Urinary Disorders Flashcards
Cystitis can happen from Infection or No Infection (Irritants)
Which part of the Renal system does it affect…
Anywhere
Cystitis
Types / Describe basics
Acute….
Recurrent…..
Acute Uncomplicated…..
Acute Complicates….
Acute: Invasion of urinary tract by organism
Recurrent: 2 or more in 6 months /
3 or more is 1 year
Acute Uncomplicated: Organism affects bladder involvement only
Acute Complicates: Organsim causes Upper UTI: Fever, Flank Pain, Chills, CVA tenderness
Treatment for Bacteriuria Colonization…
None
Colonization = Asymptomatic bacteriuria
Urine is normally sterlie except…
Distal urethra
Normal ph balance of urine…
Normal pH Value of human…
Slightly acidic, kills bacteria
7.35 - 7.45
Bacteria that causes 80% of UTIs
E coli
Why do preggers with UTI need aggressive tx to prevent acute pyelonephritis…
Can cause preterm labor
Before starting a physical assessment for UTI have the patient void first…
True
Hallmark symptoms for Cystitis (5)….
3 other possible Symptoms…..
If fever, N/V and Flank pain are present, it maybe this problem…
Dysuria – Burning or pain during urination
Urinary urgency – Strong, sudden need to urinate
Urinary frequency – Frequent urination, often in small amounts
Suprapubic pain – Discomfort or pressure in the lower abdomen
Cloudy, strong-smelling, or bloody urine
3 other symptoms
Low-grade fever (more common in severe cases)
Nocturia (frequent urination at night)
Malaise (general discomfort or feeling unwell)
Pyelonephritis
Complications for CYSTITIS….
Pyelonephritis (Kidney Infection)
Bacteria can spread from the bladder to the kidneys, causing a more severe upper urinary tract infection (UTI).
Symptoms: Fever, chills, flank pain, nausea, vomiting.
May lead to kidney damage if untreated.
- Recurrent UTIs
Frequent bladder infections (≥3 infections in 12 months or ≥2 in 6 months).
Can be due to underlying conditions like incomplete bladder emptying or anatomical abnormalities.
Hematuria (Blood in Urine)
Gross hematuria (visible blood in urine) or microscopic hematuria (only seen under a microscope).
Usually resolves with treatment but may require further evaluation.
- Interstitial Cystitis (Chronic Bladder Inflammation)
Persistent bladder pain and urinary symptoms even after infection clears.
Can lead to long-term discomfort and urinary dysfunction. - Sepsis (Rare but Life-Threatening)
Cystitis is diagnosed using the clear catch method, Describe….
What is it looking for in the urine…
Hand Hygine
Clean up of penis / vag
Catch ONLY MIDSTREAM Urine
Leukocyte Esterase (LE)
Definition: An enzyme released by white blood cells (WBCs) when they respond to infection or inflammation.
Normal Value: Negative
Clinical Significance:
Positive → Suggests a urinary tract infection (UTI) or inflammation in the urinary tract.
- Nitrites
Definition: Bacteria that cause UTIs (especially Gram-negative bacteria like E. coli) convert nitrates into nitrites in urine.
Normal Value: Negative
Clinical Significance:
Positive → Suggests a bacterial UTI, especially from nitrate-reducing bacteria (e.g., E. coli, Klebsiella, Proteus).
Negative does not rule out UTI, as not all bacteria convert nitrates to nitrites.
- White Blood Cells (WBCs) in Urine (Pyuria)
Definition: Presence of WBCs in urine, indicating infection or inflammation.
Normal Value: 0-5 WBCs per high-power field (HPF)
Normal Value: 0-5 WBCs per high-power field (HPF)
Clinical Significance:
>5 WBCs/HPF → Suggests UTI, kidney infection (pyelonephritis), or bladder inflammation (cystitis).
- Red Blood Cells (RBCs) in Urine (Hematuria)
Definition: Presence of RBCs in urine, indicating bleeding in the urinary tract.
Normal Value: 0-3 RBCs per HPF
Clinical Significance:
Microscopic hematuria (small amount, only seen under a microscope): Could indicate UTI,
Gross hematuria (visible blood in urine): Could indicate bladder cancer, kidney disease, or severe infection.
- Casts in Urine
Casts are cylindrical structures formed in the renal tubules and indicate different kidney conditions.
When to have a patient get a urine culture…
If complicated UTI is suspected
Signs & Symptoms:
Incomplete bladder emptying, weak stream, hesitancy
Bladder distension, suprapubic discomfort
Urgency with little output, frequent small voids
For….
Post-void residual (PVR) >100 mL on bladder scan
Suspected Urinary Retention / Obstruction
For Suspected Retention/ Obstruction
Interventions:
Encourage double voiding (urinate, wait, try again).
Straight catheterization if PVR is high and patient is unable to void.
Notify provider if urinary retention persists or worsens.
Prepare for Pelvic Ultrasound or CT scan to evaluate obstruction causes…….. (Name 3)
(stones, strictures, tumors).
Pelvic Ultrasound (US) & CT Scan for Retention/Obstruction
Purpose:
Identify bladder outlet obstruction, kidney stones, tumors, or structural abnormalities.
Nursing Considerations for Pelvic US:
✅ Before the Procedure:
Full bladder required for transabdominal US → Instruct to drink 32 oz of water 1 hour before.
(TRUE or FALSE)
Empty bladder required for transvaginal US (if applicable).
✅ After the Procedure:
Encourage hydration.
Inform that mild discomfort may occur.
(TRUE or False)
After the Procedure:
Encourage hydration.
Inform that mild discomfort may occur.
True
Nursing Considerations for CT Scan (With/Without Contrast):
✅ Before the Procedure:
(3)
✅ After the Procedure:
(2)
Check renal function (BUN, creatinine) if contrast is used.
Assess for iodine/shellfish allergy (contrast may cause reaction).
NPO for 4-6 hours if contrast is required.
After
Encourage fluids to flush contrast.
Monitor for allergic reactions (rash, swelling, difficulty breathing).
Recurrent UTI (≥2 in 6 months or ≥3 in 1 year)
Risk Factors:
Poor hygiene, sexual activity, menopause
Incomplete bladder emptying, urinary retention
Diabetes, catheter use
Teachings: (4)
Monitoring & Treatment:
Obtain urine culture & sensitivity for appropriate antibiotics.
Consider low-dose prophylactic antibiotics for recurrent cases.
Assess for underlying conditions (e.g., urinary retention, reflux).
Nursing Teachings (4)
Encourage increased hydration (>2L/day).
Urinate after intercourse to flush bacteria.
Wipe front to back for perineal hygiene.
Avoid irritants (bubble baths, scented wipes, tight underwear).
Vesicoureteral Reflux (VUR) is…
Urine Backflow from Bladder to Kidneys
Interstitial Cystitis (Chronic Bladder Pain Syndrome)
Symptoms:
Pelvic pain, bladder pressure, urgency, frequency
No infection on urine culture
Pain worsens with bladder filling, relieved after urination BUT can burn while voiding but not with everyone
Nursing Considerations:
✅ Lifestyle Modifications: (3)…..
Pain Management: 1 & 3 medications….
Avoid bladder irritants: caffeine, alcohol, spicy foods, artificial sweeteners.
Encourage bladder training (gradually increasing time between voids).
Promote stress reduction techniques (yoga, relaxation therapy).
PAIN MANAGEMENT
Pelvic floor therapy if muscle dysfunction is present.
Medications:
Pentosan polysulfate sodium (Elmiron) – Protects bladder lining.
