Genitourinary #1 Flashcards
Urge Incontinence
-Pathophysiology
-Management Order
-Patho: Detrusor muscle overactivity
-Mgmt:
1) Bladder training (voiding diary, decrease fluid intake)
2) Diet (avoid alcohol, caffeine, spicy, chocolate)
3) Kegel exercises
4) Antimuscarinics (Tolterodine, Oxybutynin)
5) Mirabegron
6) Botox injections, bladder augmentation
Overflow incontinence
-Pathophysiology
-Etiologies
-Symptoms
-Diagnostics (GOLD)
-Management
-Patho: Detrusor muscle under activity (impaired contractility)
-Etiologies: MC in neurological disorders (DM, MS, spinal injuries). Also bladder outlet obstruction (BPH, uterine fibroids, prolapse)
-Symptoms: loss of urine w/o warning, leakage, dribbling, hesitancy, frequency, loss with changes in position
-Diagnostics: Post void residual > 200mL
-Management: Intermittent indwelling catheterization (first line), Cholinergics (Bethanechol) increases detrusor muscle activity
Stress Incontinence
-Pathophysiology
-MC type of…
-Etiologies
-Symptoms
-Management
-Leakage of urine when abdominal pressure > urethral pressure during coughing, straining, sneezing, etc.
-MC type of incontinence in young women
-Etiologies: laxity of pelvic floor muscles (childbirth, surgery, postmenopausal) OR urethral hyper mobility (insufficiency support from pelvic floor muscles)
-Symptoms: urine leakage, no urgency prior to leakage
-Management: Kegel exercises (initial TOC), lifestyle modifications (weight loss, no smoking, pads, drink less). Pessaries. Midurethral sling (definitive)
Uterine Prolapse (uterine herniation into the vagina)
-Risk Factors
-Symptoms
-RF: Weakness of pelvic floor muscles (childbirth, obesity, multiple births, heavy lifting, loss of estrogen in postmenopausal state)
-Symptoms: vaginal fullness, heaviness sensation, low back pain, abdominal pain, urgency, frequency, stress incontinence
Uterine Prolapse
-Grades
-Management
-Grade 0: no descent
-Grade 1: uterus descent into upper 2/3 of vagina
-Grade 2: cervix approaches the introitus
-Grade 3: cervix outside the introitus
-Grade 4: entire uterus outside the introitus
-Management: pessaries, surgical (hysterectomy or sacrospinous ligament fixation)
Peyronie Disease
-What is it?
-Symptoms
-Management (depends on the curvature degree)
-Fibrotic changes of tunica albuginea leads to abnormal penile curvature
-Symptoms: penile pain, curvature, shortening, sexual dysfunction
-Management: urologist referral.
–Observation: if curvature 30’ or less
–Oral pentoxifylline or intralesional injection collagenase (Clostridium histolyticum) if 30 degrees or more, > 3 months, or sexual dysfunction.
Vesicoureteral Reflux
-What is it?
-MC type
-Symptoms (prenatal vs postnatal)
-Diagnostics
-Management
-Retrograde passing of urine from bladder into the upper urinary tract
-Primary (MC Type): inadequate closure or incompetent UVJ
-Symptoms: hydronephrosis on prenatal US, febrile UTI if postnatal
-Diagnostics: Renal and bladder US (initial), Voiding cystourethrogram (DOC)
-Mgmt:
–Grades I and II: observation and ABX to avoid recurrent UTI.
–Grades III and IV: surgical correction
Acute Cystitis
-Pathophysiology
-Risk Factors
-What makes it complicated?
-Etiologies
-Patho: Ascending infection of lower urinary tract from urethra
-RF: Sex in women, pregnancy, elderly, DM, immunocompromised, indwelling catheter
-Complicated: symptoms > 7 days, males, elderly, pregnant, DM, immunocompromised, catheter use
-Etiologies
–E. Coli (MC)
–Enterococci with indwelling catheters
Acute Cystitis
-Symptoms
-Diagnostics
-Symptoms: irritative symptoms (dysuria, urgency, frequency), hematuria, suprapubic pain, tenderness
-Diagnostics
–UA: pyuria (>10 WBC’s/hpf), hematuria, cloudy urine, nitrites
–Urine culture: definitive
—Do culture if complicated UTI
Acute Cystitis Treatment
-Uncomplicated (1st and 2nd line)
-Adjunct
-Complicated
-If Pregnant…
-Uncomplicated: Nitrofurantoin, Bactrim, or Fosfomycin (first line). Fluoroquinolones (-oxacin) if sulfa allergy.
-Adjunct: increase fluid intake, void after sex, Hot sitz baths
-Complicated: Fluoroquinolones PO or IV, Aminoglycosides (-micin or -mycin) x 7-10 days
-Pregnancy: Amoxicillin, Augmentin, Nitrofurantoin (NO BACTRIM, AMINO, FLUORO, or DOXY)
When should you treat asymptomatic bacteriuria?
-Pregnant, history of hip arthroplasty
Pyelonephritis
-MC etiology
-RF
-Symptoms (think BOTH)
-Diagnostics
-E. Coli MC etiology
-RF: DM, history of recurrent UTI’s, pregnancy
-Symptoms: upper tract symptoms (fever, chills, back/flank pain, nausea, vomiting). Lower tract symptoms (dysuria, urgency, frequency). CVA tenderness, fever, tachycardia.
-Diagnostics
–UA: Pyuria (>10 WBCs/hpf), Nitrites, hematuria, cloudy urine, bacteriuria, WBC casts
-CBC: leukocytosis with left shift
-Culture: Definitive diagnostic
What is HALLMARK for pyelonephritis on UA?
WBC Casts**
Pyelonephritis Treatment
-Outpatient
-Inpatient
-Pregnancy
-Outpatient: Fluoroquinolones (1st line)
-Inpatient: 3rd or 4th gen Cephalosporin, Fluoroquinolones, Aminoglycosides
-Pregnancy: IV Ceftriaxone
Urethritis
-MCC of Non-Gonoccocal Urethritis?
-Symptoms
-Diagnostics
–Most sensitive
–Gram stain (no organisms vs gram-negative diplococci)
-Chlamydia Trachomatis MCC of NGU
-Urethral discharge, pruritus, dysuria, abdominal pain or abnormal vaginal bleeding
-Gonorrohea: abrupt onset of symptoms, opaque/white/yellow/clear thick discharge
-Diagnostics
–NAAT (most sensitive). First void or first catch urine.
–Gram Stain: no organisms seen is suggestive of NGU.
–Gram-negative diplococci = Gonorrhea
