Genito Urinary Flashcards
Urinary frequency
Need to urinate more frequently than normal
Associated with UTIs, increased fluid intake, caffeine / alcohol, diabetes, diuretic use, bladder cancer
Urinary urgency
A sudden compelling urge to urinate
Urinary frequency can cause urgency
Hallmark feature associated with overactive bladder or associated with diuretics
Urinary retention
Inability to completely or partially empty the bladder
Causes; obstructive (cancer, kidney/bladder, BPH) or non obstructive causes (stroke, childbirth, pelvic injury, neurological damage)
Urinary incontinence
Unintentional passing of urine
Lack of voluntary control
Stress incontinence, urge incontinence, overflow incontinence and total incontinence
Treatment for urinary incontinence
1st line antimuscarinics (oxybutynin, tolerations, solifenancin)
2nd line beta 3 agonist e.g mirabegon
Duloxetine can be used in moderate to severe stress incontinence in women
treatment of urinary frequency and incontinence
Combination of drug treatment and non-drug treatment
Non-drug treatment for urinary frequency and incontinence
Pelvic floor exercises and bladder training
Avoid drinking caffeine and alcohol
Decrease stress
Keep healthy BMI, avoid constipation
Nocturnal enuresis in children
Involuntary discharge of urine during sleep
Non-drug treatment - enuresis alarms, reassurance, fluid advice (dont drink lots before bed), toilet behaviour or reward systems
Drug treatment oral or sublingual desmopressin or imipramine (only if not responding to other treatment)
Desmopressin
5 years +
Oral or sublingual use
Avoid in fluid overload and to Stop if nausea or vomiting occur = hyponatraemia convulsions
Urinary retention types
Acute - medical emergency, abrupt development over past hours
Chronic - gradual development over months or years
Inability to empty bladder
Considerations of urinary problems
Consultation room - sensitive matter, private
Detail history; short or long term or accompanying symptoms
Establish type of urinary problem presented
Sinister causes; unexplained weight loss, total incontinence, haematuria
Rule out infections diagnostic tests; urinary analysis or culture sensitivities
Past medical history; fractures increase risk, diabetes, anatomical abnormalities, recent infection?
Pregnant?
Family history; poly kidneys
Mirabegron
Caution; history QT interval prolongation, stage 2 hypertention
Advise contraception for women of child bearing age
S/e - arrhythmias, constipation, diarrhoea, dizziness, headache
Consider monitoring blood pressure before and regularly
Benign prostatic hyperplasia (BPH)
Most common cause for urinary retention in men
Complications of BPH- renal impairment, urinary retention or recurrent infection
Drug and non drug treatment used
Non drug treatment for BPH
Catheterisation
Surgery for more severe symptoms that don’t respond to medicine
Drug treatment for urinary retention
Alpha blockers - alfuzosin, doxazosin, tamsulosin, indoramin - relax prostatic smooth muscle
S/E; hypotension are CI; postural hypotension, intra-operative floppy iris syndrome, micturition syncope
If there is no identifiable cause - catheterisation in men and women
If caused by BPH
Alpha blockers
Or if risk of further progression ADD 5 alpha reductase inhibitors; finasteride and dutasteride
Counselling point for alpha blockers
Take 1st dose at bed
Driving can be impaired
Reviewed after 4-6 weeks and then every 6-12 months
Risk of falls with frail and elderly and deterioration in cognitive function
Types of urinary retention
Acute - immediate catheterisation and alpha blockers for at least 2 days before catheter is removed
Chronic - catheter used intermittently. Alpha blockers used ( if high risk patient or enlarged prostate add 5 alpha reductase inhibitor) , surgery in severe cases,
Alpha blockers
Alfuzosin, doxazosin, tamsulosin
Relax smooth muscle and increase urinary flow rate and improve obstructive symptoms
