Urological

Question 1

Urinary incontinence
Causes, types, sx, ix, mx

Answer 1

Causes:
- urge: idiopathic, neuro conditions, inflammation and bladder irritants
- stress: urethral hypermobility and intrinsic sphincter deficiency
- overflow: enlarged prostate (bph, cancer and inflammation), diabetes, obstructing masses, fistulas, spinal cord injuries and anticholinergic meds

Transcient causes:
• D – elirium
• I – nfection
• A – thropy
• P – harmaceuticals
• E – xcess excretion
• R – estricted mobility
• S – tool impaction

Ix:
- bladder diary
- urinary stress test
- urinanalysis
- renal function tests
- PSA
- post void residual bladder scan
- renal Uss
- MRI

Mx:
• Self-monitoring
• Bladder training - Kegles
• Lifestyle changes
- Absorbent materials, urine bottles, vaginal pessaries
- Caffeine reduction
- Weight loss
• Medical equipment
• Surgery
• Drug review
• Medication -Antimuscarinics, topical oestrogen, alpha-adrenergic antagonists (selective vs non-selective), 5-alpha reductase inhibitors

Question 2

Urinary tract infection (UTI)
Stages, types, sx, dx, ix, mx

Answer 2

Types:
- Cystitis: lower UTI- urethra or bladder infection, prostitis, often uncomplicated but can progress to upper or complicated UTI.
- Pyelonephritis: upper –or complicated UTI, or ureters, kidney infection usually due to bacterial ascent.
- Typical: Uncomplicated, self-resolving. Common pathogens include uropathogenic E. coli, Klebsiella pneumoniae, and Enterococcus faecalis.
- Atypical: Seriously ill, Poor urine flow, Abdominal/bladder mass, Raised creatinine,Septicaemia, Failure to respond to Abx in 48 hours, Non-E.coli organisms.
- Recurrent: Two or more UTIs in six months or three or more in 12 months.
- Catheter associated UTI

Sx:
- Lower: urinary frequency, urinary urgency, suprapubic pain, dysuria, heamaturia
- Upper: fever, chills, flank pain, nausea, vomiting, costovertebral or renal angle tenderness, recurrent lower UTI symptoms

Dx:
- Nitrites: strongly suggestive of bacteriuria, as nitrates are broken down into nitrites only in
the presence of bacteria.
- Leukocyte esterases: an enzyme leukocytes produce in response to bacteria in the urine.
- On MC&S, the following findings would be consistent with a UTI:
- Bacteriuria: the presence of bacteria in urine. Historically, ≥ 105 bacterial colonies/mL of
urine were needed to diagnose a UTI. However, a UTI can be diagnosed if the symptoms are present with as low as 102 bacterial colonies/mL. If there is bacteriuria without symptoms, this is termed asymptomatic bacteriuria. It is more common in older patients, and asymptomatic bacteriuria is only treated in pregnant women, before urological
operations or if there are associated symptoms.
- Pyuria: the presence of WBCs in the urine. Sterile pyuria (WBCs in the urine, without
infection) can indicate a range of diagnoses, including renal malignancy, pelvic malignancy
and genitourinary tuberculosis

Ix:
- renal US
- USS
- CT (acute)

Mx:
- personal hygiene
- vit c supplement
- D-mannose, cranberry products
- analgesia
- abx