Week 6: Womens' health (3) (urinary symptoms) Flashcards

Question

investigations for LUTS in men

Answer 1

* history to identify possible causes and comorbidities * exam of abdomen * urine dipstick * urinary frequency volume chart * renal function test * DRE

Answer 2

conservative * OAB- bladder training, advice on fluid intake, lifestyle * PFMT for men with stress UI caused by prostatectomy * containment products e.g. catheter/ pads /collecting devices pharmacological * overactive bladder- anticholinergic * nocturnal polyuria- late afternoon loop diuretic

Answer 3

* reduce fluid intake (but not too much) containing alcohol, caffeine and artificial sweetners * distraction techniques such as breathing exercises

Answer 4

conservative * intermittent bladder catherization * bladder training less effective than surgery pharmacological * BPH- alpha blocker e.g. tamsulosin

Answer 5

* acute retention * catheterise * offer alpha blocker before removing catheter * chronic retention * catheterise * surgery if symptoms are bad

Answer 6

*Complaint of any involuntary leakage of urine… associated with…* * *Massive impact on QoL* * *Social exclusion* * *Sense of shame* * *Just put up with it attitude*

Answer 7

stress Urge mixed overflow

Answer 8

* Complaint of involuntary leakage on effort or exertion, or on sneezing or coughing * In men: Abdominal abnormality involving supporting tissues around bladder nec and proximal urethra * **I**n female: pregnancy, childbirth, older age- weakened pelvic floor * Treatment: PFMT, surgery

Answer 9

* The complaint of involuntary leakage (or urine) accompanied by or immediately proceeded by urgency e.g. key in door scenarios * **Cause:** overactive contraction of detrusor muscle, diabetes, Alzheimer’s, Parkinsons, MS, stroke

Answer 10

* The complaint of involuntary leakage (or urine) associated with urgency and also with exertion, effort, sneezing or coughing

Answer 11

* Caused by an obstruction or **blockage** in bladder à prevents from fully emptying

Answer 12

Is common in older people. In this type of incontinence, there are no particular stress or urge symptoms: the aetiology is often related to a combination of wider health problems (e.g. disability, cognitive impairment, mobility problems).

Answer 13

* advice on fluid intake and lifestyle measure * referral for bladder training * if symptoms persist * anticholinergic drug e.g. **oxybutynin/ mirabegron** (medication can take at least 4 weeks to work)

Answer 14

* reduce caffeine * reduce fluid intake * weight loss if \>30kg/m2 * reduce smoking * supervised pelvic floor muscle training * absorbent containment products * pads * pharmacology: duloxetine (only if women prefers drugs to surgical treatment) * surgery

Answer 15

* sudden inability to pass urine * usually painful and requires emergency treatment with a catheter

Answer 16

**BPH**, meatal stenosis, paraphimosis, penile constricting bands, phimosis, prostate cancer, balanitis, prostatitis, prostatic abscess

Answer 17

prolapse (cystocele, rectocele, uterine), pelvic mass (gynaecological malignancy, uterine fibroids, ovarian cyst)

Answer 18

* bladder calculi, bladder cancer, faecal impaction, GI malignancy, urethral stricture, foreign bodies, UTI

Answer 19

anticholinergics, opioids, anaesthetics, alpha-adrenoreceptor agonists, benzos, NSAIDs, alcohol, CCB

Answer 20

* peripheral nerve e.g. DM, Guillain-Barre syndrome, pernicious anaemia * brain: stroke, MS, Parkinson’s * spinal cord: invertebral disc. disease, meningomyelocele, MS, cauda equina**)**

Answer 21

* unable to pass urine * extreme discomfort * tender, distended bladder

Answer 22

* urinalysis (infection, haematuria, proteinuria, glucosuria) * MSU * blood tests (FBC, U and E, PSA) * imaging * US – hydronephrosis, post voidal residue * CT scan, look for masses * MRI? CT brain scan looking for intracranial lesion * MRI of spine- cauda equine, prolapse * urodynamic studies * cystoscopy

Answer 23

* immediate bladder decompressionà catherization (offer alpha-blocker before removal of catheter) * dependent on cause * e.g. prostatic surgery if BPH * TWOC – trial without catheter standard practice

Answer 24

* describes a bladder that does not empty completely * can cause LUTS symptoms * not immediately life-threatening * can lead to hydronephrosis and renal impairment and puts the patient at risk of acute-on chronic retention

Answer 25

* BPH is the most common * prostatic carcinoma * drugs * antispasmodics * antihistamines * anticholinergics * congenital deformities * urethral strictures * infection e.g. tb, gonorrhoea * trauma e.g. fractured pelvis, iatrogenic * risk factors * more common in men

Answer 26

* some patients with chronic urinary retention do not have any symptoms * urinary frequency, urgency, hesitancy * poor urinary stream * post-micturition dribbling * nocturia * UI * sensation of incomplete voiding * UTI * acute urinary retention

Answer 27

* urinalysis * MSU for microscopy * blood tests (U&Es, FBC, blood glucose, PSA) * voiding diary * imaging