Antihistamines (hydroxyzine) – Reduces inflammation.
Amitriptyline – Low-dose antidepressant for neuropathic pain.
Suspected retention/ Obstruction
(This Diagnostic)
Recurrent UTIs, Reflux, Interstitial Cystitis
(This Diagnostic)
Suspected retention/ Obstruction
CT / US
Recurrent UTIs, Reflux, Interstitial Cystitis
CYSTOSCOPY
Cystoscopy
Patient Education & Preparation: (6)
Explain the purpose (e.g., diagnosing bladder problems, removing stones, taking a biopsy).
Obtain informed consent from the patient.
Assess for allergies to anesthesia, iodine, or contrast (if contrast is used).
NPO status: Usually not required unless under general anesthesia.
Encourage increased fluid intake before the procedure if done under local anesthesia.
Instruct the patient to empty their bladder before the procedure.
Post Cystoscopy
Mild burning, pink-tinged urine, and urinary frequency are normal for ….
Report heavy bleeding, bright red clots, fever, chills, or inability to urinate (may indicate infection or injury).
Watch for signs of urinary retention (distended bladder, decreased urine output).
Pain & Discomfort Management:
Encourage increased fluid intake to flush the bladder and reduce irritation.
Recommend _________ for urethral discomfort.
Administer pain medications (e.g., acetaminophen, phenazopyridine) as needed.
1-2 days
sitz baths or warm compresses
______ is inflammation of the bladder, most commonly caused by a urinary tract infection (UTI) due to bacterial infection.
However, it can also result from non-infectious causes such as irritation from chemicals, radiation, or interstitial cystitis (chronic bladder inflammation without infection)
Cystitis
Is surgical management used for Cystitis….
Yes to remove obstruction
Drug therapy slide
Where do the following medications work.
Urinary tract Analgesics
Urinary tract anti antiinfectives
Urinary tract antispasmpdics
Bladder protectants
Alpha-Blockers used to treat BPH
Testosterone blockers to treat BPH
Urinary tract Analgesics:
Fundus of the bladder
Urinary tract anti antiinfectives
Opening of the ureter
Urinary tract antispasmpdics
Muscle layer
Bladder protectants
Endothelial layer
Alpha-Blockers used to treat BPH
Urethra
Testosterone blockers to treat BPH
Prostate gland
Medication
Fosfomycin….
UTI Specific Antibiotics
Medication
Nitrofurantoin
UTI specific antibiotic
Medication
Trimethoprim
Trimethoprim / sulfamethoxazole
UTI specific Antibiotic
Non uti specific Antibiotics (4)
Ciprofloxacin
Levofloxacin
Cefixime
Cephalexin
Cystitis / UTI
Urine acidifiers (2)
Methenamine
Methylene Blue
Cystitis/UTI
Antifungal medication
Fluconazole
Fluconazole (Diflucan) –
Type of medication/ Used for..
✅ Side Effects (SE):
GI upset (nausea, diarrhea)
Hepatotoxicity (liver damage)
QT prolongation (arrhythmia risk)
Headache
Patient teaching (4)
Antifungal (Used for Yeast Infections, Fungal UTIs, Candidiasis)
Teachings
Take with or without food, but avoid alcohol (liver toxicity risk).
Report signs of liver damage (yellow skin/eyes, dark urine, right upper abdominal pain).
Monitor for irregular heartbeats if taking with other QT-prolonging drugs.
May interact with warfarin & increase bleeding risk – monitor INR.
Methylene Blue – Use…
✅ Side Effects (SE):
Blue-green urine or stool (harmless)
Nausea, vomiting
Headache, dizziness
Serotonin syndrome (if used with SSRIs)
✅ Patient Teaching: (4)
Cystitis/ Urinary Antiseptic & Dye
Teaching
Urine & stool may turn blue-green – this is expected.
Avoid SSRIs, SNRIs, or MAOIs to prevent serotonin syndrome.
Drink plenty of water to flush the dye and prevent irritation.
May stain clothing & contact lenses.
Methenamine - Use
✅ Side Effects (SE):
GI upset (nausea, vomiting)
Crystalluria (kidney stones)
Rash
✅ Patient Teaching: (3)
(Hiprex, Urex) – Urinary Antiseptic (Prevents UTI, Not Treats Active Infections)
Requires acidic urine (pH <5.5) for activation – Avoid antacids & alkalizing foods (citrus, dairy).
Drink plenty of fluids to prevent kidney stones.
Avoid in kidney/liver disease due to risk of toxicity.
Trimethoprim
✅ Side Effects (SE):
Hyperkalemia (increased potassium)
Rash (Stevens-Johnson Syndrome risk)
GI upset (nausea, vomiting)
Bone marrow suppression (anemia, low WBCs, low platelets)
✅ Patient Teaching:
Use: (Used Alone or in Trimethoprim-Sulfamethoxazole (Bactrim)) – UTI Antibiotic
Take with a full glass of water to prevent kidney stones.
Avoid excess potassium intake (e.g., bananas, potassium supplements).
Report rash, sore throat, bruising/bleeding (signs of serious reactions).
Monitor for signs of infection (low WBCs).
Contraindicated in pregnancy & folate deficiency.
Nitrofurantoin - Use…
✅ Side Effects (SE):
GI upset (nausea, vomiting)
Brown-colored urine (harmless)
Pulmonary reactions (cough, SOB, lung fibrosis in long-term use)
Peripheral neuropathy (tingling, numbness)
Hepatotoxicity (rare)
Patient Teaching….
(Macrobid, Macrodantin) – UTI Antibiotic
Patient Teaching:
Take with food or milk to reduce GI upset.
Complete full course of antibiotics, even if symptoms improve.
May cause harmless brown urine discoloration.
Report difficulty breathing, persistent cough, or numbness/tingling (signs of serious adverse reactions).
Avoid in patients with severe kidney disease.
Fosfomycin - USE
✅ Side Effects (SE):
Nausea, diarrhea, headache
Vaginitis
Dyspepsia (indigestion)
Dizziness
✅ Patient Teaching:
(Monurol) – Antibiotic for UTI
Teaching
Single-dose treatment: Dissolve in water and take on an empty stomach for best absorption.
Avoid antacids (may reduce effectiveness).
Increase fluid intake to flush bacteria from the urinary tract.
This medication maybe used for Cystitis during pregnancy
One-time dose
GI side effects can limit usefulness for some patients
Fosfomycin (Monurol)
Older; not effective against as many Gram-negative bacteria
Suppression therapy for chronic UTI
Nitrofurantoin
Action: Broad spectrum; blocks folic acid production causing bacterial death.
Trimethoprim
Trimethoprim-sulfamethoxazole
Type of drugs
&
SE
Sulfonamides (Sulfa Drugs)
SE:
Photophobia
GI distress
Steven- Johnson Syndrome
Caution with renal impairment
Take with full glass of water
Black box warning on these types of medications include
Tendon rupture
CNS effects
Peripheral neuropathy
Name Class of medication & Regular SE
Fluoroquinolones
Ciprofloxacin
Levofloxacin
Moxifloxacin
Fluoroquinolones
Ciprofloxacin
Levofloxacin
Moxifloxacin
SE…..
Black box warning….
SE: QT prolongation, liver toxicity, headache
Black box: tendon rupture, CNS effects, peripheral neuropathy
Urine acidifiers
Methenamine & Methylene Blue
Teaching
Take with food
Drink 8 - 10; 8oz glasses water per day
Avoid alkalinizing products (Citrus, Milk, Antacids)
Phenazopyridine (Azo-Standard, Pyridium)
Use…
SE….
