treatment

Answer 13

-Behavior modification with/without -RX intervention
-Education
-Manage constipation
-Enuresis alarms
-Medication: desmopressin, anticholinergics

Question 14

what is lower urinary tract/bladder urolithiasis?

Answer 14

-Stones formed anywhere in urinary tract
-Usually composed of uric acid

Question 15

lower urinary tract/bladder urolithiasis etiology

Answer 15

dehydration and immobility

Question 16

lower urinary tract/bladder urolithiasis pathogenesis

Answer 16

travel through ureters, bladder, or urethra.
Often originate in bladder d/t urinary stasis, or in ureters and travel

Question 17

lower urinary tract/bladder urolithiasis CM

Answer 17

Obstruction, infection, hematuria, pyuria, pain.
-Similar to nephrolithiasis in terms of risk factors & stone characteristics
-May cause symptoms of urinary tract obstruction or infxn

Question 18

lower urinary tract/bladder urolithiasis treatment

Answer 18

If infxn: tx with appropriate ABX, based on C&S results
-Stones not passed spontaneously: endoscopic (transurethral) lithotripsy

Question 19

what is cystitis (UTI)?

Answer 19

Inflammation of bladder lining.
Uncomplicated: isolated incidence
Complicated; 2 or more infxns/yr.

Question 20

cystitis etiology

Answer 20

Infxn (most common), chemical irritants, stones, trauma.
-Predisposing factors: female, age, DM, catheterization, bladder dysfunction, trauma, sexual activity, poor hygiene, & urinary stasis

Question 21

cystitis pathogenesis

Answer 21

E. Coli travels to bladder (80% of UTI’s)

Question 22

cystitis CM

Answer 22

-Frequency, urgency, dysuria, suprapubic pain & cloudy urine.
-Children: Fever, irritability, poor feeding, vomiting, diarrhea, ill appearance.
-Older adults: Lethargy, anorexia, confusion & anxiety

Question 23

cystitis treatment

Answer 23

-Most female patients tx´d based on symptoms.
-Males/children/complicated cases require urine C&S &/or further assessment.
-Symptomatic cystitis in elderly: Close rx monitoring to avoid toxicity
-Aymptomatic bacteriuria in elderly, do NOT treat.

Question 24

what is bladder neoplasm (cancer)?

Answer 24

-4th most common CA in males; 9th in females.
-Risk increases with age; predisposing factors include smoking & exposure to carcinogenic chemicals.
-Originate from lining of urinary tract.
-Benign tumors are superficial & usually noninvasive

Question 25

bladder neoplasm CM

Answer 25

-Painless hematuria (blood in urine)
-frequency, urgency
-Cystoscopy used for dx with tissue bx (biopsy)

Question 26

bladder neoplasm treatment

Answer 26

-surgery, radiation therapy, chemotherapy & immunotherapy
-Protocols based on type, grade & stage of bladder CA

Question 27

what is vesicoureteral reflux?

Answer 27

-backwards flow of urine from bladder to ureters, can reach kidneys and damage
-d/t defect of valve, failure to close the passage
1/3 children with UTI’s have reflux.

Question 28

vesicoureteral reflux CM

Answer 28

-Recurrent UTI, voiding dysfunction, renal insufficiency or HTN in children.
-May resolve spontaneously or require surgery.

Question 29

what is ureterocele?

Answer 29

-Congenital cystic dilation of distal end of the ureter.
-75% located at bladder neck or in urethra.
-May be unilateral or bilateral.
-Prenatal DX with sonogram & postnatal frequent UTI’s.

Question 30

ureterocele CM

Answer 30

hydronephrosis (enlargement), UTIs, voiding dysfunction, hematuria, urosepsis, or failure to thrive

Question 31

what is Urethral Valve Disorder?

Answer 31

-Valves are mucosal folds that resemble thin membranes & cause obstruction with attempts to void.
-Varying degrees of obstruction.
-Most occur posteriorly in distal prostatic urethra.

Question 32

what is Urethrorectal & Vesicourethral Fistulas? CM?

Answer 32

-fistula between rectum & urogenital tract
-Rare & commonly associated with imperforate anus
-Clinical manifestations: Feces & gas passed through urethra