Answer 28

* intermittent or indwelling self-catheterisation before offering surgery * stop precipitating medication * lifestyle e.g. reduce fluid ,alcohol, caffeine * bladder training * surgery- if cause of retention * drugs * BPA- alpha blockers e.g. tamuslosin- relaxes urinary tract * alpha 5 reductase inhibitor e.g. finesteride- takes 6 weeks

Answer 29

* Following resolution of urinary retention through catheterization * Kidneys can often over diureseà over filter * Can lead to worsening AKI * Can lose Countercurrent- more water loss * Urine output should be monitored for 24h post catheterisation * Patients with high urine volumes should be supported with IV fluids * Prevent dehydration

Answer 30

Dilation of the renal pelvis and calyces due to obstruction at any point in the urinary tract causing increased pressure and blockage. It can be: 1. Unilateral- caused by upper urinary tract obstruction 2. Bilateral- caused by obstruction in the lower tract

Answer 31

1. Progressive atrophy of kidney develops as the back pressure from the obstruction transmitted to the distal part of the nephron 2. **GFR declines, if bilateral= renal failure**

Answer 32

* USS or * Only tell structural problem not functional problem * CT scan- can show stones high in calcium * Only tell structural problem not functional problem * **Diuretic renography (MAG3) = functional test** * Give furosemide to increase diuresis

Answer 33

* Can see that in a normal urinary tract after giving furosemide you get a flow of liquid * In obstructed giving furosemide will not change activity

Answer 34

* Bedwetting = involuntary wetting during sleep at least 2x/week in children aged \>5 yrs with no CNS defects * Key questions * Age? * Primary or secondary? * Never achieved sustained continence at night (primary) * Restarted having been dry at night for 6+ months (secondary) * Do they have daytime symptoms? * Do they have pain passing urine or pass urine infrequently? * Are they constipated?

Answer 35

* Usually managed in primary care * Reassurance, alarms with positive reward system, ?desmopressin (man made vasopressin)

Answer 36

* Usually caused by disorders of the lower urinary tract e.g. anatomical, OAB * NICE recommends referral to secondary care

Answer 37

* Treat underlying cause if it has been identified e.g. UTIs, constipation, diabetes, psychological problems, family problems, physical or neurological problems * Primary/secondary care

Answer 38

like diary * Frequency — high frequency with normal 24-hour volume * Polyuria (passing more urine than usual) — up to 3 L of urine in 24 hours is normal. * Nocturia (waking at night to urinate). * Nocturnal polyuria (passing, at night, more than 35% of the 24-hour urine production).

Answer 39

* increase in the number of cells e.g. ‘plasia’ or ‘trophy’à glandular enlargement of the prostate * without malignancy * common in advancing age * failure of apoptosis

Answer 40

* urinary frequency * urinary urgency * hesitancy * incomplete bladder emptying * push or strain * UTI * urinary retention

Answer 41

* DRE * It should be firm but not hard, and smooth without nodules. The median sulcus should be clearly defined. A gland that is hard rather than firm, nodular and lacks a clear median sulcus suggests carcinoma of prostate. * urine- dipstick and MSU * blood (U&Es, FBC, LFTS, PSA) * PSA * is elevated with a large, benign prostate → needs to be combination of clinical examination

Answer 42

* alpha-adrenergic antagonists or alpha blockers e.g. **tamsulosin** * 5-alpha reductase inhibitor (5-ARI) e.g. **finasteride** * takes months to work * reduce long-term risk of acute retention or need for surgery * can cause problems with libido and erectile dysfunction * surgery- for those with large prostate or inadequate response to therapy e.g. transurethral resection of the prostate (TURP)

Answer 43

1. Commonest cancer in men 2. 2^nd commonest cause of death from cancer in men 3. 1 in 8 men will be diagnosed with prostate cancer 4. Rare in men \<59

Answer 44

1. Increased age 2. Family history (BRACA2 gene mutation) 3. Ethnicity 1. Black \> White \>Asian

Answer 45

prostate cancer

Answer 46

in the central location

Answer 47

* urinary symptoms * UTI * Prostatism * raises PSA * opportunistic finding from rectal exam * indicdental fidning at transurthral resection of the prostate * Metastatic disease in the bone (usually spine) causing bone pain

Answer 48

* Increasingly found following investigation of elevated prostate- specific antigen (PSA) in otherwise asymptomatic man * **Prostate specific antigen (PSA)**

Answer 49

* Prostate cancer * Infection * Inflammation * Large prostate * Urinary retention

Answer 50

Gleason classification is used to grade tumours on histological appearance * Grade 1 * Well differentiated tumour composed of uniform cells * Grade 5 * Anaplastic diffuse tumour with cells showing great variation in their structure and high mitotic rate

Answer 51

* **DRE** : hard and irregular prostate * **US**: used to define prostatic mass * Increased PSA level in blood * Biopsy of prostate- histological diagnosis * Radiographs and bone scans sued to stage the tumour

Answer 52

* Treatment options include surgery, hormone therapy and radiotherapy * Before treatment is started a histological diagnosis of prostatic carcinoma is require. * Treatment depends on stage of tumour * T1/T2: radical surgical resection of the prostate may be curative. TURP may be required * Local radiotherapy can be used if the pt is unfit for surgery and to treat local or distant spread of the tumour * Surveillance