Caution in elderly and cataract surgery (Risk floppy iris syndrome)
Can reduce BP; may need to reduce dose of anti hypertensives and use CAUTION
CI; patients with postural hypotension and micturiton syncope (faint when pass urine)
S/e; dry mouth, diarrhoea, headache, dizziness, vomiting, first dose HYPO
Finasteride
Absorbed through skin; wear gloves
MHRA - rare report of depression and suicidal thoughts
Side effects; sexual dysfunction
Cases of male breast cancer have been reported
Excreted in semen and use of condom recommended
Dutasteride
Excreted in semen so use condoms
S/e; breast disorders, sexual dysfunctions
Regularly evaluated for prostate cancer
Cases of male breast cancer reported
Urinary tract infections
Symptoms; urinary urgency and or frequency, abdominal discomfort, stinging during urination, flank pain and or fever
Causative agents; E.coli
Treatment;
Nitrofurantoin and trimethoprim
UTI and Nitrofurantoin
Men - 100 mg (MR) BD for 7 days
women - 100 mg (MR) BD for 3 days
CI; acute prophyrias, G6PD deficiency, infants less than 3 months old
Avoid at term (last trimester) may produce neonatal haemolysis
S/e; urine discolouration, anaemia
UTI and trimethoprim
Men - 200 mg BD for 7 days
Women - 200 mg BD for 3 days
Anti-folate don’t use in 1st trimester avoid use unless needed in later pregnancy
Not to take if patient on methotrexate
S/e - diarrhoea, fungal overgrowth, nausea, vomiting, skin reactions, blood disorders
Tamsulosin OTC
Indicated in adults for treatment of functional symptoms of benign prostatic hyperplasia
Alpha 1 adrenoceptor antagonist
Replacing muscles in the prostate gland and urethra
Male patients 45 to 75 years
Symptoms of BPH for minimum of 3 months
2 week initial supply, if there has been improvement supply another 2 weeks must see Dr
CI; postural hypotension, floppy iris syndrome
Flomax 400 mcg
Tamsulosin OTC referral criteria
Glaucoma or cataracts surgery
Symptoms lasting over 3 months, dysuria, haematuria, cloudy urine and fever
No improvement after initial 2 week supply OR max supply exceeded and not been seen by Dr
Taking interaction medication; verapamil, diclofenac, warfarin, anole-antifungals, alpha blocker, sildenafil
Hx diabeties, urinary incontinence, prostate surgery, blurry or cloudy vision
Fraser guidelines on contraception
For prescribing under 16
Best interest to the patient
Patient understands advice and is competent
Can’t persuade patient to inform their parents
Continue to have sex
Mental and psychical health will suffer
Contraception types
Hormonal - most effective, only used after first period
Intra-uterine devices - highly effective, localised side effects used by all women of all ages but less appropriate in those with pelvic inflammation disease
Barrier methods - condoms, diaphragms, less reliable but improvement with spermicides,
Combined oral contraception
Contains oestrogen and progesterone
Oestrogen content - ethinylestradiol range (20 to 40 mcg)
Progesterone content - desogestrel, levonorgestrel, norehisterone etc
Inhibits ovulation
Can be monophasic - strengths of oestrogen and progestogen are constant or phasic when the strengths of the hormones components vary
Typically 21 days followed by 7 day break
Phasic for patients who do not have withdrawal bleeding or who have breakthrough bleeding with monophasic preparations
Advantages of COC
Reliable and reversible
Reduced dysmenorrhea and menorrhea
Reduces incidence of pre menstrual tension
Less symptomatic fibroids and function ovarian cyst
Less benign breast disease
Reduces risk ovarian and endometrial cancer
Reduce risk pelvic inflammatory disease
Examples of monophasic COC
Microgynon
Yasmin
Rigevidon
Cilest
Phasic COC examples
Logynon
Synphose
Tradene
Ethinylestradiol content
Low strength - 20 mcg used for women with risk factors for circulatory disease
Standard strength - 30 to 35 mcg used
