Urology Flashcards
- *DYSURIA/UTI**
- Lower anatomic causes
- Upper anatomic causes
- Lower :
Urethritis ( usually from STD source)
vulvovaginitis (bacterial, infectious (candida, HSV, BV), irritant sources ) - Upper: Pyelonephritis, renal/perinephric abscess, prostatitis
UTI
- Uncomplicated vs complicated UTI
- Uncomplicated: Cystitis in immunocompetent nonpregnant healthy woman without anatomic/functional abnormality (regardless of her age
- Complicated: Means risk of treatment failure :
Immunocompromised, male gender, infection past the bladder (pyelonephritis), anatomic or functional abnormality of the urinary tract (enlarged prostate, stone, diverticulum, neurogenic bladder) , multi drug-resistant bacteria
UTI
Common Pathogens
Microbiology - KEEPS
Klebsiella pneumoniae
E Coli – most common (75-95%), especially in women
Enterococci – most common in LTC facilities
Proteus mirabilis – most common in men
Staph saprophyticus
UTI
Risk Factors
Age
Female
Neurogenic bladder/urinary incontinence, vesicoureteral reflux, posterior urethral valves, prolapse, BPH
Indwelling catheter, recent surgery/instrumentation
Diabetes, other comorbidities
Sexual activity
DYSURIA
Differentials
Cystitis, Pyelonephritis, Urethritis
Vulvovaginitis, Cervicitis
Interstitial cystitis (bladder pain syndrome)
Prostatitis, epididiymo-orchitis
Foreign body
Urolithiasis
Dermatologic
Irritant/Contact dermatitis, lichen sclerosus, lichen planus, psoriasis, Stevens-Johnson, Behçet syndrome
BPH, urethral stricture
Neoplastic
Trauma/surgery
UTI
Name complicating conditions/factors to treatment (5)
Complicating conditions :
- pregnant
- co-morbidity
- exposure to antibiotics in the past 3 months
- travel
- previous drug-resistant infection
UTI
- Treatment for uncomplicated cystitis in nonpregnant females
- Treatment for uncomplicated cystitis in pregnant females
- Treatment for complicated cystitis in nonpregnancy and pregnancy
Empiric antibiotics for simple cystitis
A)Nitrofurantoin (macrobid) 100mg PO BID x 5-7d (careful in reduced creatinine clearance)
B) TMP-SMX (Bactrim/Septra)DS 1 tab BID x 3d
C) Fosfomycin 3g PO x 1 (appropriate but inferior efficacy)
Empiric antibiotics for uncomplicated cystitis in pregnancy
A) Nitrofurantoin (Macrobid) 100mg PO BID x 7d
B) Amoxicillin 875mg PO BID x 3-7d
Avoid TMP-SMX in first trimester and at term
Acute Pyelonephritis or complicated cystitis
Ciprofloxacin 500mg PO BID x7d or Levofloxacin 500mg PO daily x 7d
Can consider initial intravenous dose: Ceftriaxone 1g IV or 24h dose of aminoglyocoside
Complicated cystitis in Pregnancy:
Inpatient and Ceftriaxone or pip tazo and for when they are safe to be d/c as an outpatient: Keflex, augmentin (amox -clav), cefixime (suprax)
UTI
-Treatment in men
Fluoroquinolones (eg. Cipro 500mg PO BID or Levofloxacin 500mg PO daily) x 10-14d
Consider shorter courses of fluoroquinolones for uncomplicated pyelonephritis (eg. 7d as per ACP)
Consider TMP-SMX DS 1 tab BID x 14d if culture sensitive
UTI
Prevention
Post Coital Voiding
Avoiding spermicides
Hydration
Perineal hygiene
Healthy voiding habits
Avoid unnecessary urinary catheters (consider intermittent cathterization)
Aseptic technique for urinary catheters
May consider cranberry prophylaxis (eg. juice or tablet)
May consider discussing antibiotic prophylaxis (continuous x 1 year or postcoital) vs. self-treatment in recurrent UTI (eg. 2+/6mo, 3+/12mo)
May consider vaginal estrogen therapy in peri/post-menopausal women
Recurrent Cystitis
- Definition
- Risk factors
- 3 or more symptomatic culture positive UTI/ 12 months; 2 or more/ 6 months
- Genetic factors ; Urogenital anatomy variation (shorter anal urethral distance)
Recurrent Cystitis
-Prophylaxis
Continue UTI prophylaxis (taken daily for 6 months ; up to 12 months)A) Nitrofurantoin 50-100 mg once daily
- TMP/SMX 3x per week
- Cephalexin 125-250 mg daily
Post Coital Prophylaxis
- Nitrofurantoin 100 mg once
- TMP/SMX 40/200 once
Post Menopausal Women
- Topical estrogens or lubricants
