Trigger - bladder and urethral disorders Flashcards
which bladder cancer type is assocaited with chronic inflammation d/t stones, catheters, UTIs, and more
squamous cell carcinomas
hepatomegaly, lymphadenopathy +/- lymphedema suggests what
metastatic spread of bladder cancer
MC presenting symptom in bladder CA
hematuria
what is the gold standard for dx bladder cancer
cystoscopy with biopsy
what will urine cytology show in bladder cancer
abnormal shed epithelial cells
transurethral tumor resection +/- intravesical chemo is used when
for superficial bladder cancer (TIS, Ta, T1)
also see:
BCG and anti-TB
BCG and anti-TB treatment is used when?
treatment for superficial bladder cancer (TIS, Ta, T1)
Also see:
transurethral tumor resection +/- chemo
radical cystectomy and urinary diversion is used when?
treatment for invasive bladder cancer
also used:
+/- chemo, immunotherapy, radiation
a 4 year old girl with a 3 month hx of achieving urinary continence is now wetting her bed every night. what is the term used to describe this
primary nocturnal enuresis
secondary would be in patients who were previously continent for 6+ months.
a patient has a tumor that is extending into, but not past, the fatty layer of the bladder. What stage of bladder cancer is he in?
stage T3
TIS - on superficial bladder lining
Ta - extending into bladder lining
T1 - extends into connective tissue
T2 - extends into muscle
T3 - extends into fat
T4 - extends past fat and beyond bladder tissue
confusion and anemia can be assocaited with which condition
nocturnal enuresis
first line med tx for nocturnal enuresis
desmopressin
2nd line includes: imipramine, oxybutinin
what is more common in men
- Bladder cancer
- nocturnal enuresis
what is more common in women
- interstitial cystitis
- urethral prolapse
assocaited with chronic pain syndromes as well as certain foods/drinks (spicy, caffiene, alcohol)
interstitial cystitis
hunner’s ulcers/lesions on cystoscopy
interstitial cystitis
also see:
increased mast cells on biopsy
glomerulations
cystscopy shows glomerulations and increased mast cells on biopsy
interstitial cystitis
also see:
hunners ulcers/lesions
1st line med is amitriptyline
interstitial cystitis
followed by:
- hydroxyzine
- nifedipine
- pentosan polysulfate sodium
note: this is NOT the first line TREATMENT, only the first line med. first line tx is lifestyle mod and self care
what is the only FDA approved tx of interstitial cystitis
pentosan polysulfate sodium (elmiron)
SE includes elevated LFTs, GI upset and hair loss
pentosan polysulfate sodium (elmiron)
CI with anticoagulants/antiplatelets (LMWH, heparin)
pentosan polysulfate sodium (elmiron)
hydrodistention, electrocauterization and intravesical lidocaine is used when
3rd line treatment for interstitial cystitis
when do you use botulinum injections to the detrusor muscle and sacral neuromodulation
refractory interstitial cystitis
when are phenazopyridine and methenamine used in this lecture?
interstitial cystitis as adjunct tx
this condition is usually iatrogenic in etiology and is MC in men
urethral strictures
spraying of the urinary stream with obstructive voiding s/s are seen in which condition?
urethral stricture
when are cystourethrograms and cystourethroscopy used?
to evaluate and visualize urethral strictures
cystourethroscopy can also help confirm dx of mass in urethral meatus or urethral prolapse
when is a post void residual ultrasound used?
in urethral srictures to r/o urinary retention
this condition is d/t malformation of the urethral malformation or weakness of the pelvic floor
urethral prolapse
what is the difference between prepubescent and postmenopausal urethral prolapse
prepubescent is usually asymptomatic with spotty vaginal bleeding
post menopausal is symptomatic with vaginal bleeding, dysuria, urgency, frequency and nocturia. presents with hematuria. can have venous thrombosis, obstruction and necrosis
what is the difference in treatment for prepubescent and postmenopausal urethral prolapse
both recieve sitz baths, topical abx and estrogen
perpubescent - manage comorbid dz
post menopausal - do not use estrogen or abx of necrosis, thrombosis or bleeding
exam showing donut shaped protrusion of tissue obscuring urethral meatus
urethral prolapse
what is MC method of surgical treatment in urethral prolapse
excision of mucosa with short term cath (may need long term estrogen cream if post menopausal)
this is associated with parkinsons, bladder stones, tumors and prostate disease
urge incontinence d/t overactive detrusor muslce
urethral incompetence with intrinsic sphincter deficiency is the cause of what type of urinary incompetence
stress incontinence
duloxetine is off label medication for which condition
urinary stress incontinence
beta 3 adrenergic agonists, TCAs and alpha blockers are used in the treatment of what condition
urinary urge incontinence
tibial nerve stimulation is used as treatment in what condition
urinary urge incontinence
CI in gastric retention and glaucoma
antimuscarinics
DDI with potassium chloride
anticholinergics
what are the perks of farifenacin and solifenacin
these are the anticholinergics used in UI that have less cog impairment
what are the perks of oxybutinin
anticholinergic often MC prescribed d/t cost
mirabegron and vibegron
beta 3 agonists. used in patients who cannot tolerate anticholinergic therapy
when is sacral neuromodulation used?
refractory interstitial cystitis
urinary overflow incontinence (high risk of failure)
SE is HTN, tachycardia, UTI
beta 3 agonists
also see: dry mouth, constipation
DDI with QT prolonging drugs
Beta 3 agonists
urethral dilation, urethrotomy and urethroplast are all treatments for what
urethral stricture
