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NURP 532 > Week 12 GU/Urinary > Flashcards

Week 12 GU/Urinary Flashcards

1
Q

how does prostatitis occur? most common organism?

A
  • ascending infection from urethra from urine into prostate
  • E.coli
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2
Q

acute bacterial prostatitis sx’s

A
  • acute onset
    • frequency, urgency, burning
  • weak stream, hesitancy (from inflamed prostate)
  • Fever
  • Suprapubic, perineal, or rectal pain
  • Painful ejaculation, hematospermia
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3
Q

acute bacterial prostatitis PE

A
  • abdominal exam
    • bladder distention
    • urinary retention
  • gentle digital rectal exam.
    • prostate → tender, enlarged, or boggy
    • don’t massage the prostate = spread infection
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4
Q

acute prostatitis diagnostics

A
  • Urinalysis
  • Urine culture
  • CBC w/ diff
  • GC/CT testing if
    • < 35
    • high-risk sexual behavior
  • Transrectal ultrasound
    • Only if not improving or Diagnosis unclear
  • PSA testing should not be done
    • will be elevated even 2 months after tx
  • Diagnosis based on history and physical + urinalysis
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5
Q

acute prostatitis management

A
  • if STI → give ceftriaxone and doxycycline x 10 days
  • if > 35 yrs → fluoroquinolone or Bactrim x 10 - 14 days (up to 4 wks if severe)
  • if lower urinary tract sx’s → hydration, pain control, and alpha-1 blockers
  • if chronic (> 3 months) → refer urology
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6
Q

admission for acute bacterial prostatitis

A
  • if failed outpatient management
  • inability to take oral medications if n/v,
  • resistance to recent fluoroquinolone use
  • if they’re systemically ill or toxic appearing
  • urinary retention
  • chronic prostatitis = managed by urology
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7
Q

conditions that cause urethritis

A

gonorrhea

chlamydia

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8
Q

urethritis diagnostics

A
  • most common cause non gonococcal → chlamydia
  • NAAT chlamydia/gonorrhea
    • women → vaginal swabs (preferred)
      • or clean catch urine (easier)
    • men → first catch urine
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9
Q

nongonococcal urethritis is most common with? Treatment

A

Chlamydia

  • Treat empirically for both infections if you do not have lab evidence of just one infectious cause**
    • Azithromycin 1 g once
    • OR
    • Doxycycline 100mg bid x 7 days + ceftriaxone
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10
Q

urethritis sx’s

A
  • gonorrhea - many asymptomatic
    • female: thin, purulent ,odorous leukorrhea, dysuria, intermenstrual bleeding, lower and pain
    • male: burning on urination, penile discharge
  • chlamydia - many symptomatic, dysuria
    • female: mucopuruluent discharge from cervical os
    • male: penile discharge
  • Erythema
  • Urethral pruritis
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11
Q

most common cause of epididymitis in men over 35? under 35?

A
  • men under 35: STI - chlamydia/gonorrhea
    • if anal sex: consider enteric organism
  • men over 35: urinary tract pathogen
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12
Q

epididymitis on exam

A
  • gradual onset
  • Severe scrotal pain and swelling
  • Pain radiate to lower abdomen
  • Fever
  • Dysuria • Frequency • Hematuria
  • Epididymis is tender and swollen; erythema.
  • Positive Prehn sign (pain relief when affected testicle elevated)
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13
Q

Epididymitis diagnostics

A
  • Doppler ultrasound (differentiate torsion)
  • UA and CBC (reveals WBC and bacteriuria)
  • NAAT - dx chlamydia/gonorrhea
  • CRP is not needed, but it is elevated in epididymitis
  • normal cremaster reflex
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14
Q

Epididymitis treatment

A
  • 2–14 yrs
    • Based on urine culture
    • Urology referral
  • Sexually active, < 35 years old
    • Empiric CT/GC treatment
    • ceftriaxone IM & doxycycline
  • Insertive anal intercourse
    • Empiric treatment for CT/GC and enteric organisms
  • > 35 years old:
    • Treatment for enteric organism
    • levofloxacin or ciprofloxacin
  • Bed rest, scrotal elevation, hot or cold compresses, NSAIDS as needed
    • F/u in 1 week if no improvement but should be improved in 3 days
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15
Q

orchitis occurs when? management

A
  • testicular edema
  • painful testes, tenderness
  • systemic post viral infection
    • mumps infection
  • same bacteria or STI that caused epididmyitits (can occur same time)
  • viral - conservative
    • NSAIDS
    • elevation
  • doppler ultrasound
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16
Q

testicular torsion sx’s /exam

A
  • trauma or strenuous exercise can cause pain
  • severe pain with an acute onset, swollen
  • unilateral
  • nausea, vomiting, fever
  • urinary symptoms
  • High rise- raised testicle
  • NO cremasteric reflex
  • Newborn:
    • painless firm, blue scrotal mass, non tender
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17
Q

