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Urology Flashcards

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1
Q

What supports the pelvic?

A

LEVATOR ANI MUSCLES
• Pubococcygeus
• Puborectalis
• Iliococcygeus

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2
Q

What are sx of pelvic organ prolapse?

A
  • Asymptomatic
  • Vaginal bulging
  • +/- Suprapubic pressure/pain
  • Urgency
  • Frequency
  • Urge incontinence
  • Recurrent UTI
  • Unusual position to void – pelvic titling/squatting/standing
  • Constipation – manual splinting
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3
Q

How do you tx anterior/cystocele? Mild, recurrent UTI, high stage cystocele?

A 
Mild
•	Observe/ no tx
Recurrent UTI
•	PVR eval
High stage Cystocele
•	Upper-tract image*
•	Check for hydroureteronephrosis w/ severe vaginal prolapse
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4
Q

What can cx enterocele?

A

• Post hysterectomy

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5
Q

How do you tx enterocele?

A

Refer

• If dysparunia or extension past introitus

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6
Q

How do you tx rectocele?

A

Nonsurgical Therapy
• Pessary
• Tx chronic cough, obesity, constipation
Refer
• If dyspareunia or difficulty defecating

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7
Q

What are two introitus issues in newborns?

A

imperforate hymen

labial fusion

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8
Q

What is imperforate hymen?

A
  • Prevents the output of normal vaginal secretion producing a hydrometrocolpos
  • Obstructs menses from excreting the body
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9
Q

How do you tx labial fusion?

A
  • Observe unless urine pools and can be associated w/ UTI

* Topical estrogen can be used

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10
Q

How do you tx labial fusion?

A
  • Observe unless urine pools and can be associated w/ UTI

* Topical estrogen can be used

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11
Q

What are the different types of incontinence?

A

stress
urge
mixed
overflow

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12
Q

What is stress incontinence?

A

• Involuntary urine leakage on effort/exertion/sneezing/coughing

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13
Q

What can cx stress incontinence?

A
  • Repeated vaginal deliveries and obstructed labor → weakness/disruption of the pelvic floor muscle and ligaments → poor support at bladder neck and sphincter
  • Meds → anticholingeric, opiates
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14
Q

How to tx stress incontinence?

A

Mild-Mod
• Lifestyle changes – wt loss, ↓caffeine, pelvic floor muscle training, response to alpha adrenergic agonist
• Refer if nothing works

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15
Q

What is urge incontinence?

A

• Involuntary loss of urine (frequency)+ urgency

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16
Q

What is RF for urge incontinence?

A

• Many births

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17
Q

What cx urge incontinence?

A

• Overactive Bladder (OAB) → loss of urine while attempting to inhibit mictrution

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18
Q

What are cx of OAB?

A
  • Neuropathic injuries – brain/spinal cord
  • Radiation
  • Inflammation (interstital cystitis, UTI)
  • Caffeine intake
  • BOO → bladder damage
  • DM
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19
Q

What are sx for urge incontinence?

A
  • Sudden urge w/ uncontrolled loss of urine – NOT associated w/ physical activity
  • +/- Cough induced
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20
Q

What are drugs to tx urge incontinence?

A

• Meds
o First line – anticholinergic agent (Oxybutynin, Tolterodine, Fesoterodine, Trospium)
o B3 agnoist
o Botox for the bladder

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21
Q

What is mixed urinary incontinence?

A

• Stress + OAB +/- urge incontinence

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22
Q

How to tx mixed urinary incontinence?

A
  • Tx the one that is the MOST bothersome: stress vs urge incontinence
  • If BOTH → tx urge incontinence (anticholinergic)
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23
Q

What is overflow incontinence?

Study These Flashcards
A

• Involuntary loss of urine + bladder over-distension

24
Q

What are the types of overflow incontinence?

Study These Flashcards
A

atonic bladder

outflow obstruction

25
``` o BPH o Bladder neck contracture/uretheral stricture o Cystocele o Pelvic organ prolapse o Hx of incontinence surgery Type of overflow incontinence? ```
outflow bladder
26
``` o Meds o Spinal/peripheral nerve injuries o Long-standing overdistension o DM Type of overflow incontinence? ```
atonic bladder
27
How to dx overflow incontinence?
PVR (post void residual)
28
What residual vol indicates overflow bladder?
>200ml
29
How to tx overflow inctoninence?
tx the underlying cx
30
What are the host defenses in LUTI?
* Urine has specific characteristics that inhibit bacterial growth and colonization → TAMM-HORSFALL GLYCOPROTEIN (factor that inhibit bacterial adherence – GOOD!) * ↑↑ Lactobacillus is GOOD – but meds can destroy them
31
What are host RF?
• ↓ Estrogen/abx can cause alterations to the periurethral environment → damage to periurethral flora
32
16-35yo RF - LUTI?
sexual intercourse | diaphragm use
33
36-65yo RF - LUTI?
gyn surgery | bladder prolapse
34
65yo+ - LUTI?
* Incontinence | * Chronic use of urinary catheters – nursing homes
35
Bug for acute cystitis?
e coli
36
Sx for acute cystitis?
* Dysuria * Frequency * Urgencys * Low back/suprapubic pain * Hemturia * +/- Cloudy/foul smelling * +/- Fever
37
What test to run for acute cystitis?
UA (+) nitrate and leukocyte >3-5WBC + RBC
38
What is dx for acute cystitis?
culture
39
What test to run for recurrent cystitis?
UA US CT - if suspecting fistula
40
How to tx cystitis?
nitro/TMP-SMX/Fluroquinolone x3-5days
41
What to keep in mind re: the drugs for acute cystitis?
nitro is more sensitive to e. coli than TMP SMX and fluroquinolone
42
What abx is useless against e.coli?
pcn
43
How to tx recurrent acute cystitis?
longer tx: 7-14days | source is found? remove (urinary calculi)
44
What are prophylactic plans for cystitis - drugs?
long term LD nitrofuratnoin pt initiated therapy: keeping abx at home and culture in the meanwhile - nitro x3-5days related to sex: hygiene and nitro x1dose
45
What are nonpharm tx for prophylactic cystitis?
hygiene cranberry lactobacillus vaginal suppositories
46
What can cause bacterial persistence in acute cystitis?
incomplete tx obstructive uropathy nephrolithiasis
47
What to ask if pt has recurrent infxn of cystitis?
pneumotruia and hx of radiation --> suspect fistula
48
What to ask if pt has recurrent infxn of cystitis?
pneumotruia and hx of radiation --> suspect fistula
49
Biggest RF for bladder cancer?
* Smoking | * Occupation exposure
50
Sx for bladder cancer?
* HEMATURIA * Frequency * Urgency * Dysuria * Palpable mass
51
What test to use for suspected bladder cancer BEFORE referral? Why?
• CT/urgoram → used to R/O
52
What test to use for suspected bladder cancer BEFORE referral? Why?
• CT/urgoram → used to R/O
53
Tx options for bladder cancer?
* Intravesical Therapy * Transurethral Resection of Bladder Tumor (TURBT) * Removal of bladder * Chemotherapy * Radiation – MINOR ROLE
54
Tx options for bladder cancer?
* Intravesical Therapy * Transurethral Resection of Bladder Tumor (TURBT) * Removal of bladder * Chemotherapy * Radiation – MINOR ROLE
55
If bladder is removed - how to get urine out?
Ileal conduit | orthotopic neobladder

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