Urinary tract Analgesics
SE: Reddish/Orange urine, GI upset
TAKE WITH MEAL
Darifenacin
Fesoterodine
Oxybutinin
Solifenacin
This type of medication….
This type of function….
Antispasmodics (anticholinergic)
Collaborative management & Interventions for Cystitis
2-3 L daily / if not contraindicated
Clean & wipe front to back
Avoid bubble baths, scented lubricant
Empty bladder before and after sex
Don’t delay urination
Cranberry juice
Rare, chronic inflammation of lower urinary tract.
R/T Genetic & Immunity dysfunction NOT Infection
Interstitial Cystitis
Interstitial Cystitis
Rare, chronic inflammation of lower urinary tract.
R/T Genetic & Immunity dysfunction NOT Infection
Diagnose how?
Describe features…(3)
Diagnosis NO WBC, RBC, Bacteria
CYSTOSCOPY for accurate Diagnosis
Small bladder capacity, Hunner ulcers, small hemorrhages
SS
Pain with bladder filling & Voiding
Frequency/ Urgency
Nocturia
Suprapubic/ Pelvic pain (Can radiate to groin / rectum)
Condition….
Tx….
Interstitial Cystitis
Tx: bladder protectant: pentosan polysulfate sodium (Elmiron)
Pentosan polysulfate sodium (Elmiron)
Use…
Disease…
Restores bladder lining
Interstitial Cystitis
Urethritis
Causes by infection ?
Group with highest incidences…
Symptoms ….
Causes by infections (STI most common) & non infection
Highest incidences 20- 24
Symptoms: Mucopurulent / Purest Discharge, dysuria, discomfort
Urethritis
Diagnostics….
Interventions:
Non-infectious
Infectious
Diagnostics: UA, STI Testing, HIV Testing.
Pelvic exam & Urethroscopy
Interventions:
Non-infectious: Estrogen cream (Postmenopausal)
Non-infectious:
Avoid irritants (e.g., harsh soaps, spermicides)
Hydration to flush out irritants
NSAIDs or Phenazopyridine for symptom relief
Infectious: Antibiotic therapy
Structures
Incontinence
Urolithiasis
Urolithiasis
Urithelial Cancer
All of this in common…..
Non-infectious urinary disorders
Strictures:
Narrowing of the urethra is more common in which sex…
Males
Urethral vs Ureter Stricture
SS….
Back pain, blood in the urine, nausea, UTI, pain worsens with increased fluids
Vs
Decreased urine stream, urgency, incomplete emptying, spraying of stream, straininf/pain, UTI
Ureter
Back pain, blood in the urine, nausea, UTI, pain worsens with increased fluids
Vs
Urethral (More common in males)
Decreased urine stream, urgency, incomplete emptying, spraying of stream, straininf/pain, UTI
Cuases of Hydronephrosis or Hydroureter
Urinary obstruction (e.g., kidney stones, tumors, enlarged prostate)
Vesicoureteral reflux (urine flows backward from bladder to kidneys)
Congenital defects
Pregnancy (compression of ureters)
Hydronephrosis
Flank pain (unilateral or bilateral)
Decreased urine output or difficulty urinating
Swelling in the abdomen or flank area
Nausea & vomiting (if severe obstruction)
VS
Flank or lower abdominal pain
Urinary retention or difficulty urinating
Hematuria (blood in urine)
Urinary tract infections (UTIs) due to stagnation
Hydronephrosis
Flank pain (unilateral or bilateral)
Decreased urine output or difficulty urinating
Swelling in the abdomen or flank area
Nausea & vomiting (if severe obstruction)
VS
Hydroureter
Flank or lower abdominal pain
Urinary retention or difficulty urinating
Hematuria (blood in urine)
Urinary tract infections (UTIs) due to stagnation
Diagnostics for urethral strictures
Urinary Flow Test: Measures the Flow and amount
Pelvic & urethral US
MRI
Cystoscopy
Renal US / Scan
Retrograde ureteroscopy
Involuntary loss of urine severe enough to cause social or hygiene problems
Incontinence
Incontinence is most common in which group of people…
Women >65
Risk factors for incontence (6)
Chronic conditions
Vag delivery
Pelvic prolapse
Diabetes
HF
Obesity
This type of incontinence involves Small amounts of urine with cough, sneeze, exercise….
Stress Incontinence
________] incontinence is the involuntary leakage of urine during activities that increase intra-abdominal pressure, such as coughing, sneezing, laughing, or exercise.
It is often caused by weakened pelvic floor muscles or urethral sphincter dysfunction.
Management (8)
Stress Incontinence
Weight reduction
Stop smoking
Pelvic muscle therapy (Kegels)
Vaginal cone therapy
Pessary devices
Estrogen therapy
Surgery
Medications for Stress incontence
Hormones
Estrogen vaginal cream or Estrogen ring
Anticholinergic
Oxybutynin
Alpha-Adrenergic agonist
Clonidine (Catapres) – Used for hypertension and ADHD
Methyldopa – Used for hypertension, especially in pregnancy
Beta3 Agonist
Mirabegron (Myrbetriq) – Used for overactive bladder (OAB) to relax the bladder muscle and increase storage capacity
Antidepressants: Tricyclic & SNRI
Tricyclic Antidepressants (TCAs):
Amitriptyline
Imipramine
Nortriptyline
Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs):
Duloxetine
Venlafaxine
Estrogen (Topical to peri & vag areas) used to treat ____ incontinence
Action….
Time length to achieve benefits…..
Stress
Enhances nerve conduction to Urinary Tract, improve blood flow reduces tissue deterioration
4 - 6 weeks to work
In this type of incontinence, the Detrusor Muscle contracts before the bladder is full.
Urge incontinence
SS of this incontinence
Urgency, frequency, nocturia, loss of large amount or urine.
Management
Bladder training
Pelvic muscle therapy
Weight reduction
Avoiding bladder irritants
Smoking Cessation
Urge incontinence
Anticholinergic
Most Important Dr
ug: Oxybutynin (Ditropan)
✅ Use: Treats overactive bladder (OAB) and urge incontinence by relaxing bladder muscles and reducing involuntary contractions.
✅ Common Side Effects: Dry mouth, constipation, blurred vision, dizziness, urinary retention.
✅ Serious Side Effects: Confusion (especially in elderly patients), tachycardia, heat intolerance.
✅ Nursing Considerations: (4)
Used for Stress Incontinence with which other meds…(4)
Monitor for urinary retention.
Encourage fluid intake and fiber to prevent constipation.
Use caution in elderly patients due to risk of confusion and falls.
Educate about dry mouth management
Meds
Estrogen
Alpha-Adrenergic Agonist
Beta3 Agonist
Antidepressants: Tricyclic & SNRIs
Alpha-Adrenergic Agonist
Most Important Drug: Midodrine (ProAmatine)
✅ Use: Treats orthostatic hypotension by constricting blood vessels and increasing blood pressure.
✅ Common Side Effects: Goosebumps, chills, urinary retention, headache, dizziness.
✅ Serious Side Effects: Severe hypertension (especially when lying down), bradycardia.
✅ Nursing Considerations: (4)
Used to treat Stess incontinence with which other meds…
Monitor blood pressure (supine and standing) to prevent supine hypertension.
Instruct patient to avoid lying down for several hours after taking the medication.
Monitor for urinary retention (can worsen existing bladder conditions).
Educate patient to rise slowly to prevent dizziness.
