Problems with Elimination Urinary Flashcards
An Uncomplicated UTI is what?
Uncomplicated
- Healthy person w/normal urinary tract system,
- Treatment with oral antibiotics
A COMPLICATED UTI is what?
COMPLICATED:
- Having an underlying condition that increases the risk of failing therapy. Multiple UTI’s.
- A person w/structural (prostate) or functional system (retention), immunocompromised
- Treatment: Parenteral therapy (IV) often indicated.
What are some predisposing factors for UTIs?
- Women’s risk is higher due to short urethra in younger years and low estrogen related dilation in later years.
- Predisposing factors
- Hygiene (in women, wiping back to front)
- Trauma
- Instrumentation
- Sexual intercourse
- Neurologic factors
- Obstruction with stones
- Bubble bath/hot tub
- Uncircumcised penis
- Catheterization
- Anomalies: Vesicoureteral Reflux (from lower urinary to upper urinary system)
- Douching
Incidence of UTI
- Men 15 to 50 YO rarely develop UTI -antibacterial substances in prostatic fluid, longer urethra
- More than 50% of women (by 30 YO) will have one UTI
Signs and Symptoms of UTI:
NOTE: Symptoms and signs of cystitis can be subtle in the very young and very old.
- Burning with urination (dysuria)
- Frequency
- Urgency
- Incontinence
- Suprapubic, abdominal, flank (CVA) discomfort: pyelo
- Hematuria
Collecting the history:
What should you ask to discern that a patient may have a UTI?
- Onset, course, duration of symptoms
- Other genital problems, discharge, STI
- Review predisposing factors
- Hx of urinary tract problems
- What do they drink, amount, type of drink
- Other pertinent medical history (Diabetes, sickle cell, neurological disorder)
Completing the Physical:
What would you examine for suspected cystitis (UTI)?
- VS
- Heart and lung
- Palpate abdomen
- Palpate back for costovertebral angle (CVA) tenderness
- Inguinal lymph nodes
- *Women**
- *-Pelvic exam: inspect external genitalia, Possibly milk urethra for discharge, assess rectal area, speculum exam, bimanual for cervical motion tenderness, mass.**
- *Men**
- *-Inspect penis, scrotum**
- *-Retract foreskin (smegma)**
- *-Palpate (check for epididymitis, tenderness, masses)**
- *-Prostate exam (very gently)**
What diagnostic tests would you order for suspected cystitis?
- Urinalysis, micro as indicated.
- In most cases, positive leukocyte esterase (WBCs) and nitrates (from bacteria) indicate infection. Usually positive for blood.
- WBC casts in the urine are indicative of kidney inflammation
- Bacteria w/o pyuria usually due to contamination
- pH normal around 6 (acidic), infection often increases pH
- STI testing (GC and Chlamydia)
- Wet prep in females if indicated (BV, trich, yeast)
- Imaging
- *-Ultrasound**
- *-VCUG (voiding cystourethrography)**
- *-Urodynamic testing**
What are some potential differentials for cystitis?
- Vaginal/pelvic infection
- Prostatitis, epididymitis
- Bladder tumor
- Interstitial cystitis
- Benign prostatic hyperplasia (BPH-) nocturia, stream changes
- Over-active bladder/urge incontinence
- Pelvic organ prolapse
- Irritant urethritis
What is the most common pathogen associated with UTIs?
- Escherichia coli (75 to 95 percent), with occasional other species of Enterobacteriaceae, such as Proteus mirabilis* and *Klebsiella pneumoniae, and other bacteria such as Staphylococcus saprophyticus
Detecting Contamination in a specimen:
In healthy, non-pregnant woman - organisms such as lactobacilli, enterococci, Group B streptococci, and coagulase-negative staphylococci (other than S. saprophyticus) from voided urine most commonly represents contamination
NON-PHARMACOLOGICAL treatments for UTI:
- Increase fluid intake avoiding foods/fluids that irritate bladder: caffeine, etoh, tomato, citrus, spicy
- Cranberry supplements to change pH (cranberry juice can contain too much sugar which increases infection so can use unsweetened)
- -Prevents e-coli from adhering to uroepithelial cells
PHARMACOLOGICAL therapy for UTI
- Empiric should cover all likely pathogens
Uncomplicated:
First line:
- Nitrofurantoin (Macrobid) 100 mg BID x 5d
- Trimethoprim/Sulfamethoxazole (Bactrim DS) one DS tab BID x 3d
- Fosfomycin (Monurol) 3 gm orally in single dose
Second line:
- Ciprofloxacin 250 mg BID x 3 d
- Levofloxacin (Levaquin) 250 mg BID x 3 d
Complicated:
- ciprofloxacin : 500 mg orally BIDx 7 days (7 to 14 d in men)
- levofloxacin : 750 mg orally BIDx5 days (500mg daily for 7-14d in men)
- trimethoprim/sulfamethoxazole: 160/800 mg orally BIDx7-14 days
When should clinical manifestations respond to antimicrobial therapy?
