Patho - Disorders of the Lower Urinary Tract Flashcards
voiding function etiologies
-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
incontinence
Any involuntary urine loss
-Never normal in any circumstances & not a normal part of aging
stress incontinence
Due to increase in intra-abdominal pressure
-Precipitated by effort or exertion
-D/t weakened pelvic muscles or intrinsic urethral sphincter deficiency
urge incontinence
-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
mixed continence
due to a combination of stress & urge incontinence
Overactive bladder syndrome
Frequent/sudden urge to urinate, can be accompanied by urinary incontinence
Overflow incontinence
bladder so full that leaks urine (overflows). Causes include obstruction of urethra & underactive/inactive detrusor muscle.
Neurogenic bladder
broad classification of voiding dysfunction; any pathology that disrupts CNS communication that causes urination
Functional incontinence
r/t physical or environmental limitations resulting in an inability to access a toilet in time
treatment for voiding dysfunction
- Lifestyle changes: wt loss, reduce caffeine intake & avoid constipation
- Behavioral, pharmaceutical & surgical options
- Pelvic floor muscle training (for stress incontinence)
- Bladder training
- Rxs: anticholinergic agents, vaginal or oral estrogen & alpha-adrenergic blockers
what is enuresis?
Intermittent incontinence while asleep
-Inappropriate wetting of clothing or bedding
enuresis pathogenesis
-Deficiency in ADH (vasopressin)
-Nocturnal overactivity of detrusor -muscle
-Immature or abnormal arousal mechanisms
-Familial pattern
enuresis treatment
-Behavior modification with/without -RX intervention
-Education
-Manage constipation
-Enuresis alarms
-Medication: desmopressin, anticholinergics
what is lower urinary tract/bladder urolithiasis?
-Stones formed anywhere in urinary tract
-Usually composed of uric acid
lower urinary tract/bladder urolithiasis etiology
dehydration and immobility
lower urinary tract/bladder urolithiasis pathogenesis
travel through ureters, bladder, or urethra.
Often originate in bladder d/t urinary stasis, or in ureters and travel
lower urinary tract/bladder urolithiasis CM
Obstruction, infection, hematuria, pyuria, pain.
-Similar to nephrolithiasis in terms of risk factors & stone characteristics
-May cause symptoms of urinary tract obstruction or infxn
lower urinary tract/bladder urolithiasis treatment
If infxn: tx with appropriate ABX, based on C&S results
-Stones not passed spontaneously: endoscopic (transurethral) lithotripsy
what is cystitis (UTI)?
Inflammation of bladder lining.
Uncomplicated: isolated incidence
Complicated; 2 or more infxns/yr.
cystitis etiology
Infxn (most common), chemical irritants, stones, trauma.
-Predisposing factors: female, age, DM, catheterization, bladder dysfunction, trauma, sexual activity, poor hygiene, & urinary stasis
cystitis pathogenesis
E. Coli travels to bladder (80% of UTI’s)
cystitis CM
-Frequency, urgency, dysuria, suprapubic pain & cloudy urine.
-Children: Fever, irritability, poor feeding, vomiting, diarrhea, ill appearance.
-Older adults: Lethargy, anorexia, confusion & anxiety
cystitis treatment
-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.
what is bladder neoplasm (cancer)?
-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
bladder neoplasm CM
-Painless hematuria (blood in urine)
-frequency, urgency
-Cystoscopy used for dx with tissue bx (biopsy)
bladder neoplasm treatment
-surgery, radiation therapy, chemotherapy & immunotherapy
-Protocols based on type, grade & stage of bladder CA
what is vesicoureteral reflux?
-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.
vesicoureteral reflux CM
-Recurrent UTI, voiding dysfunction, renal insufficiency or HTN in children.
-May resolve spontaneously or require surgery.
what is ureterocele?
-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.
ureterocele CM
hydronephrosis (enlargement), UTIs, voiding dysfunction, hematuria, urosepsis, or failure to thrive
what is Urethral Valve Disorder?
-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.
what is Urethrorectal & Vesicourethral Fistulas? CM?
-fistula between rectum & urogenital tract
-Rare & commonly associated with imperforate anus
-Clinical manifestations: Feces & gas passed through urethra