Meds
Estrogen
Anticholinergic
Beta3 Agonist
Antidepressants: Tricyclic & SNRI
Beta-3 Agonist
Most Important Drug: Mirabegron (Myrbetriq)
✅ Use: Treats overactive bladder (OAB) by relaxing the bladder muscle and increasing storage capacity.
✅ Common Side Effects: Increased blood pressure, dry mouth, headache, nausea.
✅ Serious Side Effects: Urinary retention, tachycardia, arrhythmias.
✅ Nursing Considerations: (4)
Use with these other meds to treat Stess incontinence….
Monitor blood pressure (especially in hypertensive patients).
Assess for urinary retention, especially in patients with bladder outlet obstruction.
Educate patients that it may take several weeks for full effects.
Use with caution in patients with cardiovascular disease.
Meds
Estrogen
Anticholinergic
Alpha-Adrenergic Agonist
Antidepressants (Tricyclic & SNRI)
SS of this incontinence
Constant dribbling of urine, sense of incomplete emptying, pelvic discomfort, palpable bladder
Treated with Anticholinergic & Antispasmodics
Overflow Incontinence
Oxybutynin
Solifenacin
Tolterodine
Oxybutynin
Solifenacin
Tolterodine
This type of medication
Common & serious SE
Anticholinergic
Common side effects include dry mouth, constipation, blurred vision, dizziness, urinary retention, and drowsiness.
Serious side effects include tachycardia, confusion, hallucinations, heat intolerance, and increased intraocular pressure (risk in glaucoma patients). These medications can also cause cognitive impairment and falls in older adults, so
Urge incontinence is treated with these 2 types of medications …
Anticholinergic
Oxybutinin
Solifenacin
Tolterodine
&
Antispasmpdics
Hyoscyamine (Levsin)
Management for this type of incontinence includes…..
Bladder training
Bladder compression (Crede methis)
Intermittent self-catheterization
Drug therapy
Surgery for obstruction
Overflow management
Overflow Incontinence
Pharmaceutical management
Only this medication, short term after surgery.
Contradictions to this medication (5)
Medocation Increases bladder pressure
Bethanechol chloride
Cholinergic (Make Wet / Pee)
Contraindications:
Urinary or GI obstruction (risk of rupture)
Peptic ulcers (increases gastric acid secretion)
Asthma or COPD (may cause bronchospasm)
Bradycardia or hypotension (lowers heart rate and blood pressure)
Parkinson’s disease (may worsen symptoms due to increased acetylcholine)
Functional Incontinence
Quality & Timbing of urine loss varies, difficulty to detect problems
Management…decivces….
Habit training
Prompted voiding
Devices:
Pessaries, condom catheter, intermittent or long-term Catheterization
Physical assessment for incontence
Assess abdomen
Inspect females for prolapse (NP)
Health care provider will perform comprehensive examination including DRE
Digital Rectal Exam
Prostatic hyperplasia (BPH)
First assessment for urinary incontinence
Followed by…
Lab
Urinalysis to rule out infection / Culture if indicated
Imaging assessment
Bladder scan
CT of kidneys & ureter
VCUG
Urodynamic testing
EMG for Pelvic Miscles
Imaging assessment for Urinary Incontinence
______ is a fluoroscopic imaging test where contrast dye is inserted into the bladder via a catheter to assess vesicoureteral reflux (VUR), bladder emptying, and structural abnormalities during urination.
_____ evaluates bladder function by measuring pressure, flow, and capacity to diagnose conditions like overactive bladder, urinary retention, and incontinence.
assesses nerve and muscle activity in the pelvic floor using electrodes to identify neuromuscular disorders, pelvic floor dysfunction, or nerve damage affecting urination.
EMG of pelvic muscles
Urodynamic testing
VCUG
Voiding Cystourethrogram (VCUG) is a fluoroscopic imaging test where contrast dye is inserted into the bladder via a catheter to assess vesicoureteral reflux (VUR), bladder emptying, and structural abnormalities during urination.
Urodynamic Testing evaluates bladder function by measuring pressure, flow, and capacity to diagnose conditions like overactive bladder, urinary retention, and incontinence.
Electromyography (EMG) of Pelvic Muscles assesses nerve and muscle activity in the pelvic floor using electrodes to identify neuromuscular disorders, pelvic floor dysfunction, or nerve damage affecting urination.
Urolithiasis is most commonly associated with…
Dehydration
Risk factors for….
Metabolic (Dehydration)
Family history, Obesity, diabetes, Gout
Diet: High Calcium, Vitamin D oxalate, Purine, alkali
Obstruction/ Urinary Stasis
Diuretics use
UTI / prolonged cather use
Urolithiasis
The most common type, these stones form from excess calcium, oxalate, or phosphate in the urine. Causes include dehydration, high oxalate intake (e.g., spinach, nuts, chocolate), hyperparathyroidism, and kidney disorders.
Made from…
Calcium Stones (Calcium Oxalate & Calcium Phosphate)
Develop due to high uric acid levels, often from a high-purine diet (red meat, shellfish), gout, diabetes, or chronic dehydration. These stones are more common in people with acidic urine (low pH).
Uric Acid Stones
Composed of magnesium, ammonium, and phosphate, these stones form in alkaline urine due to recurrent urinary tract infections (UTIs) with urease-producing bacteria (e.g., Proteus, Klebsiella). They grow quickly and can become large (staghorn calculi).
Struvite Stones
Caused by cystinuria, a rare genetic disorder that leads to excessive cystine (an amino acid) in the urine, resulting in recurrent kidney stones. These stones form in acidic urine and are difficult to dissolve.
Cystine Stones
Serum Creatinine (SCr):
Normal values….
Elevated: Indicates kidney dysfunction, decreased filtration (e.g., acute kidney injury, chronic kidney disease, dehydration).
Low: May indicate low muscle mass, liver disease, or malnutrition.
0.6 – 1.2 mg/dL
Blood Urea Nitrogen (BUN)
Normal values….
Elevated: Suggests kidney dysfunction, dehydration, heart failure, or high protein intake.
Low: May indicate liver disease or malnutrition.
7 – 20 mg/dL
Glomerular Filtration Rate (GFR)
Normal….
Kidney disease….
Kidney failure…
Decreased GFR: Indicates progressive kidney damage, common in chronic kidney disease (CKD) and acute kidney injury (AKI).
Normal ≥90 mL/min/1.73m²
<60 (kidney disease)
<15 (kidney failure)
Creatinine Clearance (CrCl):
Men…..
Women….
Low CrCl: Suggests kidney impairment or decreased filtration capacity.
Men: 97-137 mL/min
Women: 88-128 mL/min
pH of Urine: 4.5 – 8.0
Acidic (<5.5)….
Alkaline (>7.5)……
Acidic (<5.5): Suggests uric acid or cystine stones, metabolic acidosis.
Alkaline (>7.5): Indicates struvite stones or urinary tract infections.
Pentosan polysulfate sodium (Elmiron) is primarily used to treat _____ a chronic bladder condition causing pain, urgency, and frequency.
It acts as a ________, helping to restore the damaged glycosaminoglycan (GAG) layer of the bladder wall, reducing irritation from urine.
interstitial cystitis
bladder protectant
Caused by weakened pelvic floor muscles and urethral sphincter dysfunction, leading to urine leakage with increased abdominal pressure (e.g., coughing, sneezing, laughing). Common in postpartum women, aging, and obesity.
(Overactive Bladder) – Results from detrusor muscle overactivity, causing a strong, sudden urge to urinate with involuntary leakage. Seen in neurological conditions (e.g., Parkinson’s, stroke), infections, or bladder irritants.