Within 48 hours
In the interim, for some patients with cystitis, a urinary analgesic such as over-the-counter oral phenazopyridine (AZO) three times daily as needed may be useful to relieve discomfort due to severe dysuria.
A two-day course is usually sufficient.
It will turn your urine neon orange and it stains.
When should follow up be scheduled for cystitis (UTI)?
- If still symptomatic after completing medication or after 48 to 72 hr of appropriate antibiotic therapy.
- If Symptoms reoccur within 2 weeks: Do a Urine culture then treat with different agent for 7 d.
What is asymptomatic bacteriuria?
- Asymptomatic bacteriuria refers to patients who have no symptoms of UTI (dysuria, urinary frequency or urgency, suprapubic pain in patients with simple cystitis and fevers with cystitis symptoms, flank pain, or costovertebral angle tenderness in patients with acute complicated UTI).
–Symptoms are different if patient has neurogenic bladder (check for malaise, fevers, increased spasticity)
What is the Epidemiology of asymptomatic bacteriuria?
- Increase w/advancing age in healthy females
1% school age
>20% older than 80 years - Correlates w/sexual activity and diabetes.
Greater among premenopausal married women - It is transient; it rarely lasts longer than a few weeks
- Rare among healthy young males
6-15% among males older than 75 years - Bacteriuria is extremely common among patients with indwelling catheters
How is asymptomatic bacteriuria diagnosed?
- Presence of at least 100,000 organisms per ml of urine and no symptoms
- The high quantitative threshold is intended to increase the likelihood that bacteriuria reflects bladder bacteriuria rather than urethral, vaginal, or fecal contamination.
- Pyuria may be present
- Prevalence of pyuria in patients w/diabetes mellitus and asymptomatic bacteriuria is almost 80 percent
- Generally, no role for routine screening (non pregnant population)
- Females, a second specimen should be obtained (preferably within two weeks) to confirm growth of the same organism over the same quantitative threshold.
- Males, a single urine specimen meeting the criteria is sufficient for making the diagnosis.
What is the treatment for asymptomatic bacteriuria?
- No antibiotics, self limiting
- The unnecessary treatment of ASBU can lead to antibiotic resistance, adverse drug effects, C. difficile infection, and contribute unnecessarily to the costs of medical care
- Treatment (even in immunocompromised) does not appear to reduce the frequency of symptomatic infection or prevent other adverse outcomes
- Necessary to screen and treat in pregnancy, recent renal transplant patient and patients undergoing urinary tract surgeries.
What is acute pylonephritis?
- Upper urinary tract infection of the renal pelvis, tubules, and/or interstitial tissue
- Can lead to scarring to kidney, kidney failure, abscess formation, sepsis.
- Less common and more serious than lower tract infections.
- Subjective data and exam same as UTI
*interesting fact: approx. 75-80% of pyelo cases occur on right side
True or False: Most cases of acute pyelonephritis occur from undiagnosed UTIs.
True.
- Most cases of acute pyelonephritis are the consequence of an undiagnosed UTI
- Annual rates in women are 15-17 cases/10,000
- Annual rates in men are 3-4 cases/10,000
What are some signs and symptoms of pyelonephritis?
Note: The symptoms and signs of pyelonephritis can be subtle in the very young and very old. Confusion, irritability etc.
Signs and symptoms:
- Symptoms of cystitis may or may not be present
- Fever (>38ºC; 100.4º F), chills, flank pain, costovertebral angle tenderness, and nausea/vomiting.
- In some cases, the presentation may mimic pelvic inflammatory disease. Patients with acute complicated pyelonephritis may present with sepsis, multiple organ system dysfunction, shock, and/or acute renal failure.
- In some cases, complicated pyelonephritis may be associated with weeks to months of insidious, nonspecific signs and symptoms such as malaise, fatigue, nausea, or abdominal pain.
