24 - Urologic Diseases II Flashcards Preview

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Flashcards in 24 - Urologic Diseases II Deck (69)
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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


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

Urine is normally sterile


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.


Describe a contamination

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


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.


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

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


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

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


What are the risk factors for UTIs?

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


Describe urine collection for a urinalysis

- Midstream clean catch, catheterization, suprapubic aspiration


What are you looking for in a urinalysis?

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


What are you looking for in a urine culture?

>100,000 colonies/ml


What are the common pathogens for UTI?

Ascending infection
- E coli

Hematogenous infection
- Staphylococcus


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


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


How common is urinary incotinence?

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


What are the major types of urinary incontience?

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


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)***


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 ***


What are the different types of treatment with UUI?

- Behavioral modification
- Lifestyle changes
- Medications
- Surgery


Describe behavioral modifications for UUI

- Controlling fluid intake
- Timed voiding


Describe lifestyle changes for UUI

- Weight loss
- Dietary changes
- Smoking cessation


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


What are the surgical options?



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


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


What are male risk factors for SUI?


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


What are the treatment options for SUI?

KNOW THIS ******

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


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


What are vesical fistulas?

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


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)