Urogenital Issues Flashcards
constitutional symptoms of genitourinary disease
group of symptoms that can affect many different systems of the body:
Fever, chills
• Fatigue, malaise
• Anorexia, weight loss
musculoskeletal symptoms of genitourinary disease
Unilateral costovertebral tenderness
• Low back, flank, inner thigh, or leg pain
• Ipsilateral shoulder pain
urinary problems
Dysuria (painful burning or discomfort with urination)
• Nocturia (getting up more than once at night to urinate)
• Feeling that bladder has not emptied completely but unable to urinate more; straining to start a
stream of urine or to empty bladder completely
• Hematuria (blood in urine; pink or red-tinged urine)
• Dribbling at the end of urination
• Frequency (need to urinate or empty bladder more than every 2 hours)
• Hesitancy (weak or interrupted urine stream)
• Proteinuria (protein in urine; urine is foamy)
female symptoms
Abnormal vaginal bleeding • Painful menstruation (dysmenorrhea) • Changes in menstrual pattern • Pelvic masses or lesions • Vaginal itching or discharge • Pain during intercourse (dyspareunia)
male symptoms
Difficulty starting or continuing a stream of urine • Discharge from penis • Penile lesions • Testicular or penis pain • Enlargement of scrotal contents • Swelling or mass in groin • Sexual dysfunction
risk factors for UTI
Female-shorter urethra than males
ii. Being sexually active
iii. Birth control methods such as diaphragm, spermicidal agents
iv. Completing menopause- lack of estrogen causes changes in urinary tract
v. Urinary tract abnormalities- congenital causes
vi. Blockage of urinary tract- kidney stone or enlarged prostate
vii. Suppressed immune system
viii. Using a catheter
possible symptoms of UTI
Burning with urination
ii. Strong, persistent urge to urinate
iii. Passing frequent, small amounts of urine
iv. Urine that appears cloudy, red, bright pink, or brown in color
v. Strong smelling urine
vi. Pelvic pain in women, rectal pain in men
vii. Constitutional symptoms
viii. Confusion
ix. Decreased appetite
x. Sepsis
xi. Fall risk
xii. Can possibly lead to death
other risk factors for kidney and urinary tract disorders
Age over 60
•Personal or family history of diabetes or hypertension
• Personal or family history of kidney disease, heart attack, or stroke
Personal history of kidney stones, urinary tract infections, lower urinary tract obstruction, or
autoimmune disease
• African, Hispanic, Pacific Island, or Native American descent
• Exposure to chemicals (e.g., paint, glue, degreasing solvents, cleaning solvents), drugs, or
environmental conditions
• Low birth weight
What causes an upper UTI
kidney or ureteral infections
what causes a lower UTI
cystitis (bladder infection) or urethritis (urethral infection)
Why is an upper UTI more serious?
causes threat to renal tissue which can cause renal infections, glomerulonephritis, renal papillary necrosis or renal tuberculosis
what are the symptoms associated with LOWER UTIs
urinary urgency and frequency a sensation to void dysuria (painful urination) Irritation of the neck of the bladder or the urethra can result in a burning sensation localized to these areas low back pain hematuria pyuria (pus or WBCs in the urine) bacteriuria painful intercourse pelvic/lower abdominal pain
Where can you find the pain located on a body diagram?
over the bladder and on the lower back
what are the symptoms associated with UPPER UTIs?
Unilateral costovertebral tenderness
Flank pain
Ipsilateral shoulder pain
Fever and chills
Skin hypersensitivity (hyperesthesia of dermatomes)
Hematuria (blood [RBCs] in urine)
Pyuria (pus or white blood cells in urine)
Bacteriuria (bacteria in urine)
Nocturia (unusual or increased nighttime need to urinate)
Who is more common to get a LOWER UTI?
more common in women
What are some predisposing factors associated with LOWER UTIs?
diabetes mellitus, gout,
hypertension, obstructive urinary tract problems, and medical procedures requiring urinary
catheterization
Who is at an increased risk in general for UTIs?
older adults; both men and women
What is cystitis?
inflammation with infection of the bladder
comes with recurring pelvic pain, pressure or discomfort in the bladder and pelvic region associated with frequent urination and urgency along with a dull achy or acute stabbing
interstitial cystitis is inflammation without infection
what are the risk factors for kidney stones?
Family or personal history of kidney stones
ii. Age >40
iii. Male
iv. Dehydration
v. Diets high in protein, sodium, sugar, oxalate
vi. Being obese
vii. Digestive disorders
viii. Renal tubular acidosis
ix. Cystinuria
x. Hyperparathyroidism
xi. UTI
What is a kidney stone?
solid mass of tiny crystals
symptoms of kidney stones
•Pain (depends on the rapidity of onset and on the location) •Acute, spasmodic, radiating •Mild and dull flank pain •Lumbar discomfort with some renal diseases or renal back pain with ureteral obstruction Hyperesthesia of dermatomes (T10 through L1) •Nausea and vomiting •Palpable flank mass •Hematuria •Fever and chills •Urge to urinate frequently •Abdominal muscle spasms •Renal impairment indicators
Describe some specific tests PTs can perform to rule in/out kidney stones
You can do Murphy’s percussion; the
physician can order CT scan, abdominal x-ray, urinalysis, urine cultures and ultrasound.
