24 - Urologic Diseases II Flashcards Preview

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Flashcards in 24 - Urologic Diseases II Deck (69)
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1

Describe the occurrence of UTIs

- Most UTIs are bacterial cystitis, and occur mainly in females.
- Approximately 40% of all nosocomial (hospital acquired) infections are UTIs, and most are associated with the use of urinary catheters.
- There are more than 1 million catheter-associated UTIs/year in the U.S

2

What do you need to know about the normal state of urine?

Urine is normally sterile

3

Describe an infection (UTI)

Infection (UTI)
- The combination of a pathogen(s) within the urinary system and human host symptoms and/or inflammatory response to the pathogen(s)
- Treatment and management needed.

4

Describe a contamination

- Organisms are introduced during collection or processing of urine
- No health care concerns.

5

Describe a colonization

- Organisms are present in the urine, but are causing no illness or symptoms (asymptomatic bacteriuria)
- Depending on the circumstances, significance is variable, and the patient may not need treatment.

6

What are the clinical symptoms of cystitis (bladder and lower UTI)?

Cystitis
- Urinary urgency
- Frequency
- Dysuria
- Hematuria
- Foul-smelling urine
- Suprapubic pain
- May have associated urethritis , prostatitis or epididymitis

7

What are the clinical symptoms of pyelonephritis (upper UTI)?

- Typical symptoms of cystitis
- Fever
- Rigors
- Flank or abdominal pain
- Nausea and vomiting

8

What are the risk factors for UTIs?

- Poor fluid intake/chronic dehydration
- Infrequent voiding
- Incomplete bladder emptying
- Chronic constipation
- Postmenopausal vaginal atrophy
- Staghorn calculi

9

Describe urine collection for a urinalysis

- Midstream clean catch, catheterization, suprapubic aspiration

10

What are you looking for in a urinalysis?

- Leukocyte esterase
- Nitrite
- Blood, gross or microscopic
- >10 WBCs/HPF (but 5 is suspicious, consider tx)

11

What are you looking for in a urine culture?

>100,000 colonies/ml

12

What are the common pathogens for UTI?

Ascending infection
- E coli

Hematogenous infection
- Staphylococcus

13

How do you treat a UTI?

Empiric antibiotic therapy with sulfamethoxazole/trimethoprim or fluoroquinolones

Adjust antimicrobials based on culture sensitivities for persistent symptoms and complicated/recurrent UTIs

Modify any contributing risk factors

May consider low dose antibiotic suppression for recurrent infections if all modifiable risk factors have been addressed

14

What is urinary incontinence (UI)?

- Any involuntary loss of urine
- Severity varies from a loss of a few drops of urine to complete bladder emptying
- May occur only occasionally or several times/day
- Due to bladder dysfunction, sphincter dysfunction, or both

15

How common is urinary incotinence?

- Approximately 40% of all women are affected
- More common in women than in men (~2:1)

16

What are the major types of urinary incontience?

- Urge Urinary Incontinence (UUI)
- Stress Urinary Incontinence (SUI)

17

Describe Urge Urinary Incontinence (UUI)

- Involuntary urine leak accompanied by or immediately preceded by a strong, sudden desire to urinate
- Occurs when bladder pressure overcomes sphincter mechanism

There must be urgency WITH leaking (might be freqency)***

18

Side note: what is overactive bladder?

Overactive Bladder (OAB): Frequency and urgency with or without UUI

If you don't leak, it is OAB, not UUI, but MUST have freqency ***

19

What are the different types of treatment with UUI?

- Behavioral modification
- Lifestyle changes
- Medications
- Surgery

20

Describe behavioral modifications for UUI

- Controlling fluid intake
- Timed voiding

21

Describe lifestyle changes for UUI

- Weight loss
- Dietary changes
- Smoking cessation

22

Describe the medications that can be used for UUI

Anticholinergics are the mainstay of treatment for UUI/OAB***
- Inhibits involuntary detrusor muscle contraction
- Side effects include dry mouth, constipation, urinary retention, nausea, blurred vision, tachycardia, drowsiness, and confusion.
- Contraindicated in patients with narrow-angle glaucoma

Beta 3 Agonist
- Must monitor for hypertension

23

What are the surgical options?

s

24

What is Stress Urinary Incontinence (SUI)?

***** KNOW ALL OF THIS *****

- SUI: Involuntary urine leak with any sudden increase in abdominal pressure: cough, sneeze, lifting, straining, exercise
- In women, continence is maintained by combination of striated sphincter tone and passive anatomic coaptation of the urethra by supporting pelvic floor muscle attachments

25

What are female risk factors for SUI?

*******

Risk factors for female stress incontinence: Pregnancy/child birth, aging, obesity, pelvic surgery, trauma, or radiation, constipation, chronic respiratory problems/smoking, hormone changes

26

What are male risk factors for SUI?

*******

In men stress incontinence is primarily postsurgical (transurethral prostate resection, radical prostatectomy)

27

What are the treatment options for SUI?

KNOW THIS ******

- Pelvic floor strengthening exercises
- Formal pelvic floor physical therapy
- Pessary placement
- *****Surgical Treatment

28

What is the MOST EFFECTIVE surgical treatment of SUI?

**********

***** Midurethral sling placement
- Mesh
- Biologic graft
- Autologous fascia

Other option
- Periurethral bulking agent injection
- Not as effective

29

What are vesical fistulas?

Two types:
- Vesicovaginal fistulas
- Vesicointestinal (colovesical) fistulas

30

Describe vesicovaginal fistulas

Vesicovaginal fistulas
- Often related to obstetrical trauma, gynecologic surgery, gynecologic malignancies, or pelvic radiation
- Often presents with continuous incontinence
- Treated with fulguration or surgical repair
- May require urinary diversion if due to advanced gynecologic malignancy

Mimics SUI, but it is different because it is not related to an increase in pressure (coughing)