Occurs due to incomplete bladder emptying from obstruction (BPH, pelvic organ prolapse) or weak detrusor muscle contraction (diabetes, spinal cord injury), leading to chronic urine retention and leakage.
The bladder works normally, but physical, cognitive, or environmental barriers (e.g., dementia, mobility issues, stroke) prevent timely toileting, leading to accidental urine loss.
Overflow
Urge
Stress Incontinence
Functional Incontinence
Stress Incontinence – Caused by weakened pelvic floor muscles and urethral sphincter dysfunction, leading to urine leakage with increased abdominal pressure (e.g., coughing, sneezing, laughing). Common in postpartum women, aging, and obesity.
Urge Incontinence (Overactive Bladder) – Results from detrusor muscle overactivity, causing a strong, sudden urge to urinate with involuntary leakage. Seen in neurological conditions (e.g., Parkinson’s, stroke), infections, or bladder irritants.
Overflow Incontinence – Occurs due to incomplete bladder emptying from obstruction (BPH, pelvic organ prolapse) or weak detrusor muscle contraction (diabetes, spinal cord injury), leading to chronic urine retention and leakage.
Functional Incontinence – The bladder works normally, but physical, cognitive, or environmental barriers (e.g., dementia, mobility issues, stroke) prevent timely toileting, leading to accidental urine loss.
Which class of medications is commonly used to treat urge incontinence by relaxing the detrusor muscle?
Anticholinergics (e.g., oxybutynin, tolterodine) – These drugs block acetylcholine receptors to relax the bladder and reduce urgency.
What is the mechanism of action of mirabegron in treating overactive bladder?
Mirabegron (a β3-adrenergic agonist) works by relaxing the bladder’s detrusor muscle, increasing bladder capacity, and reducing urgency.
Which medication is primarily used to treat stress incontinence by increasing urethral sphincter tone?
Duloxetine (a serotonin-norepinephrine reuptake inhibitor, SNRI) is used for stress incontinence as it enhances sphincter contraction.
What is the primary medication used for neurogenic bladder to stimulate bladder contraction?
Bethanechol chloride (a cholinergic agonist) stimulates bladder contraction to improve voiding in neurogenic bladder.
Which urinary tract analgesic is commonly prescribed for symptom relief in urinary tract infections (UTIs)?
Phenazopyridine (Pyridium) – A urinary analgesic that relieves pain and burning but does not treat the infection itself.
Which antibiotic is commonly used for uncomplicated UTIs and requires patient education about urine discoloration
Nitrofurantoin (Macrobid) – Commonly used for UTIs and may turn urine a dark yellow or brown color.
Which medication is used for urinary retention but should be avoided in patients with asthma due to its cholinergic effects?
Bethanechol chloride – Used for urinary retention but can cause bronchoconstriction, making it unsafe for asthma patients.
Which antifungal medication is commonly prescribed for urinary tract fungal infections, particularly in immunocompromised patients?
Fluconazole (Diflucan) – An antifungal used for Candida-related urinary infections, particularly in immunocompromised patients.
Use: Bethanechol chloride is a cholinergic agonist used to treat _________ by stimulating the bladder’s detrusor muscle, promoting urination.
It is commonly prescribed for postoperative or neurogenic bladder dysfunction.
Serious side effects may include ….(4)
Nursing Considerations:
Before administering, assess for bladder distension and ability to void.
Monitor ….(3)
Administer on an empty stomach to reduce nausea.
Contraindicated in asthma, peptic ulcer disease, hyperthyroidism, and bradycardia due to its parasympathetic effects.
Educate the patient on potential dizziness and gastrointestinal discomfort
urinary retention
hypotension, bradycardia, bronchospasm, and severe abdominal discomfort.
Monitor
blood pressure, heart rate, and respiratory status due to the risk of hypotension and bronchospasm.
Symptoms of kidney stones
(6)
Stomach Pain
Back pain
Vomiting
Dizziness
Fever
Blood in urine
Severe Pain in Urolithiasis happens with these conditions (2)
Renal colic (Lumbar region radiating to side down and to testies / bladder
Uretal colic (Radiates to Genital & thighs)
Still NV, Sweating, pallor
Urolithiasis
Pain management…
Opiods preferred
Antispasmodics
Extracorporeal shock wave lithotripsy.
Use…
Anesthetic used….
Stent….
Fluid increase….
Breaks kidney stones
Local anesthesia
Yes, stent placement
Increase fluids to pass stones
Percutaneous lithotripsy may involve placement of ____ to ensure proper drainage
How long…
Nephrostomy
1 - 5 days
Nephrostomy tube is inserted into kidneys from this part of the body…
Back
24 hours after nephrostomy tube
Don’t (4)
Drive
Take Sedative
Drink alcohol
No NSAIDS (Aspirin, Ibuprofen, Naproxen Sodium)
Empty nephrostomy bag when…
Flush tube how often…
Clean insertion site & change dressing how often….
Half full
Everyday
Every 3 days
Can you shower with a nephrostomy tube?
Baths?
Yes, shower. Cover with plastic, if it gets wet, remove and put dry dressing on
No baths or submersion in water
Ureteral stent allows urine to go through or around the tube.
How does it stay in place….
Self curling ( J Tubes)
Urolithiasis
Pain:
Describe colicky & non-colicky pain…
Renal colic: Severe, sharp, intermittent pain in the flank, radiating to the lower abdomen or groin.
Non-colicky pain: Dull, aching pain when the stone causes partial obstruction.
Greatest risk factor for Urothelial Cancer
Other risk factors…
Tobacco use (Greatest Risk)
Chemical/ radiation exposure
Why ask about hobbies & occupation when getting a H&P for bladder cancer…
Exposure to chemicals
Most common sign for Urothelial Cancer…
Urinalysis: Micro/ Macroscopic, painless hematuria
Bladder cancer stages
Confined to lining of the bladder
Stage 0
Bladder cancer stages
Cancer has invaded the lamina propia or first connective layer of the bladder
Stage 1
Bladder cancer stages
Cancer has invaded into the muscle layer of the bladder
Stage 2
Bladder cancer stages
Cancer has spread into the fatty tissue layer or adjacent organs (Prostate, Vagian)
Stage 3
Bladder cancer stages
Cancer has invaded the pelvic or abdominal wall, lymph nodes , distant organs
Stage 4
Usual first option for bladder cancer…
Surgery
Considerations
TURBT is a minimally invasive procedure used to diagnose and remove ____ via a cystoscope inserted through the urethra.
When is this procedure performed….It
Type of anesthesia…
After procedure client may require…
Transurethral Resection of Bladder Tumor (TURBT):
bladder tumors
STAGE 1
non-muscle invasive bladder cancer (NMIBC).
General
Foley catheter
Big difference post care fir a Partial & Radical cystectomy….
Radical = Full bladder removal
Requires ileal conduit, continent urinary reservoir, or neobladder
Partial Cystectomy are not common
Used for…
Muscles invasive tumors that are limited to 1 part of the bladder
When to call a doctor for Urostomy (4)
🚨 No urine output for 4+ hours
🚨 Fever, chills, foul-smelling urine (possible UTI)
🚨 Severe skin irritation or bleeding around the stoma
🚨 Stoma turns pale, dark, or black (possible necrosis)
An ileal conduit is the most common type of ___
After a radical cystectomy (bladder removal) for conditions such as bladder cancer, neurogenic bladder, or trauma.