What are some diagnostic tests used for pyelonephritis?
- Suggestive of pyelonephritis
- Symptoms of cystitis + fever or other signs of systemic illness
- -Systemic illness: fever, chills, rigors, or acute mental status changes
- CVA tenderness w/pyuria and bacteriuria
- Fever or sepsis w/pyuria and bacteriuria.
- Urinalysis (either by microscopy or by dipstick) and urine culture with susceptibility data
- Obtain prior to therapy
- White cell casts suggest a renal (kidneys) origin for pyuria. See picture of the casts at http://www.medical-labs.net/white-cells-casts-in-urine-419/
- CBC w/diff
- If indicated: blood culture, ESR, GC/Chlamydia, wet prep (vaginal smear)
What are some imaging diagnostic tests that can be done for pyelonephritis?
- Imaging of upper urinary tract if there are persistent clinical symptoms after 48 to 72 hrs of appropriate antibiotic therapy for acute uncomplicated urinary tract infection.
-CT abdomen and pelvis w/ and w/o contrast to detect anatomic of physiologic factors
–Contrast needed to assess renal perfusion
–Non contrast to assess for calculi, gas forming infections, hemorrhage, obstruction or abscess
–May be normal in mild cases - Renal ultrasound though not study of choice
A kidney ultrasound can show:
–Something abnormal in the size or shape
–Blood flow to kidneys
–Signs of injury or damage - Imaging also if the patient is severely ill or has symptoms of renal colic or history of renal stones, diabetes, history of prior urologic surgery, immunosuppression, repeated episodes of pyelonephritis, or urosepsis.
-CT scan-preferred
-Ultrasound
-Voiding cystourethrogram (VCUG)
Potential differentials for pyelonephritis include:
- Appendicitis, acute abdomen
- Cholecystitis
- Pancreatitis
- Diverticulitis
- Pneumonia
- Prostatitis
- Epididymitis
- PID (Pelvic Inflammatory Disease)
- Nephrolithiasis
PHARMACOLOGICAL THERAPY FOR PYELONEPHRITIS
- Oral fluoroquinolone
- Ciprofloxacin (500 mg orally twice daily or 1000 mg extended release once daily)
- Levofloxacin (750 mg orally once daily) for five to seven days.
*NOTE: Patients with complicated pyelonephritis should be managed initially as inpatients. Broad-spectrum parenteral antibiotics should be used.
Pyelonephritis Follow up should occur when…
Note: Symptoms should improve promptly if antimicrobial therapy is effective.
- Those treated as outpatients, should have close follow-up either face-to-face or by telephone within 48 to 72 hours.
- Any patients who have worsening symptoms following initiation of antimicrobials, persistent symptoms after 48 to 72 hours of appropriate antimicrobial therapy, or recurrent symptoms within a few weeks of treatment should have additional evaluation, imaging, and repeat urine C & S.
- For patients who had hematuria on initial presentation, a urinalysis should be repeated several weeks following antimicrobial therapy to evaluate for persistent hematuria.
ACUTE GLOMERULONEPHRITIS
(AKA GLOMERULAR NEPHRITIS)
is:
- Glomerulonephritis is damage to the glomeruli
- Glomerulonephritis can lead to kidney failure
- Causes:
- Strep throat
- Impetigo: skin infection
- Genetics
- Autoimmune disorders, such as systemic lupus erythematosus
- Type 1 and type 2 diabetes
- Inflammation of the blood vessels: vasculitis
- Viruses, such as HIV, hepatitis B, and hepatitis C
- Inflammation of the tissue lining the heart: endocarditis
- Drugs and toxins
What is the predisposition/incidence in acute glomerulonephritis?
- Poststreptococcal glomerular nephritis (PSGN) is the most common cause of acute nephritis worldwide.
- It primarily occurs in the developing world.
- The risk of PSGN is greatest in children between 5 and 12 years of age, and in older adults greater than 60 years of age.
PSGN stands for:
Post-Strepptococcal Glomerular Nephritis
What are some signs/symptoms of acute glomerular nephritis?
Glomerulonephritis sometimes causes no symptoms and is discovered during a routine urine test.
- The symptoms of acute glomerulonephritis may include:
- Hematuria
- Foamy appearance of urine
- Less frequent urination
- Swelling in the morning, especially in the face, feet, hands, and abdomen
- Fatigue
- Hypertension
- If a latent period of 7 to 10 days occurs between the onset of infection and gross hematuria, poststreptococcal glomerulonephritis (skin-impetigo) is the usual etiology.