In clinic, can do costovertebral test (same as Murphey’s; just tells you the location of where to hit)
What action can a PT take if a kidney stone is suspected?
encourage water intake and refer to PCP
List some primary obstructive disorders
congenital malformations, renal or ureteral calculi (stones), polycystic kidney disease,
or neoplasms or the urinary tract (bladder, kidney)
list some secondary obstructive disorders
BPH, malignant prostatic enlargement, AAA, PID, endometriosis, pregnancy,
neoplasms of pelvic or abdominal structures
What is nephrolithiasis?
kidney stone and can travel to become ureteral stone (very painful); both cause
sudden, sharp, severe pain (renal or ureteral colic)
Where can renal pain refer to on a body diagram?
renal pain sensation is aching and dull but can occasionally be a severe, boring type of pain
can refer to ipsilateral shoulder, iliopsoas and mid back
Renal and ureteral pain can be felt through which dermatomes?
T10 to L1
What causes ureteral pain?
a ureteral obstruction from a urinary calculus or “stone” consisting of mineral salts that causes spasm that produces intermittent or constant severe colicky pain until the stone is passed
what is benign prostatic hyperplasia?
enlarged prostate commonly seen in men over 50
it interferes with normal urine flow
they have difficulty urinating
there is straining to empty the bladder which stretches it causing it to be less efficient
if urine collects in the bladder a UTI can occur
risk factors for BPH
Men
Increases with age (by 55 one in four men, by 75 half of men show symptoms)
Family history: Brother or father with prostrate problems
Obesity
American/Australian men vs Chinese/Japanese/Indian men
Erectile dysfunction
Lack of physical activity
possible symptoms of BPH
Weak urine stream Difficulty starting urination Stopping and starting while urinating Dribbling at the end of urination Frequent or urgent need to urinate/difficulty postponing urination Nocturia Straining while urinating Not being able to completely empty the bladder UTI Formation of stones in the bladder Reduced kidney function Back/side/abdominal pain Worse in cold weather or as a result ofphysical or emotional stress
Questions to ask patient if you suspect BPH?
Have you had any pain or discomfort while urinating?
Have you been urinating more frequently without an increase in fluid intake?
Have you experienced any pain in your abdomen, groin, orgenital area?
Have you had to wake up more frequently at night to urinate?
What would you find in a systems review for someone with BPH?
Back/side/abdominal pain that doesn’t change with any movements
What is urinary incontinence?
involuntary leakage of urine
What are the risk factors for UI?
Advancing age
Alzheimer’s disease or dementia
Arthritis or other musculoskeletal problems
Overweight/obese
Chronic cough
Chronic constipation
History of recurrent urinary tract infections
History of sexually transmitted diseases
Enlarged abdomen (e.g., ascites, pregnancy, obesity, tumor)
Diabetes mellitus
Neurologic disorders
Medications
caffeine and alcohol
What meds can increase the risk of UI?
Sedatives o Diuretics o Estrogens o Anticholinergics o Antibiotics o Alpha-adrenergic blockers (antihistamines, decongestants) o Calcium channel blockers o Antipsychotics o Antidepressants o Antiparkinsonian drugs o Laxatives o Opioids o Vincristine o Angiotensin-converting enzyme (ACE) inhibitors
what risk factors are specific to women?
Pregnancy (multiparity) Vaginal or cesarean* birth Previous bladder or pelvic surgery Pelvic trauma or radiation Bladder or bowel prolapse Menopause (natural or surgically induced; estrogen deficiency)† Tobacco use
what risk factors are specific to men?
Enlarged prostate gland
Prostate or pelvic surgery
Radiation (acute and late complications), especially when combined with brachytherapy
how might incontinence impact a person’s life?
- restrict activities for fear of urine loss and odor
- decreased psychological health
- skin breakdown
- UTIs
4 types of incontinence
stress incontinence
urge incontinence
overflow incontinence
mixed incontinence
what is stress incontinence?
occurs when the support for the bladder or urethra is weak or
damaged, but the bladder itself is normal. With stress incontinence, pressure applied to the
bladder from coughing, sneezing, laughing, lifting, exercising, or other physical exertion
increases abdominal pressure, and the pelvic floor musculature cannot counteract the
urethral/bladder pressure
causes 75% of UI cases
what is urge incontinence?
involuntary
contraction of the detrusor muscle (smooth muscle of the bladder wall) with a strong desire to
void (urgency) and loss of urine as soon as the urge is felt
what is mixed incontinence?
combination of urge and stress
what is overflow incontinence?
overdistention of the bladder and the bladder cannot empty
completely. Urine leaks or dribbles out so the client does not have any sensation of fullness or
emptying
What are PT interventions for stress and urge incontinence?