Answer 53

* Hormonal manipulation is beneficial since testosterone promotes tumour growth * Testosterone * Dihydrotestosterone (potent) * Therefore to reduce testosterone * Surgical **castration** or * Medical castration (LHRH and GnRH agonists) * Both would promote T release initially (5-6 weeks) * Can cause depression (may give androgen blockers) * However overtime this will stop testosterone release * Palliative care

Answer 54

* 5 year survival rate for T1 tumours is 75-90% * However 5 year survival falls to 30-45% if there is local or metastatic spread

Answer 55

renal cell carcinoma transitional cell carcinoma

Answer 56

90% * **Presents in parenchyma of the kidneys** * Pyramids * Cortex * Medulla * **Epidemiology** * Arise from tubular epithelium * Rare in children (peak incidence 60-70) * can be staged

Answer 57

* Male: female ratio 3:1 * Risk factors * Dialysis * Smoking * Obesity

Answer 58

* haematuria or incidental finding * Non specific symptoms * Fatigue * Weight loss * Fever * May be mass in loin * RCCs often metastasize before local symptoms develop * If advanced * Small number can secrete hormone like substances such as PTH-rP (pts present with hypercalcemia) * Large varicocele may be presence

Answer 59

* Radiology- US or CT * Endoscopy- flexible cystoscopy * Urine- cytology

Answer 60

* Localised RCC * Surveillance * Increasingly small tumours removed with partial nephrectomy to preserve some renal function * For large tumours with no distant metastases treatment involves a radical nephrectomy with removal of the associated adrenal gland, perinephric fat, upper ureter and the para-aortic lymph node

Answer 61

* Little effective treatment for metastatic disease * Chemotherapy and radiotherapy resistant * Palliative treatment- target angiogenesis

Answer 62

* Can affect anywhere from the calyx to the bladder * Most commonly found in bladder

Answer 63

* Haematuria * Incidental finding on imaging (US or CT) * Weight loss * Loss of appetite * Signs/symptoms of obstruction

Answer 64

* Analgesic misuse * Exposure to aniline dyes used in the industrial manufacture of dyes, rubber and plastics * Smoking * Male to female ratio is 3:1 * Can be **diagnosed and treated by transurethral** resection of bladder tumour (TURBT)

Answer 65

* 75% are superficial * 5% are Tis this is carcinoma in situ (CIS) or flat tumour * 20% are muscle invasive * Tumours are also graded * Worse prognosis if it has invaded muscle

Answer 66

* Investigation via cystoscopy and biopsy allows histological examination and staging * Diagnosis based on cytological exam of the urine to check for presence of malignant cells and cystoscopy of the lower urinary tract

Answer 67

* non muscle invasive * Treated with TURBT +/- intravesical chemotherapy to bladder

Answer 68

* TURBT + intravesical chemotherapy (in bladder), intravesical BCG treatment, cystectomy

Answer 69

cystectomy (removal of bladder) and radiotherapy (with radiosensitiser) or palliative care

Answer 70

* Urinary tract normally sterile and resistant to bacterial colonisation * Major defence * Emptying of bladder during micturition * Vesicoureteral valves * Immunological factors * Macrophages and neutrophils * Mucosal barriers * Urine acidity

Answer 71

* Ascending colonisation of bacteria from urethra * Colonisation and multiplication of microorganisms * Bladder- cystitis * Kidney- pyelonephritis

Answer 72

**most common: Escherichia coli (flagellar, pili attachment, capsular polysaccharide, haemolysing and toxins)** Klebsiella pneumoniae,

Answer 73

* Dysuria * Cloudy urine * Nocturia * Urgency * Suprapubic tenderness * Haematuria * Pyrexia (usually mild)

Answer 74

* High fever +/- rigors * Loin pain and tenderness * Nausea/vomiting * Symptoms of cystitis

Answer 75

STI post sexual intercourse contact with irritation vaginal atrophy

Answer 76

* **Urine dipstick** (not usuful in pt \>65)- MSU * leucocyte esterase * nitrites * blood * pH * protein * Urine culture if complicated UTI * Imaging considered using US

Answer 77

* Uncomplicated infections can be treated with nitrofurantoin, trimethoprim, pivmecillinam or Fosfomycin * 3 days course as effective as 5 or 7 * Limiting prescription to 3 days reduces the selection pressure for resistance

Answer 78

**Treatment of complicated lower UTI** * E.g. male, pregnancy , catheter associated * Nitrofurantoin, trimethoprim, pivmecillinam, Fosfomycin or cefelaxin * Pregnant women- cefalexin * 5-7 days

Answer 79

* 7-10 day * Use Abx with systemic activity (not nitrofurantoin, Fosfomycin) * Possibly IV initially unless good PO absorption and patient well enough/ tolerating orally * Co-amoxiclav * Ciprofloxacin (effective as a 7 day coruse) * Gentamicin (IV only: nephrotoxic)

Week 6: Womens' health (3) (urinary symptoms) Flashcards

(106 cards)