- Hematuria occurring concurrently with the onset of symptoms (ie, “synpharyngitic glomerulonephritis”) is typical of IgA nephropathy (auto immune).
When acute glomerular nephritis is suspected, what questions should the provider ask?
- Onset, course, duration of symptoms
- Review predisposing factors
- The latent period between Group A Strep (GAS) infection and Glomerular Nephritis (GN) is dependent upon the site of infection: between one and three weeks following GAS pharyngitis and between three and six weeks following GAS skin infection
- History of urinary tract problems
- What do they drink, amount, type of drink
- Other pertinent medical history (DM, sickle cell, neurological disorder)
Physical exam of a patient with suspected acute glomerulonephritis should include:
- VS
- Mouth (tonsil, petechiae) (Strep?)
- Skin (possible strep infection)
- Edema
- CVA, abdomen, bruit, groin for lymph nodes
- Heart/lungs
Diagnostics for suspected acute glomerulonephrits:
- Chemistry panel (eGFR reduction)
- Urine tests (proteinuria, leukocyturia, hematuria-erythrocyte casts)
- Hepatitis testing
- Culture for skin/throat (25% or less positive)
- Streptozyme test (measures 5 different streptococcal antibodies)
- Kidney biopsy (definitive dx)
- Imaging tests may be done to evaluate the kidneys and surrounding structures.
- -Ultrasound
- -Abdominal CT scan
Differentials for acute glomerulonephritis:
Possible etiologies:
- Post infectious (Strep, impetigo, viral)
- IgA nephropathy commonHepatitis B
- Endocarditis
- Membranoproliferative glomerulonephritis (uncommon dx)
Secondary causes:
- Lupus nephritis
- Henoch-Schönlein purpura (IgA vasculitis) nephritis
What is the treatment for acute glomerulonephritis?
- Support and tx for clinical manifestations of disease
- Medications
-Loop diuretics (furosemide) to reduce fluid retention and blood pressure.
-Corticosteroids (immune suppression)
-ACE inhibitors to control blood pressure and protein excretion (watch for hyperkalemia) If blood pressure uncontrolled with furosemide (Lasix) - If it becomes chronic :
Lifestyle Changes
-Restrict salt and water intake.
-Restrict intake of potassium, phosphorous, and magnesium.
-Reduce protein in the diet.
-Maintain a healthy weight through diet and exercise.
-Take calcium supplements.
-Dialysis and Transplant (rarely indicated)
**Referral to Nephrology
Follow up for acute glomerulonephritis patients:
- Need kidney biopsy if not typical course-No etiology noted
- After meds a successful diuresis typically begins within one week, and the serum creatinine returns to the previous baseline by three to four weeks
- The urinary abnormalities disappear at differing rates.
- Hematuria usually resolves within three to six months
- Proteinuria improves slowly (if severe 6 months). A mild increase in protein excretion is still present in 15 percent at 3 years, and 2 percent at 7 to 10 years.
Hematuria is
Bloody urine: indicative of an underlying illness/condition.
Microscopic:
-3 or more RBCs per HPF (high powered field) in urinary sediment from two of three properly collected, clean catch midstream urine specimens
Macroscopic: Gross hematuria
- Exceeding 1 million RBCs
- If the urine appears brown it is likely to be glomerulonephritis
- If its pink or red it’s likely lower tract origin.
- Clots: almost always lower tract
Signs and symptoms of hematuria
Pink or red urine or brown, cola-colored urine on toilet tissue.
Other symptoms:
Pain (often seen in renal colic/stone),
dysuria (often it’s a lower infection),
dull flank pain (pyelonephritis),
hesitancy & dribbling (BPH).
What to ask a patient with suspected hematuria
- Onset, duration, when during voiding do they occur.
- Describe color, amt
- PMH: renal disease, lupus, sickle cell
- Meds: herbs, OTC, NSAIDs, anticoagulants, laxative (phenolphthalein), Pyridium & Rifampin (orange/red urine)?
- Any other symptoms, recent illness (strep)
- Trauma or intense exercise?
- Bladder vs rectal in origin (Female vaginal origin)
- Bruising or bleeding concerns?