Biofeedback, Kegel exercises, vaginal cones, pelvic floor exercises; behavioral modification
Risk factors for prostate cancer
Most common cancer among men and second leading cause of death in men
Very rare under age 40
Rises rapidly in men over 50
60% of cases are over age 65
Men of African descent are at a higher risk
Asian or Hispanic men have less of a chance of getting it than Caucasian males.
Most common in North America, northwestern Europe, Australia, and the
Caribbean.
Least common in Asia, Africa, Central America, and South America
Relative with prostate cancer doubles your odds, more relatives with cancer= higher
risk
Men with high red meat/ fat/ dairy diet increases your risk
Workplace exposure to toxic combustion products (firefighters)
Inflammation of the prostate increases risk
signs and symptoms of prostate cancer
Problems passing urine Hematuria Impotence Pain in hips, back, chest, or other areas from cancer spread to bone Weakness or numbness in legs/feet Bowel/Bladder Incontinence Lymphedema of the scrotum
what would you find in systems review that would suggest immediate referral for prostate cancer?
Report of change in urination, blood in urine
No change in pain with lumbar movements
Unsteadiness during walk and turn
Smell of urine
What is the prostate pain pattern?
pain in bladder and prostates/penis
referred to lower back
risk factors for renal cancer
Smoking (two times the risk as nonsmokers)
Obesity
Hypertension
Long-term dialysis
Von Hippel-Lindau (VHL) syndrome (genetic, familial syndrome)
Occupation (coke oven workers in the iron and steel industry; asbestos and cadmium
exposure)
Gender (men twice more likely than women)
signs and symptoms including regions of pain for renal caner
blood in the urine, pain in the side that does not go away a lump or mass in the side or abdomen, weight loss fever general fatigue or feeling of poor health swollen lymph nodes swollen legs/feet/scrotum, anemia back pain just below ribs that doesn’t go away
signs and symptoms of bladder cancer
Blood in the urine
• Pain during urination
• Urinary urgency
risk factors for testicular cancer
HIV/AIDS Infection Carcinoa in Situ Age: peak 20-34 years Race + Ethnicity: 4/5x White>black 3xWhite>Asian American Body Size: tall men
signs and symptoms of testicular cancer
A lump or nodule in either testicle
An enlarged (swollen) testicle
A dull ache in the lower abdomen or groin
A sudden gathering of fluid in the scrotum
Feeling of heaviness in the scrotum
Low back pain
Swollen breasts
What is the most important risk factor for bladder cancer
Smoking: the most important risk factor for bladder cancer. Smokers are at least 3 times as
likely to get bladder cancer as nonsmokers. Smoking causes about half of the bladder
cancers in both men and women. When smokers inhale, some of the carcinogens (cancer causing
chemicals) in tobacco smoke are absorbed from the lungs and get into the blood.
From the blood, they are filtered by the kidneys and concentrated in the urine. These
chemicals in urine can damage the cells that line the inside of the bladder, which increases
the chance of cancer developing.
What are other risk factors for bladder cancer
Workplace exposures: Certain industrial chemicals
Race and ethnicity: Whites are about twice as likely to develop bladder cancer as African
Americans.
Age: 9 out of 10 people with bladder cancer are older than 55.
Gender: more common in men
Chronic bladder irritation and infections: Urinary infections, kidney and bladder stones,
bladder catheters left in place a long time, and other causes of chronic bladder irritation
have been linked.
Personal history of bladder or other urothelial cancer: having a cancer in the lining of any
part of the urinary tract puts you at higher risk of having another tumor.
Bladder birth defects
Genetics and family history: family members with bladder cancer have an increased risk of
getting it themselves.
Chemotherapy and radiation therapy: Long-term use of the chemotherapy drug
cyclophosphamide (Cytoxan) can irritate the bladder and increase the risk of bladder cancer;
people who are treated with radiation to the pelvis are more likely to develop bladder
cancer.
Certain medicines or herbal supplements: pioglitazone (Actos) for diabetes for more than
one year may be linked with an increased risk of bladder cancer; dietary supplements
containing aristolochic acid (mainly in herbs from the Aristolochia family) have been linked
with an increased risk of urothelial cancers, including bladder cancer.
Low fluid consumption: Drinking more fluids and emptying bladders often keeps chemicals
from lingering in their bodie
most common treatment for bladder cancer
Tansureal Resection
risk factors for chronic kidney disease
advancing age diabetes HTN smoking obesity high cholestrol NOT white family history > 65 years kidney transplant certain OTC drug intake
What is a consideration of someone with end-stage renal disease?
Fluid Restriction: patients with ESRD need to restrict their fluid intake to control BP and prevent
CHF
follow-up questions if you suspect prostatisis?
do you ever have burning pain or discomfort during urination?
does it feel like your bladder is not empty when you finish urinating
do you have to go to the bathroom every 3 hours or more?
do you ever have pain in your testicles, penis?
do you have any discomfort during or after sexual climax?
guidelines for immediate medical attention for urogenital disease
presence of any blood in the urine
presences of cervical spine pain at the same time as urinary incontinence
saddle anesthesia secondary to cauda equina lesion
