Chapter 29: Disorders of the Lower Urinary Tract Flashcards Preview

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Flashcards in Chapter 29: Disorders of the Lower Urinary Tract Deck (17):
1

Diagnostic Tests

- Urinalysis: for diagnosis of infection (tells pH, Ketones, bacteria, protein, and casts)

- Ultrasonography: Visualization of the Urinary System

- Fluroscopic voiding cystourethrography or radionuclide voiding cystography: used to identify refluxor urethral abnormalities

- Urodynamic testing: used for diagnosing voiding dysfunctions

- urine culture diagnoses UTI

2

Post Void Residual

- residual urine: normally the adult bladder contains less than 50 to 100 ml following voiding

- if urine left in the bladder is over 100 ccs it is deemed urinary retention

3

Incontinence

- report of any involuntary urine loss

- is never normal under any circumstances

- is not a normal part of aging

4

Stress Incontinence

- occurs when urine is involuntarily lost with increases in intra-abdominal pressure

- precipitated by effort or exertion

- due to weakening of pelvic muscles or intrinsic urethral sphincter deficiency

5

Urge Incontinence

- involuntary sudden leakage of urine along with or immediately following the sensation of a need to urinate (urgency)

- Due to an overactive detrusor muscle (muscle around bladder)

- may be idiopathic, due to bladder infection, radiation therapy, tumors or stones, or CNS damage

6

Incontinence (overactive bladder syndrome and mixed incontinence)

- overactive bladder syndrome: urgency is associate with increased daytime frequency and nocturia, though not neccessarily with incontinence

- mixed incontinence: due to a combination of stress and urge incontinence

7

Incontinence (neurologic bladder and Overflow incontinence)

- neurologic bladder: broad classification of voiding dysfunction in which the specific cause is a pathology that produces disruption of nervous communication governing micturition

- overflow incontinence: bladder becomes so full that it leaks urine or "overflows"
(causes include obstruction of the urethra; underactive/inactive detrusor muscle)

8

Incontinence (functional incontinence)

- related to physical or environmental limitations resulting in an inability to access a toilet in time

9

Incontinence (Diagnosis)

- bladder diary, recording the time, frequency, and volume of micturtion as well as incidents of incontinence

- diagnostic tests include residual urine measurment, filling cystometry studies, and pressure flow studies during voiding

10

Treatment of incontinence

- lifestyle changes which include weight loss, reducing caffeine intake, and avoiding constipation

- behavioral, pharmaceutical, and surgical options

- pelvic floor muscle training (for urge incontinence)

- bladder training

- medication including anticholinergic agents (oxybutynin), vaginal or oral estrogen, and alpha-adrenergic blockers (Prazosin)

11

Enuresis

- intermittent incontinence while asleep

- inappropriate wetting of clothing or bedding

- typically refers to incontinence in children, particularly at night

12

Cystis

- Inflammation of the bladder lining

- From infection, chemical irritants, stones, trauma

- Most cases have an infectious etiology and result from infection originating in the urethra

- Predisposing factors include female gender, increased age, catheterization, DM, bladder dysfunction, poor hygiene, and urinary stasis

- glucose in diabetics predisposes to bladder dysfunction

13

Cystis (Manifestations & Symptoms)

- Manifestations: frequency, urgency, dysuria, suprapubic pain, and cloudy urine

- Symptoms in children include fever, irritability, poor feeding, vomiting, diarrhea, and ill appearance

- Symptoms in older adults may include lethargy, anorexia, confusion, and anxiety (confusion is first sign of infection)

14

Management and Treatment of Cystis

- Most female patients treated based on symptoms

- Males/children/complicated cases may require urine culture and/or further assessment

- Antibiotics

- Symptomatic cystitis in elderly: managed with close drug monitoring to avoid toxicity; asymptomatic bacteriuria in elderly should not be treated

15

Lower Urinary Tract Urolithiasis

- Stones forming anywhere in the urinary tract

- Most often caused by stones traveling to the ureters, bladder, or urethra from the kidney

- May also originate in the bladder or ureters

- Manifestations: associated with tissue irritation and obstruction

- Similar to nephrolithiasis in terms of risk factors and stone characteristics

- If infection present: treated with appropriate antimicrobials, based on culture and sensitivity tests

- For stones that do not pass spontaneously: endoscopic (transurethral) lithotripsy

16

Ureterolithiasis

- Usually those that were able to pass through the junction of the renal pelvis and ureters

- Manifestations include ureteral colic, hematuria, tachycardia, tachypnea, diaphoresis, and N/V

- Treatment: alpha-adrenergic blockers, shock-wave lithotripsy, and ureteroscopy are first-line treatments; surgery may be needed

17

Bladder (Vesical) Urolithiasis

- Due to stones traveling from ureters, but may form in bladder because of urinary stasis

- Manifestations: hesitancy, frequency, and dysuria; hematuria possible

- If infection: antimicrobial therapy based on culture and sensitivity

- Stones that don’t pass spontaneously may require endoscopic lithotripsy