- Foods: beets, blackberry
Physical exam to evaluate hematuria
- VS
- Mouth (tonsil, petechiae), skin, edema (looking for systemic infection like strep)
- CVA tenderness, abdomen, renal bruit, groin for lymph nodes
- Heart/lungs
- Female pelvic exam
Cystocele, rectocele
Friable cervix,
Cervical Motion Tenderness (CMT) masses
Hemorrhoids - Male
Inspect
Palpate testes & epididymis, scrotum for hydro/varicocele hernia
Rectal exam: prostate, hemorrhoids
Diagnostics for Hematuria
- UA, test for heme (semen in urine can cause heme reaction on dipstick)
- If dipstick is positive, then culture/sensitivity
- CBC (platelet count), Chemistry, PT/PTT
- Sickle cell
- CT urography (CTU) check for stones, infection
- Cystoscopy + CTU = complete eval
- CT abd/pelvis if trauma
- Strep, ANA
Differentials for Hematuria
- Prerenal or systemic causes such as coagulation problem, drugs, diseases such as Sickle Cell (causing hypoperfusion of kidneys)
- False d/t vaginal bleeding, rectal bleeding, recent circumcision
- Food, meds
- Trauma, strenuous exercise, fever
- Renal
Nonglomerular:
-Pyelonephritis
-Polycystic kidney dx
-Neoplasm
-Congenital & vascular abnormalities
-Granulomatous disease (immune response to various stimuli), TB
Glomerular
-Glomerulonephritis
-Berger’s disease (IgA nephropathy is a kidney disease that causes the kidneys to become inflamed)
-Lupus (auto immune glomerulonephritis)
-Benign Vascular abnormalities - Post Renal
Stones
Urethritis, cystitis, prostatitis
BPH
Epididymitis
Malignant neoplasm
Common Etiology of Hematuria
- Injury to the abdomen, pelvis, or internal organs of the urinary tract
- Vigorous exercise—resolves with rest
- Urinary tract infection or kidney infection
- Cancer of the prostate, kidney, or bladder
- Kidney disease
- Kidney stones
- Bleeding disorders such as hemophilia
- Certain congenital diseases such as polycystic kidneys
- Radiation of the pelvis for cancer treatment
- Certain medications
- Timing of Hematuria:
At beginning of urine stream=bleeding in urethra
At end of urine stream=bladder neck or prostate
All throughout urine stream=lesion
Treatment and Follow-up for Hematuria
- Investigate etiology
- Under 35 YO, CBC, chemistry
- Over 35 YO likely referral
- Repeat UA in 2 weeks
- Other treatment based on etiology
KIDNEY STONES AKAUROLITHIASIS OR NEPHROLITH
- Formation of crystals from kidney move to bladder
Make up:
-80% consist of calcium (calcium oxalate)
-Uric acid
-Struvite (infection) - ½ of symptomatic people will require intervention
Most pass spontaneously; 10-30% do not pass - Common age 30-40 YO w/increase incidence w/age
- 12% men, 7% women will have symptomatic stone by age 70 YO
- Recurrence is 50% within 5 yrs
Predispositions for Kidney Stones
- Male
- Dehydration (too much salt)
- Hypercalcemia
- Medications vit C, D calcium, antacids
- Diet
- Excessive intake of oxalates: examples spinach, nuts, rhubarb
- Chronic infection
- Previous stone
- Family Hx
- Obesity
- Diabetes
- Bariatric surgery
What are some signs/symptoms of kidney stones?
- Severe flank and groin pain
- Acute unilateral flank, radiating to groin, waxes & wanes
- Hematuria
- Sudden onset colicky pain
- Nausea & vomiting
- Frequency, dysuria, urgency, suprapubic pain
- Some asymptomatic
Things a provider should ask a patient with suspected kidney stones:
- Onset, course, duration of symptoms
- Other symptoms of UTI
- Describe pain
- Previous stone
- Review diet
- Medication hx (vit C, D calcium, antacids)
- Recent trauma
- Family Hx
Physical exam for Kidney stones
VS
Inspect-Auscultate-Palpate
General (often very restless)
Peripheral edema (proteinuria)
Heart, lungs, abdomen, bowel sounds
Abdomen
Back, CVA tenderness
Pelvic to R/O Pelvic Inflammatory Disease.