It involves using a section of the ileum (small intestine) to create a conduit for urine to drain into an external ostomy bag
urostomy
Kock Pouch (pronounced “coke”) is a continent urinary reservoir created from a segment of the ileum for patients who require bladder removal (e.g., radical cystectomy for bladder cancer, neurogenic bladder, or congenital defects). Unlike an ileal conduit, the Kock pouch stores urine inside the body, and the patient self-catheterizes through a stoma to drain urine.
Who is a Candidate for a Kock Pouch?
How often to self-catheterize….
Is mucous normal in the urine with this procedure….
Seek medical help when….
Patients undergoing radical cystectomy but want to avoid an external urostomy bag.
✅ Those who are motivated and able to self-catheterize every 4–6 hours.
✅ Patients with bladder dysfunction (e.g., neurogenic bladder, interstitial cystitis).
🚫 Not ideal for:
Patients with poor hand dexterity or cognitive impairments (unable to self-catheterize).
Patients with extensive bowel disease (Crohn’s, ulcerative colitis).
Surgical Procedure
A segment of the ileum (small intestine) is removed and folded into a pouch to create a reservoir.
A one-way valve is created to prevent urine leakage.
The pouch is connected to a small abdominal stoma (usually near the navel).
4–6
✅ Expect mucus in urine (from intestinal tissue); encourage fluids to flush it.
- Prevent Complications
Complication Signs & Symptoms Prevention/Management
UTI (Most Common) Fever, cloudy urine, foul smell Hydration, proper catheterization, clean technique
Pouch Rupture/Overfilling Abdominal pain, no drainage Empty pouch every 4–6 hours, avoid skipping catheterization
Stoma Stenosis Difficulty inserting catheter Notify provider, may need dilation
Urinary Leakage Urine leakage around stoma Check pouch valve function, proper catheterization
Patient Education for Home Care
1. Self-Catheterization Routine
✅ Insert a catheter into the stoma every 4–6 hours to drain urine.
✅ Use clean technique to prevent infections.
✅ If unable to pass catheter, seek medical
When to Seek Medical Help
🚨 Inability to insert catheter (possible stenosis or blockage).
🚨 Severe abdominal pain or distension (pouch overfilling or rupture).
🚨 Signs of UTI (fever, chills, foul-smelling urine).
🚨 Leakage from the pouch (possible valve dysfunction).
Normal urine output…
Atleast >30 mL Hour
______ is a type of continent urinary diversion created using a segment of the intestine (usually the ileum or colon) to form a new bladder after the removal of the native bladder (typically due to conditions like bladder cancer).
Designed to mimic the function of the natural bladder, allowing the patient to store urine internally and void through the urethra in a relatively normal manner.
neobladder
With the neobladder the kidneys flow urine to the large intestines and then the uterers are connected to the large intestines.
This allows a patient with out a bladder to urinate in a normal fashion
What considerations must the patient have to urinate with the Neobladder
Are infections common…
Neobladder isn’t connected to nerve/brain impulses
Must Relearn to pee
Yes, infections are common
What is Bacillus Calmette-Guerin (BCG)
SE…
Immunotherapy
Mainstay for superficial cancers
Stimulates immune system to attack cancer cells
Frequency, fever, Flu like, muscle joint pain, painful urination
Chemotherapy is given for high grade / recurrent tumors.
Given through catheter, retained for ____
Starting supine & rotate posistion….
Client voids (sitting) after 2 hrs (Urine is biohazard)
Disinfect toilet with bleach for ____ after therapy
Retained for 2 hours
Rotate Q 15 - 30 mins
Disinfect 6 hrs
Systemic therapy
Chemo can be given through veins to control cancer.
Can be given before radical cystectomy to improve outcomes
SE….
Immunotherapy: New checkpoint inhibitors…. (Describe)
Antibody Drug Conjugates: (Describe)
Bladder irritation/ Hemorrhagic cystitis
checkpoint inhibitors are a class of immunotherapies that block certain proteins on immune cells and cancer cells, enabling the immune system to recognize and attack cancer cells more effectively.
ADC
ADCs are designed to deliver chemotherapy drugs directly to cancer cells while minimizing damage to normal tissues, thus improving treatment efficacy and reducing side effects.
_____ is the abnormal increase in the number of cells within a tissue or organ, leading to its enlargement. Unlike hypertrophy, which involves the enlargement of individual cells, hyperplasia results from an increased rate of cell division and proliferation.
Hyperplasia
Slow enlargement of prostate gland
Tissue hyperplasia
Bladder outlet obstruction
Lower urinary tract symptoms (LUTS) - Describe
Which disease
Benign Prostatic Hyperplasia
Retention, Leaking, Incontinence
What is I-PSS
A questioner about benign prostate hyperplasia symptoms.
Trouble urination
Weak stream
frequency
Nocturia
Incomplete emptying
Quality of life
BPH
Acute urinary retention can cause (3)
Hydronephrosis/ Hydroureter
UTI
Sepsis
The diagnosis of BPH is confirmed HOW…
Urinary symptoms are consistent with prostate enlargement, other causes are excluded, and the symptoms are assessed using tools like I-PSS.
The healthcare provider will also evaluate the severity of symptoms to determine the appropriate treatment plan.
Tamsulosin & Doxazosin are used to treat BPH how…
Type of medication…
SE…
Tamsulosin & Doxazosin
Alpha ¹ Adrenergic Antagonist
Relaxes the bladder /UT through dilation of arterioles & veins
SE: Orthostatic Hypotension/ ED
Dutasteride & Finasteride
Help with BPH how….
Type of medication….
SE….
Decrease prostate size by blocking testosterone production
5-Alpha-Reductase Inhibitors (5-ARI)
SE: Orthostatic hypotension, teratogenic, ED, Decreased libido
BPH avoid these types of medications that may cause urinary retention
Anticholinergic:
Oxybutynin
Tolterodine
Solifenacin
Antihistamine:
Diphenhydramine
Loratadine
Cetirizine
Decongestant:
Pseudoephedrine
Phenylephrine
Oxymetazoline
Antidepressants (that cause urinary retention):
Amitriptyline
Imipramine
Doxepin
Class of medication
Oxybutynin
Anticholinergic
Type of medication
Tolterodine
Anticholinergic
Type of medication
Solifenacin
Anticholinergic
Tamsulosin
Use….
SE…
Alpha-1 Adrenergic Blockers (Medications that relax prostate smooth muscles and improve urine flow):
SE
Hypotension & Dizziness – Can cause orthostatic hypotension, leading to dizziness or fainting, especially when standing up quickly.
Retrograde Ejaculation – Causes semen to flow backward into the bladder instead of exiting through the urethra.
Headache – Due to vasodilation effects.
Fatigue – Common with long-term use.
Nasal Congestion – Caused by vasodilation effects.
Edema – Some patients may experience mild swelling in the lower limbs.
Weakness – Due to lowered blood pressure.
Alfuzosin
Class….
Use….
SE….
Alpha-1 Adrenergic Blockers (Medications that relax prostate smooth muscles and improve urine flow):
SE
Hypotension & Dizziness – Can cause orthostatic hypotension, leading to dizziness or fainting, especially when standing up quickly.
Retrograde Ejaculation – Causes semen to flow backward into the bladder instead of exiting through the urethra.
Headache – Due to vasodilation effects.
Fatigue – Common with long-term use.
Nasal Congestion – Caused by vasodilation effects.
Edema – Some patients may experience mild swelling in the lower limbs.