testicular torsion management

A
  • ASAP ER → urologic consultation and surgical!
    • no US needed if high suspicion
    • if questionable, get US
      • if TT = absent or decreased blood flow on US
  • intervention w/in 6-8 hrs to save testes
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18
Q
  • can be asymptomatic
  • scrotum feels like “bag of worms”
  • dull aching pain
  • worse with standing; valsava/straining make more apparent
A

varicocele

  • abnormal dilation of the spermatic veins
  • very common
  • malfunctioning of the valves → retrograde flow
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19
Q

painless swelling in scrotum

long periods, can recur

A

hydrocele

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20
Q

hydrocele examination

A

diagnostic: tranillumination

intact cremaster reflex

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21
Q

hydrocele management

A
  • < 1 years old → watch & wait for 1 year
    • if persists → refer
  • adults → get US to r/o torsion, then conservatively for 6-9 months, refer if no improvement
22
Q

testicular tumor sx’s

A
  • Pain or discomfort in a testicle or in scrotum
  • Dull ache in lower abdomen or groin
  • Sudden build up of swelling in scrotum
  • Back pain
  • solid firm mass/ focal nodule in testicles considered tumor until proven otherwise
23
Q

work up for testicular tumor

A
  • order PSA, UA, refer to urology
  • Ultrasound - confirms size/location
  • CT - extent & location of metastasis
  • staging (1: testes, 2: retroperitoneal nodes, 3: beyond nodes)
  • serum tumor markers
24
Q

