Trigger - bladder and urethral disorders

Question 1

which bladder cancer type is assocaited with chronic inflammation d/t stones, catheters, UTIs, and more

Answer 1

squamous cell carcinomas

Question 2

hepatomegaly, lymphadenopathy +/- lymphedema suggests what

Answer 2

metastatic spread of bladder cancer

Question 3

MC presenting symptom in bladder CA

Answer 3

hematuria

Question 4

what is the gold standard for dx bladder cancer

Answer 4

cystoscopy with biopsy

Question 5

what will urine cytology show in bladder cancer

Answer 5

abnormal shed epithelial cells

Question 6

transurethral tumor resection +/- intravesical chemo is used when

Answer 6

for superficial bladder cancer (TIS, Ta, T1)

also see:
BCG and anti-TB

Question 7

BCG and anti-TB treatment is used when?

Answer 7

treatment for superficial bladder cancer (TIS, Ta, T1)

Also see:
transurethral tumor resection +/- chemo

Question 8

radical cystectomy and urinary diversion is used when?

Answer 8

treatment for invasive bladder cancer

also used:
+/- chemo, immunotherapy, radiation

Question 9

a 4 year old girl with a 3 month hx of achieving urinary continence is now wetting her bed every night. what is the term used to describe this

Answer 9

primary nocturnal enuresis

secondary would be in patients who were previously continent for 6+ months.

Question 10

a patient has a tumor that is extending into, but not past, the fatty layer of the bladder. What stage of bladder cancer is he in?

Answer 10

stage T3

TIS - on superficial bladder lining
Ta - extending into bladder lining
T1 - extends into connective tissue
T2 - extends into muscle
T3 - extends into fat
T4 - extends past fat and beyond bladder tissue

Question 11

confusion and anemia can be assocaited with which condition

Answer 11

nocturnal enuresis

Question 12

first line med tx for nocturnal enuresis

Answer 12

desmopressin

2nd line includes: imipramine, oxybutinin

Question 13

what is more common in men

Answer 13

• Bladder cancer
• nocturnal enuresis

Question 14

what is more common in women

Answer 14

• interstitial cystitis
• urethral prolapse

Question 15

assocaited with chronic pain syndromes as well as certain foods/drinks (spicy, caffiene, alcohol)

Answer 15

interstitial cystitis

Question 16

hunner’s ulcers/lesions on cystoscopy

Answer 16

interstitial cystitis

also see:
increased mast cells on biopsy
glomerulations

Question 17

cystscopy shows glomerulations and increased mast cells on biopsy

Answer 17

interstitial cystitis

also see:
hunners ulcers/lesions

Question 18

1st line med is amitriptyline

Answer 18

interstitial cystitis

followed by:
- hydroxyzine
- nifedipine
- pentosan polysulfate sodium

note: this is NOT the first line TREATMENT, only the first line med. first line tx is lifestyle mod and self care

Question 19

what is the only FDA approved tx of interstitial cystitis

Answer 19

pentosan polysulfate sodium (elmiron)

Question 20

SE includes elevated LFTs, GI upset and hair loss

Answer 20

pentosan polysulfate sodium (elmiron)

Question 21

CI with anticoagulants/antiplatelets (LMWH, heparin)

Answer 21

pentosan polysulfate sodium (elmiron)

Question 22

hydrodistention, electrocauterization and intravesical lidocaine is used when

Answer 22

3rd line treatment for interstitial cystitis

Question 23

when do you use botulinum injections to the detrusor muscle and sacral neuromodulation

Answer 23

refractory interstitial cystitis

Question 24

when are phenazopyridine and methenamine used in this lecture?

Answer 24

interstitial cystitis as adjunct tx

Question 25

this condition is usually iatrogenic in etiology and is MC in men

Answer 25

urethral strictures

Question 26

spraying of the urinary stream with obstructive voiding s/s are seen in which condition?

Answer 26

urethral stricture

Question 27

when are cystourethrograms and cystourethroscopy used?

Answer 27

to evaluate and visualize urethral strictures cystourethroscopy can also help confirm dx of mass in urethral meatus or urethral prolapse

Question 28

when is a post void residual ultrasound used?

Answer 28

in urethral srictures to r/o urinary retention

Question 29

this condition is d/t malformation of the urethral malformation or weakness of the pelvic floor

Answer 29

urethral prolapse

Question 30

what is the difference between prepubescent and postmenopausal urethral prolapse

Answer 30

prepubescent is usually asymptomatic with spotty vaginal bleeding post menopausal is symptomatic with vaginal bleeding, dysuria, urgency, frequency and nocturia. presents with hematuria. can have venous thrombosis, obstruction and necrosis

Question 31

what is the difference in treatment for prepubescent and postmenopausal urethral prolapse

Answer 31

both recieve sitz baths, topical abx and estrogen perpubescent - manage comorbid dz post menopausal - do not use estrogen or abx of necrosis, thrombosis or bleeding

Question 32

exam showing donut shaped protrusion of tissue obscuring urethral meatus

Answer 32

urethral prolapse

Question 33

what is MC method of surgical treatment in urethral prolapse

Answer 33

excision of mucosa with short term cath (may need long term estrogen cream if post menopausal)

Question 34

this is associated with parkinsons, bladder stones, tumors and prostate disease

Answer 34

urge incontinence d/t overactive detrusor muslce

Question 35

urethral incompetence with intrinsic sphincter deficiency is the cause of what type of urinary incompetence

Answer 35

stress incontinence

Question 36

duloxetine is off label medication for which condition

Answer 36

urinary stress incontinence

Question 37

beta 3 adrenergic agonists, TCAs and alpha blockers are used in the treatment of what condition

Answer 37

urinary urge incontinence

Question 38

tibial nerve stimulation is used as treatment in what condition

Answer 38

urinary urge incontinence

Question 39

CI in gastric retention and glaucoma

Answer 39

antimuscarinics

Question 40

DDI with potassium chloride

Answer 40

anticholinergics

Question 41

what are the perks of farifenacin and solifenacin

Answer 41

these are the anticholinergics used in UI that have less cog impairment

Question 42

what are the perks of oxybutinin

Answer 42

anticholinergic often MC prescribed d/t cost

Question 43

mirabegron and vibegron

Answer 43

beta 3 agonists. used in patients who cannot tolerate anticholinergic therapy

Question 44

when is sacral neuromodulation used?

Answer 44

refractory interstitial cystitis urinary overflow incontinence (high risk of failure)

Question 45

SE is HTN, tachycardia, UTI

Answer 45

beta 3 agonists also see: dry mouth, constipation

Question 46

DDI with QT prolonging drugs

Answer 46

Beta 3 agonists

Question 47

urethral dilation, urethrotomy and urethroplast are all treatments for what

Answer 47

urethral stricture