Urinary symptoms Flashcards
what is interstitial cystitis?
bladder pain syndrome
syndrome of having urinary urgency and increasing pelvic pain and pressure that is relieved with voiding
who gets interstitial cystitis?
more common with women and associated with psychiatric and pain disorders (fibromyaglia)
See dyspareunia, urinary frequency and urgency and symptoms relieved with voiding and pain with bladder filling
Diagnosis of interstitial cystitis?
bladder pain with no other cause >6 weeks and normal urinalysis
Treatment of interstitial cystitis
not curative, but focus on improving quality of life. Behavioral modification and avoidance of triggers, physical activity and amitriptyline, pentosan and polysulfate sodium
analgesics for acute exacerbations.
What does pentosan polysulfate sodium do?
repairs the urothelium and has minimal side effects (mild reversible hair loss) and approved by FDA for treatment of interstitial cystitis or bladder pain syndrome.
What do we do for refractory cases
bladder instillation therapy or intradetrusor botulinum toxin or sacral neuromodulation
cystocele symptoms and definition
this is pelvic organ collapse that creates a bulge sensation that may have associated stress urinary incontinence due to loss of anterior vaginal wall support.
neurogenic bladder cause and presentation
chronic urinary retention due to peripheral neuropathy (DM2) and impaired detrusor contractiligy and decreased sensation of bladder filling cause of incomplete bladder emptying
presentation of neurogenic bladder
see constant dribbling from urine overflow. see no associated pelvic pain
non gonococcal urtheritis presentation
presents with urinary frequency, urethral tenderness, sterile pyuria (elevated WBC on urinalysis and negative urine culture) and this is associated with atypical bacteria like CHlamydia trachomatis or mycoplasma genitalium.
These pts also have associated cervicitis (post coital bleeding, cervical motion tenderness and pain with voiding)
urgency incontinence is also called
overactive bladder
overactive bladder can cause
involuntary detrusor contractions with immediate loss of urine.
non pharmacological treatment of urinary incontinence
wt loss in overweight pts
dietary changes (lower ETOH and fluid and caffeine intake
smoking cessation
stopping offending medications and diuretics
behavioral therapy for urinary continence
bladder training (urge and mixed incontinence) timed voiding voiding diary relaxation techniques pelvic floor (kegal exercises)
which types of urinary incontinence are treated with Kegel exercises?
urge, stress and mixed incontinence
when do we use incontinence pessary?
for pts who fail conservative therapy (devices have compliance rate of about 50% but helpful in ppl who want to avoid surgery
surgery for stress incontience
highest cure rate and mid urethral sling or Burch retropubic colposuspension
only for people who fail conservative tx
when do we get urodynamic testing
helps to diagnose people who have mixed symptoms (stress or urgency)
what is urodynamic testing?
measures urine storage and evacuation and helps to diagnose incontinence type with mixed symptoms.
Not well standardized and has inconsistent reproducible results in same pt.
urinary retention is defined with:
bladder ultrasound showing more than >300 ml in volume
treatment of urinary retention
urinary catherization
what can cause acute urinary retention in a elderly?
underlying BPH,
sympathomimetics (pseudophedrine),
anithistamines with anticholinergic properties (diphenydramine)
cold medications
What causes the pathophysiology behind acute urinary retention?
urinary retention with increased bladder tension can stimulate sympathetic nervous system and result in catecholamine release and delirium.
Can have agitation and confusion without abdominal discomfort
