Nocturia ~ Tyler Flashcards
In regard to prostate cancer, the decision to treat is always based on….
In regard to prostate cancer, the decision to treat is always based on risk versus benefit. For instance, will they die of prostate cancer is we do not treat it, or will they likely die from something else?
Lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia may include what symptoms?
Lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia may include
• urinary frequency—urination eight or more times a day
• urinary urgency—the inability to delay urination
• trouble starting a urine stream
• a weak or an interrupted urine stream
• dribbling at the end of urination
• nocturia—frequent urination during periods of sleep
• urinary retention
• urinary incontinence- the accidental loss of urine
• pain after ejaculation or during urination
• urine that has an unusual color or smell
Symptoms of benign prostatic hyperplasia most often come from:
• a blocked urethra
• a bladder that is overworked from trying to pass urine through the blockage
What is usually the goal of therapy for BPH?
Symptomatic relief is the most common reason men seek treatment for BPH, and therefore symptomatic relief is usually the goal of therapy for BPH
Alpha-adrenergic receptor antagonists are thought to treat the dynamic aspect of BPH by reducing sympathetic tone of the bladder outlet, thereby decreasing resistance and improving urinary flow
What is now considered a second-line therapy for BPH?
Surgical therapy is now considered second-line therapy and is usually reserved for patients after a trial of medical therapy that has failed. The goal of surgical therapy is to reduce the size of the prostate, effectively reducing resistance to urine flow. Surgical approaches include TURP, transurethral incision, or removal of the gland via a retropubic, suprapubic, or perineal approach
Implementation of the following three guidelines will further improve PSA screening outcomes in the United States and will have a greater practical impact on men’s health than the USPSTF and AUA recommendations that are based almost solely on age.
First, avoid PSA tests in men with little to no gain. There is no rationale for recommending PSA screening in asymptomatic men with a short life expectancy. Hence, men aged >75 years should only be tested in special circumstances, such as higher than median PSAs measured before age 70 or excellent overall health.
Second, do not treat those who do not need treatment. High proportions of men with screen-detected prostate cancer do not need immediate treatment and can be managed by active surveillance. This brings in the phases of prostate cancer discussed above.
Third, refer men who do need treatment to a urologist. This allows for a multi-disciplinary approach to treatment and management involving close monitoring, patient education, and patient autonomy.
What are the three key points to remember about prostate cancer screening?
o DRE and PSA not recommended in routine screening.
o Determine the patient’s risk for BPH and prostate cancer before performing a PSA. DRE is likely not going to be a consideration except in high risk patients, and even then, it does not impact decision-making
o For men with a PSA of 4-7 ng/ml, refer to urology if their symptom score is likewise moderate to severe.
What are some differential diagnoses of cystitis?
o Pyelonephritis o Urethritis o Vaginitis o Prostatitis o Asymptomatic bacteriuria (ASB) o Interstitial cystitis o Pelvic inflammatory disease (PID) o Urinary calculi o Radiation or chemical cystitis, e.g., cyclophosphamide o Bladder cancer o Urinary incontinence
What is the most important issue to be addressed when a UTI is suspected?
The most important issue to be addressed when a UTI is suspected is the characterization of the clinical syndrome as ASB, uncomplicated cystitis, pyelonephritis, prostatitis, or complicated UTI. This information will shape the diagnostic and therapeutic approach.
When can asymptomatic bacteriuria be diagnosed?
A diagnosis of ASB can be considered only when the patient does not have local or systemic symptoms referable to the urinary tract. The clinical presentation is usually bacteriuria detected incidentally when a patient undergoes a screening urine culture for a reason unrelated to the genitourinary tract. Systemic signs or symptoms such as fever, altered mental status, and leukocytosis in the setting of a positive urine culture are nonspecific and do not merit a diagnosis of symptomatic UTI unless other potential etiologies have been considered.
What are the typical symptoms of cystitis?
The typical symptoms of cystitis are dysuria, urinary frequency, and urgency. Nocturia, hesitancy, suprapubic discomfort, and gross hematuria can be noted as well. Unilateral back or flank pain is generally an indication that the upper urinary tract is involved. Fever also is an indication of invasive infection of either the kidney or the prostate. The fact many elderly patients lack the ability to mount a fever response introduces considerable ambiguity in diagnosis and treatment. That is why 95% of medicine is “gray” and not “black and white”.
How does mild pyelonephritis present as opposed to severe pyelonephritis?
Mild pyelonephritis can present as low-grade fever with or without lower-back or costovertebral-angle pain, whereas severe pyelonephritis can manifest as high fever, rigors, nausea, vomiting, and flank and/or loin pain. Symptoms are generally acute in onset, and symptoms of cystitis may not be present. Fever is the main feature distinguishing cystitis from pyelonephritis.
What is the main feature distinguishing cystitis from pyelonephritis?
Fever is the main feature distinguishing cystitis from pyelonephritis.
What type of fever can occur in those with pyelonephritis?
The fever of pyelonephritis typically exhibits a high spiking “picket-fence” pattern and resolves over 72 h of therapy. Bacteremia develops in 20–30% of cases of pyelonephritis.
What is emphysematous pyelonephritis?
Emphysematous pyelonephritis is a particularly severe form of the disease that is associated with the production of gas in renal and perinephric tissues and occurs almost exclusively in diabetic patients. This is often found through ultrasound evaluation when a retroperitoneal abscess, or other complication, is suspicioned in a patient with pyelonephritis.
What is xanthogranulomatous pyelonephritis?
Xanthogranulomatous pyelonephritis occurs when chronic urinary obstruction (often by staghorn calculi), together with chronic infection, leads to suppurative destruction of renal tissue. On pathologic examination, the residual renal tissue frequently has a yellow coloration, with infiltration by lipid-laden macrophages.
How does acute bacterial prostatitis present?
Acute bacterial prostatitis presents as dysuria, frequency, and pain in the prostatic pelvic or perineal area. Fever and chills are usually present, and symptoms of bladder outlet obstruction are common. Often, the patient complains of “pressure” or “pain” in the area between the scrotum and anus (perineal pain). It can manifest as difficulty sitting for extended periods.
How does chronic bacterial prostatitis present?
Chronic bacterial prostatitis presents more insidiously as recurrent episodes of cystitis, sometimes with associated pelvic and perineal pain. Men who present with recurrent cystitis should be evaluated for a prostatic focus as well as urinary retention.
What is a complicated UTI?
Complicated UTI presents as a symptomatic episode of cystitis or pyelonephritis in a man or woman with an anatomic predisposition to infection, with a foreign body in the urinary tract, or with factors predisposing to a delayed response to therapy.