Weakness – Due to
Terazosin
Class…
Use…
SE…
Alpha-1 Adrenergic Blockers (Medications that relax prostate smooth muscles and improve urine flow)
SE
Hypotension & Dizziness – Can cause orthostatic hypotension, leading to dizziness or fainting, especially when standing up quickly.
Retrograde Ejaculation – Causes semen to flow backward into the bladder instead of exiting through the urethra.
Headache – Due to vasodilation effects.
Fatigue – Common with long-term use.
Nasal Congestion – Caused by vasodilation effects.
Edema – Some patients may experience mild swelling in the lower limbs.
Weakness – Due to lowered
Finasteride
Class
Use
SE
Time frame for effectiveness…
5-ARI & Alpha blockers
BPH
Teratogenic
Orthostatic Hypotension
Liver Damage KEEP LAB APPOINTMENTS
6 months
Dutasteride
Class
Use
SE
Time frame for effectiveness
5-ARI & Alpha blockers
BPH
Teratogenic
Orthostatic Hypotension
Liver Damage KEEP LAB APPOINTMENTS
6 months
Dutasteride/Tamsulosin (Combination Therapy - Jalyn)
Class
Use
SE
Time frame for effectiveness
5-ARI & Alpha blockers
BPH
Teratogenic
Orthostatic Hypotension
Liver Damage KEEP LAB APPOINTMENTS
6 months
Prostate artery embolization
Photo-selective vaporization
Transurethral needle ablation (TUNA)
Transurethral electro-vaporization
Transurethral water vapor Therapy
Urolift
May all be used for this problem
Benign prostate hyperplasia
Gold standard for BPH Surgical Management…
Type of meds held before surgery…
Address anxiety & sexual concerns
TURP
Anticoagulants
Transurethral resection of the prostate (TURP) is a surgical procedure used to treat urinary problems caused by an enlarged prostate (benign prostatic hyperplasia, BPH).
During TURP, a resectoscope is inserted through the urethra to remove excess prostate tissue, relieving pressure on the urethra and improving urine flow.
The procedure is performed under ________ anesthesia and typically requires a short hospital stay.
TURP is considered the gold standard for treating moderate to severe BPH symptoms when medications are ineffective.
general (breathing Tube Required)
or spinal
After TURP surgery monitor closely for…..
TURP Syndrome - over absorption of irrigation fluid and blood products.
HA, SOB, HTN, LOC, ECG
Pain
Continous bladder irrigation
I & O
VS
Bleeding
Obstruction
Most commonly diagnosed (non-skin) cancer in men…
Cure rate when found early…
Prostate
Nearly 100%
Prostate cancer is most common Non-Skin cancer in men.
Tumors are ____ dependent
Most are (this type)
Hormone dependent
Adenocarcinomas
Etiology/ Risk of Prostate Cancer (3)
Old age
1st degree relative
Black
Most common and most aggressive genes for prostate cancer
BRCA-2
GSTP1
BRCA-2 (Most Aggressive)
GSTP1(Most Common)
Prostate cancer is Asymptomatic early
What is a late sign….
Hematuria
Prostate-Specific Antigen (PSA)
Normal….
Elevated….
Highly suspicious….
Prostate-Specific Antigen (PSA)
Normal: ≤ 4.0 ng/mL
Elevated: > 4.0 ng/mL (may indicate BPH, prostatitis, or prostate cancer)
Highly suspicious: > 10 ng/mL (higher risk of prostate cancer)
Early Prostate Cancer Antigen-2 (EPCA-2)
Normal…..
Elevated….
Early Prostate Cancer Antigen-2 (EPCA-2)
Normal: < 30 ng/mL
Elevated: > 30 ng/mL (suggestive of prostate cancer, potentially more specific than PSA)
Transrectal Ultrasound (TRUS) & Biopsy
Ultrasound: _____ areas may suggest cancer
Biopsy: ____ Score (2-10) (higher scores indicate more aggressive cancer)
Transrectal Ultrasound (TRUS) & Biopsy
Ultrasound: Hypoechoic (dark) areas may suggest cancer
Biopsy: Gleason Score (2-10) (higher scores indicate more aggressive cancer)
Prostate Cancer Staging
Clinically non detectable tumor mass
Palpable tumor mass
Locally advanced tumor mass
Metastatic disemmination
T1
Clinically non detectable tumor mass
T2
Palpable tumor mass
T3
Locally advanced tumor mass
T4
Metastatic disemmination
Prostate cancer Treatment only if symptoms require it
Monitor with….
Maybe in active surveillance for ….
DRE / PSA
10 Years
Medication for Prostate cancer
Pain
Corticosteroids
Biphosphonates
Gives examples of these meds….
Why is biphosphonates given…
Prednisone – Commonly used for inflammation, autoimmune diseases, and asthma.
Dexamethasone –
Bisphosphonates: (TREAT & PREVENT OSTEOPOROSIS)
Alendronate (Fosamax) –
Risedronate (Actonel) –
Zoledronic Acid (Reclast, Zometa) –
External beam radiation therapy (EBRT)
GIVEN HOW OFTEN FOR PROSTATE CANCER….
SE…
5 days a week / several weeks
SE
ED
Frequency/ Diarrhea
Acute radiation cystitis
Radition Proctitis
Fatigue
Describe Low-Dose Brachytherapy for Prostate Cancer
Preformed where…
SE…
Internal radiation with lowdose Seeds implanted in body
Preformed in ambulatory care
SE
Urinary incontinence
ED
Fatigue
Leuprolide (Lupron)
Class…
Use…
Affects…
SE…
Luteinizing hormone-releasing hormone Agonist
Use: Hormone therapy for Prostate cancer
Affects: Causes Initial burst of LH release (Symptoms increase)
Then blocks testosterone secretion
SE: Hot Flashes, Bone Pain, ED , Lower libido
Bicalutamide
Class…
Use…
SE….
Anti-androgen drug
For advanced prostate cancer treatment
SE: Liver toxicity; monitor labs
Flutamide
Class….
Use….
SE…..
Class: Anti-androgen drug
Use: Prostate Cancer
SE: Liver toxicity; lab monitoring is required
Prostate Cancer
Chemotherapy
Use:
When Cancer has spread
____ cell Prostate Cancer
Curative treatment?
Small cell
Not curative
Slows growth to improve quality of life
Testicular Cancer is most common in this age group…
20 - 35
Most Testicular cancer cells are Germ-Cell tumors
Describe (Seminomas & Non-Seminomas)
Higher risk(5)
Seminomas (Most common; Best prognosis)
Non-Seminomas (More aggressive)
Risk:
White
Undescended testes
HIV
Hx of testie cancer & Marijuana Use
Testicular cancer
Has a swollen painful lump in testies…
False
It is painless
Diagnostic for Testicular Cancer
Tumor Markers (Blood Tests)
Alpha-fetoprotein (AFP):
Normal:
Elevated:
Beta-human chorionic gonadotropin (β-hCG):
Normal:
Elevated:
Lactate dehydrogenase (LDH):
Normal:
Elevated:
Tumor Markers (Blood Tests)
Alpha-fetoprotein (AFP):
Normal: < 10 ng/mL
Elevated: > 10 ng/mL (suggests non-seminomatous germ cell tumor)
Beta-human chorionic gonadotropin (β-hCG):
Normal: < 5 mIU/mL
Elevated: > 5 mIU/mL (seen in both seminomas and non-seminomas)
Lactate dehydrogenase (LDH):
Normal: 100–250 U/L
Elevated: > 250 U/L (non-specific but may indicate tumor
Orchiectomy is….