management for testicular tumor

A
  • surgery, chemotherapy, radiation
  • monitor tumor markers hog, AFP, LDH first year, q 2 months second year, q 3-6 months up to 5 yrs
  • 90% cases cured
25
benign prostatic hyperplasia
* enlargement of the prostate gland * from stromal and epithelial cell hyperplasia * causes urinary retention (→ UTI, bladder stones, kidney dz) * 50% 50 - 60 yrs * 90% \> 80 yrs * unknown etiology; testosterone, lack of exercise
26
Male Lower Urinary Tract Sx's (M-LUTS) of BPH 2 types:
* Irritative sx’s: * Frequency * Urgency * Nocturia * **Decreased bladder capacity/instability OR infection** * Obstruction sx’s * Hesitancy * Weak or intermittent urinary stream * Post-void dribbling * Feeling of incomplete bladder emptying * **Bladder outlet obstruction (BOO)**
27
BPH exam
* DRE - size, consistency, shape, symmetry, abnormalities * if nodules or induration = prostate cancer → refer * With BPH, prostate is **smooth, non tender, focal enlargement** * **rubbery** * **obliterated median sulcus** * lower abdominal exam - bladder distention from retention
28
BPH evaluation
* AUA BPH symptom score → assess severity * Urinalysis (r/o Upper urinary Infection, hematuria) * PE, DRE * BPH is NOT a risk factor for prostate cancer * PSA testing is only indicated if the patient has a life expectancy \> 10 years if findings suggest prostate cancer (abnormal DRE findings)
29
BPH mangement
* mild sx/no complications (score \< 7): behavioral * limit fluids before bedtime * limit caffeine, alcohol * double voiding * watchful waiting * mod - severe; no improvement with conservative treatment * Alpha-1 blockers- Terazosin, doxazosin bedtime * 5-alpha reductase inhibitors * finasteride - shrink prostate hyperplasia but takes 6-12 months * Conservative treatment first then pharmacological therapy. * Urology referral * TURP for BOO
30
male sexual dysfunction causes
* medications, smoking, lifestyle * increases with age * neurological causes * MS or Parkinson's * cardiovacsulcar * pharmacologic * surgical procedures * alcohol/drugs * Psychogenic * stress, performance, anxiety, relationship issues, depression * obtain a full medical history and sexual history & assess emotional status and relationship status. * yes spontaneous morning erection = psychological * if sudden onset of symptoms = psychogenic etiology. * If gradual onset and no morning erection = organic (vascular, near, hormone, anatomy, drug)
31
male sexual dysfunction management
* identify and treat the underlying cause! * Lifestyle changes and RF modifications * if symptomatic CVD or \> 3 risk factors for CAD → refer stress testing * check: lipid, glucose, testosterone, thyroid, FSH, LH * depression * pharm: #1: phosphodiesterase 5 inhibitor (Viagra or Cialis) if not high CVD risk
32
uncomplicated UTI's sx's & management
sx's of bladder irritation (freq, urgency, dysuria, suprapubic pain, odorous urine, hematuria) infection in healthy, non pregnant, premenopausal female with normal urinary tract Empiric! Give before UA results come back * phenazopyridine - urinary analgesic * orange urine * use 1-2 days for discomfort until antibiotics take effect * first line: Nitrofurantoin * Bactrim if \< 20% resistance in community
33
complicated UTI sx's & management
* Empiric! * fever, chills, flank pain, CVA tenderness, N/V (pyelonphritis or urosepsis) * male: fluroquinolone * or Bactrim or nitrofurantoin * pregnant: amoxicillin, fosfomycine, cefuroxime, cephalexin
34
recurrent UTI in women
2+ infections in 6 months or 3+ in 12 months
35
reinfection UTI
new bacterial strain or regrowth of same organism after complete eradication with treatment
36
relapse UTI
infection caused by bacterial persistence - infection by previously treated pathogen, not completely eradicated by course of antimicrobial therapy
37
UTI diagnostics
* urinalysis + dipstick * clean void * nitrite test NOT good ( bacteria doesn't always change nitrate to nitrites) * urine culture for pregnant, febrile, ill, hx freq UTIs, hospitalized, young men or complicated UTI
38
when would you treat asymptomatic bacteriuria?
* in pregnant women! screen, check urine culture and treat * no tx needed in older women, men or person with diabetes
39
undescended testes management
* Most resolve w/in 6 months of age, if not, refer to ped urology * Warm room * Cross legged in warm room * Positioning * Can feel in squatted position * **higher rate of testicular cancer even with repairmen**
40
prostate cancer screening recommendations
* 70+ don't screen * 50+ with 10+ years expected to live * 45+ high risk (African American, 1st degree (father/bro) dx with prostate cancer \< 65) * 40+ even higher risk (more than 1 first degree relative w/ ca early age) * get PSA and DRE * if low risk, start with DRE and can offer PSA as optional
41
Is PSA trustworthy?
NO! if DRE, you feel prostate is asymmetric, hard nodule in lobe and PSA is w/in normal range, STILL refer to urology
42
In the setting of a normal DRE, how should PSA be used to guide management?
* Can be elevated in non-cancerous settings * Watch for rate of **rise/trend** in a year (.75 in a year )
43
overactive bladder (OAB) management
* #1: lifestyle (weight loss, restrict fluids, bowel regulation, no smoking, bladder training (habit training, no caffeine, alcohol, spicy/acidic foods) * bladder training (void q 30 mins, then increase) * goal: void q 3-4 hrs * pelvic floor PT * if doesn't work, anticholinergics or antimuscarininc * refer if no improvements
44
overactive bladder (OAB)
* common \> 40 or all ages * detrusor muscle overactivity → urge to urinate at lower bladder volumes; frequency. * absence of an infection * r/o neuro issues (Parkinson's, lumbar disc dz), meds * check post void residual with US or straight Cath (should be \< 50ml)
45
chronic pelvic pain syndrome: non bacterial prostatitis
* Non-bacterial * sx's \> 3 months * **no** growth of org in urine culture. * potential factors may be genetic, autoimmune, or psychological * pain in perineum, testicles, pubic area, penis * pain with ejaculation. * Chronic prostatitis symptom index to assess sx's
46
chronic pelvic pain syndrome: non bacterial prostatitis workup
* urine culture, pre- and post-prostate massage * STI testing and PSA testing if indicated * consider PSA testing if a family history of prostate cancer or an abnormal exam or more obstructive symptoms * urine cultures are typically negative * if growth of the same organism, consider chronic **bacterial** prostatitis.
47
chronic pelvic pain syndrome: non bacterial prostatitis management
* screen anxiety and depression * Alpha blockers * possibly antibiotics * controversial * acetaminophen or NSAIDs. * urology referral * PT and acupuncture
48
Chronic pelvic pain syndrome: Interstitial Cystitis/Bladder Pain Syndrome sx's
* pain in pelvis, vulva, vagina, b/t vagina/anus or scrotum/anus * pain lower abdomen, Lower back * chronic pelvic pain * frequency (60x day) small amts * pain when full bladder and relief after emptying bladder * painful sex * pain similar to UTI but NO INFECTION
49
Chronic pelvic pain syndrome: Interstitial Cystitis/Bladder Pain Syndrome evaluation
* Hx, PE * Pelvic pain and Urgency/Freq Pt Sx Scale (PUF) scale * F → Pelvic exam * M → DRE * urine culture and urinalysis * urine cytology * if \> 40 or smokers * cystoscopy if considering other pathology or the diagnosis is unclear or a complex presentation, * Potassium sensitivity test is widely used in the workup of interstitial cystitis, although it's not universally accepted.
50
Chronic pelvic pain syndrome: Interstitial Cystitis/Bladder Pain Syndrome diagnosis
* sx lasting \> 6 weeks * negative urine cultures * exclusion of other disorders that have overlapping symptoms. * If diagnosis unclear → refer to either urology or urogynecology
51
interstitial cystitis treatment
* voiding diary → avoid triggers * meditation or imagery, behavior modifications, * local heat or cold application * OTC Pyridium * pelvic floor muscle relaxation techniques. * FDA approved: Pentosan * Others: amitryptiline or cimetidine * Screen depression * Cystoscopy under anesthesia/hydrodistention

NURP 532 (13 decks)

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