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Urological Disorders, Ureter, bladder, urethra, also prostate
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- Ureter, bladder, urethra, also prostate
- obstructive uropathy (blockage) may lead to hydronephrosis
-- fluid build up in kidneys
- lower UTIs
-- more common in women
- Urolithiasis
-- stones
- benign prostatic hyperplasia (BPH)
- Adequate urine volume and unimpeded urine flow are essential for kidney health
- Oliguria
- reduced urine output: less than 400ml per day
- Detrusor
- major muscle of the bladder
- Innervated by:
- sympathetic
-- relax detrusor, tighten internal sphincter
- Parasympathetic
-- contract detrusor, relax internal sphincter
- bladder usually holds 300-400ml urine
- Most common pathophysiological problem in urinary tract
- Renal calculi: kidney stones
- most common obstruction
- after age 60 in men: BPH common cause
- Prolonged obstruction results in increased hydrostatic pressure in nephrons decreasing GFR
- Progressive damage results
- Dilation of structures due to obstruction
- hydronephrosis: renal calyces and pelvis
- hydroureter: ureter
- In children, may result from anatomic abnormalities
- vesicoureteral reflux, urethral structure, stenosis
- Acute hydronephrosis is reversible with full recovery
- Sign and symptoms
- dysuria (pain), increased urine frequency, hesitancy, urgency
- Diagnosis
- urinalysis, microscopic urinalysis, CBC
- techniques
- cystoscopy, urodynamic testing
- pH
- Specific gravity
- glucose
- ketones
- leukocyte esterase
- nitrite
- protein
- bilirubin
- urobilinogen
- crystals
- casts
- bacteria
- Reveals presence or absence of bacteria
- for clean-catch samples
- cultures with greater than 100,000 colony-forming units (CFU)/mL of one type of bacteria usually indicate infection
- For samples collected with minimal contamination (ie., catheters)
- results of 1000 to 100,000 CFU/mL may be considered significant
- most commonly caused by E. coli, originating from bowels
- proteus, pseudomonas, and klebsiella
- proteus more commonly associated with catheterization or use of urinary instruments
- Women at higher risk
- healthy urinary tract
- bacteria in urethral opening only
- stagnant urine increases infection risk
- Improper perineal hygiene
- tight, restrictive clothing
- chronic dehydration
- diabetes
- use of irritating bath products
- sexual intercourse
- urinary catheterization
- use of contraceptive diaphragms and spermicides
- chronic dehydration
- diabetes
- BPH which obstructs free flow of urine
- bladder cancer
- urinary catheterization
(UTI is very uncommon in young, adult males, thus should be investigated as to cause
- Catheterization
- multi-drug resistant pathogens
- polymicrobial infection
- Urinalysis
- RBCs
- Positive leukocyte esterase, which indicates WBCs
- Nitrates, which indicate bacteria
- Urine culture
- greater than 100,000 colony-forming units (CFU)/mL
- Antibiotics
- nitrofurantion or trimenthprim-sulfamethoxazole (bactrim)
- flouroquinolenes
- phenazopyridine (pyridium)
-- pain relief
-- can turn urine a red/orange color
- Hydration important
- cranberry juice shown to decrease bacterial adherence
- serious complication of UTI
- Bacteremia with bacterial endotoxins
- acute, severe illness
- fever, chills, confusion, and hypotension
- elderly, catheterized and immunocompromised individuals are most at risk
- AKA: painful bladder syndrome (PBS)
- Urgency and frequency of urination, feeling of bladder fullness, pain
- need to urinate more than 50 times per day
- Etiology is unknown
- two different types
- ulcerative (hunner's ulcer)
- nonulcerative
- diagnosis
- cystoscopy can confirm
- urodynamic studies may help evaluate bladder function
- Nephrolithiasis (renal calculus)
- Ureterolithiasis (stones in the ureter)
- Cystolithiasis (vesical calculi) in the bladder
- calcium
- most common (hypercalcemia)
- struvite
- magnesium and ammonium phosphate (occurs in proteus UTI)
- patients with spinal cord injuries more at risk
- uric acid
- foods high in purines (gout)
- cystine
- rare, disorder of cystine metabolism
- family history
- medications
- incl. herbal supplements with hypercalcemia and hyperuricemia
- overall not a common form of cancer
- transitional cell carcinoma (TCC) most common type of bladder cancer
- tumor may penetrate into bladder muscle, metastasize
- environmental exposures
- cigarette smoking is major risk factor
- occupational exposure to organic chemicals
- spinal cord injuries with long-term indwelling catheters
Symptoms of bladder cancer:
- cardinal feature
- painless, intermittent, gross hematuria
- frequency, urgency, dysuria, sensation of incomplete bladder emptying
- assumption of UTI in women may delay diagnosis of bladder cancer
- Diagnosis
- cystoscopy, transurethral biopsy
- Stress incontinence
- most common
- women more at risk due to loss of muscle support in pelvic floor
-- childbirth, abdominopelvic surgery
-- low estrogen (menopause) contributes to weakness of pelvic floor
- Overactive bladder (OAB)
- detrusor muscle overactivity
- Overflow incontinence
- chronic overdistention and urinary retention in bladder
- detrusor muscle loses strength and elasticity
- BPH most frequent cause in men
- Neurogenic bladder
- Functional incontinence
- inability to hold urine (stroke, delirium)
- increasing age
- pregnancy
- childbirth
- obesity
- diabetes
- stroke
- neurological impairment
- prostate disease and its treatments
- X-ray of the kidney, ureter and bladder
- ultrasound
- CT scan
- IVP
- urodynamic testing
- cystoscopy may be necessary
- measurement of postvoidal residual volume in bladder
- kegel exercises
- anticholinergic drug that decr. bladder activity
- incontinence pessary
- transvaginal mesh surgical insertion
- botox injections into overactive bladder