Surgical removal of 1 or both testies
After removal of a testie how often to get the other one checked…
Every month
Diagnostic values for ED
Hemoglobin A1C (Hgb A1C):
Normal:
Prediabetes:
Diabetes:
Significance: Elevated Hgb A1C suggests poorly controlled diabetes, which is a common cause of ED due to vascular and nerve damage.
Hemoglobin A1C (Hgb A1C):
Normal: 4.0% to 5.6%
Prediabetes: 5.7% to 6.4%
Diabetes: ≥ 6.5%
Significance: Elevated Hgb A1C suggests poorly controlled diabetes, which is a common cause of ED due to vascular and nerve damage.
Diagnostic values for ED
Lipids (Lipid Profile):
Total Cholesterol:
Normal:
Borderline high:
High:
LDL (Low-Density Lipoprotein):
Optimal:
Near optimal:
High:
HDL (High-Density Lipoprotein):
Low (risk factor for ED): (men),
High (protective):
Triglycerides:
Normal:
Borderline high:
High:
Total Cholesterol:
Normal: < 200 mg/dL
Borderline high: 200–239 mg/dL
High: ≥ 240 mg/dL
LDL (Low-Density Lipoprotein):
Optimal: < 100 mg/dL
Near optimal: 100–129 mg/dL
High: ≥ 160 mg/dL
HDL (High-Density Lipoprotein):
Low (risk factor for ED): < 40 mg/dL (men), < 50 mg/dL (women)
High (protective): ≥ 60 mg/dL
Triglycerides:
Normal: < 150 mg/dL
Borderline high: 150–199 mg/dL
High: ≥ 200 mg/dL
Penile Prostaglandin E1 injections
Phosphodiesterase-5….. (Give examples)
Treatment ED
Phosphodiesterase-5: Sildenafil, Tadalafil, Vardenafil
Sildenafil, Tadalafil
Cardiovascular Health: (3)
Monitor blood pressure
avoid use with nitrates or alpha-blockers due to risk of severe hypotension.
Contraindicated in patients with severe heart conditions (unstable angina, recent heart attack, severe heart failure).
Sildenafil
SE (5)
Side Effects:
Common: Headache, flushing, nasal congestion, dizziness.
Serious: Priapism (seek emergency care) and visual disturbances.
Sildenafil
Patient Education (3)
Patient Education:
Take 1 hour before sexual activity for sildenafil, 30 minutes before or daily for tadalafil.
Limit alcohol, avoid grapefruit.
Inform that the drug does not increase sexual desire.
Acute complicated UTI
Describe SS
Acute complicated = Upper UTI infection
Fever
Flank pain
Chills
CVA tenderness
Body defenses that prevent infection
Mucin cells in bladder
Urine pH
WBC in urinary tract
Prostate proteins
Voiding
Avoid these types of fluid and this type of medication when taking all medications for UTI
Citrus juice
Milk
Antacids
Drink cranberry juice
Which antiinfectives works systemically
Trimethoprim
Can Urethritis be non-infectious
Yes
Irritation, Injury, Chemical exposure
SS
Urgency, frequency, nocturia, Large amounts of urine
Vs
Constantly dribbling, sense of incompletion emptying, pelvic discomfort, palpable bladder
Overflow vs Urge incontinence
Urge;
Urgency, frequency, nocturia, Large amounts of urine
Overflow:
Constantly dribbling, sense of incompletion emptying, pelvic discomfort, palpable bladd
Quality and timing of urine loss varies, difficult to detect patterns
This type of incontinence…
Functional
Bladder most affects this group of people…
Whites
50 - 60
Suffix -tamide
This class
Use
SE
Androgen blocker
Prostate cancer
SE LIVER TOXICITY
Suffix - teride
Class
Use
SE
ARI 5 Blocker
BPH
Lowers testosterone
SE ORTHOSTATIC, ED, LIBIDO
Suffix-zosin
Class
Use
SE
AAA Alpha
BPH
Orthostatic, ED
Relaxes arteries & veins / Relaxes bladder dilation
Suffix -floxacin
Class
Use
SE
Fluoroquinolones
Complicated UTI
SE: Liver, QT prolongation, HA
BLACK BOX:
Tendon Rupture, CNS, Peripheral neuropathy
In BPH a rise in this hormone causes the prostate to enlarge…
DHT (Testosterone)
BPH will have Upper / Lower Urinary tract symptoms…
Lower
Retention, leakage, incontinence
BHP risk increases with a family history of….
Bladder cancer
In BPH falls are a concern why?
Getting up frequent at night
I-PSS consist of 7 questions and finally ask How would you feel if this continues the rest of your life.
Give scoring…
1- 7 mild
8 - 19 mod
>20 bad
Reflux from BPH can cause…
Hydronephrosis/ Hydroureter
In BPH never give Alpha-1 Adrenergic Antagonist (Doxazosin / Tamsulosin) & 5 alpha reductase inhibitor together (dutasteride / finasteride)….
False
They are often given together
Finasteride & dutasteride have this precaution…
Teratogenic
2 pairs of chemo gloves Dont breath pill dust
2 orders needed for every renal patient..
Daily weight & I & O
Main treatment for Testicular Cancer…
Orchiectomy- testicle removal
Alpha Adrenergic Antagonist strengthen contraction force of urinary sphincter….
T
According to teacher
After a stroke & with bladder cancer this is the most likely type of incontinence…
BPH this type of incontinence….
Urge aka Over Active Bladder
Overflow
Most common drug given for urge incontinence…
Anticholinergic/ Botox
The ___ method is a manual technique used to assist with bladder emptying with overflow incontinence or urinary retention due to conditions like neurogenic bladder.
It involves applying gentle, firm pressure over the lower abdomen (just above the pubic bone) to help expel urine from the bladder.
Credé
If partial cystectomy happens describe catheter afterwards…
2
Supra pubic
&
Urethral
Bacillus Calmette-Guerin
Describe…
SE…
Fluid instilled into bladder that contains a Virus with weakened mycobacterium.
Stimulates immune system to attack cancer cells
FLU Like symptoms, frequency
Radiation can have these SE
Fistulas & Interstitial Cystitis
Illitis/ Colitis
Interventions:
Pelvic floor exercises (Kegels)
Pessary or urethral inserts
Surgery (e.g., sling procedures)
Interventions:
Bladder training and timed voiding
Pelvic floor therapy
Electrical nerve stimulation (e.g., sacral neuromodulation)
Interventions:
Clean intermittent catheterization (CIC)
Surgery for obstruction (e.g., prostatectomy)
Interventions:
Scheduled toileting and prompted voiding
Assistive devices (e.g., bedside commodes, grab bars)
Environmental modifications
Stress Incontinence
Interventions:
Pelvic floor exercises (Kegels)
Pessary or urethral inserts
Surgery (e.g., sling procedures)
Urge incontinence
Interventions:
Bladder training and timed voiding
Pelvic floor therapy
Electrical nerve stimulation (e.g., sacral neuromodulation)
Overflow
Interventions:
Clean intermittent catheterization (CIC)
Surgery for obstruction (e.g., prostatectomy)
Functional
Interventions:
Scheduled toileting and prompted voiding
Assistive devices (e.g., bedside commodes, grab bars)
Environmental modifications
Diagnostic for urethra structure…
Diagnostic for ureter stricture….
Urethra = Urine flow test
Urether = Renal US / CT scan
Alpha fetoprotein (AFP)
Beta human chorionic (LDH)
Lactate Dehydrogenase (LDH)
Are all used to diagnose….
Testicular cancer
Also
Scrotal US
Chest XR / CT
MRI brain