Diagnostic test to run for kidney stones
Dx using clinical symptoms
Diagnostics to confirm
UA, sediment
Chemistry panel, uric acid level, parathyroid hormone
Stone for analysis
Red cell casts suggest glomerulonephritis
KUB xray & Helical (spiral) non-contrast CT
Differential diagnosis for kidney stones
Infection: lower/upper tract
Acute abdomen/appy
Pelvic Inflammatory Disease
Inflammatory Bowel Disease
Obstruction
Constipation
Ectopic pregnancy
Treatment for kidney stones
Increase intake of fluids
Strain urine to collect stone
Pain management, NSAIDs
Antibiotics if infection
Antiemetics if needed
Lithotripsy uses sound waves to break up large kidney stones into smaller pieces. These
sound waves are also called high-energy shock waves.
Referral and surgery to remove large stones.
What kind of follow up is required for someone with kidney stones?
24 hr follow up (phone call) after conservative treatment
If recurring, evaluate for management of metabolic abnormal.
Refer depending on severity of symptoms
Surgery varies on location and size of stone
Characteristics of functional urinary incontinence (UI)
- Can’t get there in time
- Related to mobility and cognition
Characteristics of Urge/Overactive Bladder UI
Unable to delay once sensation of
fullness
Causes can be by tumor, stones,
uterine prolapse, cystitis, urethritis,
contraction problem with bladder
Characteristics of overflow UI
Loss of urine due to overdistention of
bladder
Caused by enlarged prostate,
prolapsed cystocele, nervous system
problem (neuropathy, MS)
Characteristics of Stress UI
Involuntary loss of urine during
coughing, sneezing, bending over,
jumping (increase intraabdominal
pressure)
Prostate surgery most common cause
in men
Characteristics of mixed Stress+Urge UI (most often)
Bladder outlet is weak and detrusor is overactive
Other possible mixed UI types include…
Functional + Stress
Functional + Overflow
Functional + Urge
Signs and symptoms of UI
Sudden desire to have to pass urine
Nocturia
Dribbling, leakage
Frequency
Hesitancy, slow stream
Need to strain
Questions providers should ask patients with suspected UI include…
Onset-duration-severity
– Leak ?
When you don’t want to
When you cough, laugh, sneeze, jump
When on way to BR
What makes it worse, better? (associated factors) Fluid intake, caffeine, emotion
Assess bowel function (constipation)
Review medications
Previous therapy
Impact on QOL
Review comorbidities Narrow angle glaucoma, neurological disabilities, DM
Physical examination for UI
VS
Inspect for cardiac overload
Auscultate lungs for fluid overload (rales)
Palpate abdomen for masses, bladder fullness, tenderness
Assess cognition, function
Assess change in sensation
Male (prostate, hernia) & female exam (prolapse, mass, tenderness)
Diagnostic tests that can be run for UI include…
History & exam alone are often enough to make the diagnosis
Urinalysis, culture if suspect infection
Urine cytology if blood or pelvic pain
Post void residual (<50=adequate emptying)
PSA
Potential differential diagnosis for UI include…
DIAPPERS:
D—delirium
I—infection
A—atrophic urethritis, vaginitis
P—pharmaceuticals
P—psychological (depression)
E—excessive urine output
R—restricted mobility
S—stool impaction
Treatment for UI includes…
Treatment is Directed at the cause of UI…….
Functional: overdiuresis, toilet access Behavior
Bladder training
Kegels for stress incontinence
Crede’s method for overflow (push on suprapubic area)
Bladder training with timing for overactive bladder
Weight loss
Diet changes to avoid irritants (caffeine, acidic, etoh, carbonation)
Change intake patterns
Treat constipation
Treat vaginal atrophy-estrogen replacement intravaginally 3 x per week (restore urethral mucosa)
Botox (OAB)
Transurethral bulking (stress=sphincter deficiency)
Pharmacologic treatment for UI includes…
- * Anticholinergic & antispasmodic for Urge** Incontinence - overactive bladder (OAB)
- Decrease bladder contraction, increase bladder capacity
- Oxybutynin*
- Tolterodine*
- Fesoterodine*
- Trospium*
- Darifenacin*
- Solifenacin*
- * Alpha-adrenergic antagonists for Stress** Incontinence, although FDA has not approved meds for this
- Stimulate urethral smooth muscle contraction
- Pseudoephedrine*
- Imipramine*
- * Beta 3 adrenergic agonist**
- relaxation of detrusor smooth muscle or bladder & increases capacity (ex Mirabegron).
When to refer for UI?
Depends on type and cause
When pain is present
Hematuria present (possible cancer)
If surgery if desired
For urodynamic testing
For fitting & placement of pessary for incontinence (stress)
