DOCSLIB.ORG

Point-Of-Care Ultrasound to Assess Anuria in Children

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Point-Of-Care Ultrasound to Assess Anuria in Children CME REVIEW ARTICLE Point-of-Care Ultrasound to Assess Anuria in Children Matthew D. Steimle, DO, Jennifer Plumb, MD, MPH, and Howard M. Corneli, MD patients to stay abreast of the most current advances in medicine Abstract: Anuria in children may arise from a host of causes and is a fre- and provide the safest, most efficient, state-of-the-art care. Point- quent concern in the emergency department. This review focuses on differ- of-care US can help us meet this goal.” entiating common causes of obstructive and nonobstructive anuria and the role of point-of-care ultrasound in this evaluation. We discuss some indications and basic techniques for bedside ultrasound imaging of the CLINICAL CONSIDERATIONS urinary system. In some cases, as for example with obvious dehydration or known renal failure, anuria is not mysterious, and evaluation can Key Words: point-of-care ultrasound, anuria, imaging, evaluation, be directed without imaging. In many other cases, however, diagnosis point-of-care US can be a simple and helpful way to assess urine (Pediatr Emer Care 2016;32: 544–548) volume, differentiate urinary retention in the bladder from other causes, evaluate other pathology, and, detect obstructive causes. TARGET AUDIENCE When should point-of-care US be performed? Because this imag- ing is low-risk, and rapid, early use is encouraged in any case This article is intended for health care providers who see chil- where it might be helpful. Scanning the bladder first answers the dren and adolescents in acute care settings. Pediatric emergency key question of whether urine is present. When a urine sample medicine providers, emergency medicine providers, and those is sought, an empty bladder may suggest rehydration before ei- working in acute care pediatric offices and urgent centers may ther attempted voiding or, if indicated, catheterization. If, on the have particular interest in this article. other hand, an overdistended bladder, hydronephrotic kidney, or hydroureter are seen, alone or in combination, this can quickly LEARNING OBJECTVES guide management to more definitive imaging or consultation, After completion of this article, the reader should be able to: avoiding delay and unneeded testing and treatment. 1. Identify common etiologies of obstructive and nonobstructive Artifactual or apparent anuria may arise from several causes anuria in children. in a child who is actually voiding; this is common when diarrhea 2. Identify the key points in ultrasound (US) differentiation be- obscures the presence of urine in diapers, when another caretaker tween obstructive and nonobstructive anuria. changes a wet diaper without a parent's awareness, or when a 3. Describe techniques for performing point-of-care US evaluation young child gives a misleading verbal report. Scant but adequate of the pediatric urinary collecting system to identify obstruction. urination can be missed when modern superabsorbent diapers appear misleadingly dry. In a well-appearing child, the finding of a normal volume of urine in the bladder on US may confirm hildren presenting with a history or chief complaint of anuria that kidney function, hydration, and voiding do not need are a common challenge for the clinician. The differential di- C further investigation. agnosis is diverse, spanning causes from dehydration or urinary An especially common cause of urinary retention in children retention to urinary tract obstruction or kidney failure. In some is dysuria leading to voluntary urine withholding, bladder disten- cases, the history and physical examination may be clear enough tion, more dysuria, and a cycle of pain and anuria. This sequence to direct care and avoid unnecessary testing. In other cases, how- may be suggested in cases where a history or suspicion of dysuria ever, point-of-care US can be useful to quickly and easily guide accompanies abdominal pain or a palpable bladder. Typical sce- further testing and treatment. narios in children include not only urinary tract infection, but also The kidney and bladder are sonographically accessible and straddle injury or vulvovaginitis in girls, meatitis or minor penile recognizable even by those new to US. Thus, the urinary tract trauma in boys, recent catheterization or urologic procedures, con- can be a useful starting point in learning and teaching ultrasonog- 1 stipation with painful stool retention, and others. raphy in the acute care setting. In cases of suspected voluntary retention leading to bladder A recent policy statement2 by the American Academy of Pe- neck contractions, US confirmation of bladder distention and diatrics endorses the use of point-of-care US in the pediatric emer- quantification of bladder volume may be sufficient to direct ap- gency department: “Ultimately, this will improve the care of propriate care. If recent catheterization or instrumentation is the pediatric patients…. As much as it is our responsibility to under- cause, common sense suggests possible urologic consultation stand the limitations and challenges associated with integrating and a reasonable, sometimes prolonged, period of waiting for point-of-care US into pediatrics, it is our responsibility to our spontaneous voiding in order to avoid renewing a cycle of pain Assistant Professor of Pediatrics and Director of Emergency Ultrasound and withholding. If, however, bladder distention is causing severe (Steimle), Assistant Professor of Pediatrics (Plumb), Professor of Pediatrics pain, especially in suspected cases of simple inflammation, infec- (Corneli), Division of Pediatric Emergency Medicine, Department of Pediatrics, tion, or minor injury, one-time catheterization may be helpful. University of Utah School of Medicine, Salt Lake City, UT. In these cases, the authors have sometimes achieved good re- The authors and staff in a position to control the content of this CME activity and their spouses/life partners (if any) have disclosed that they have no sults by passing a small straight urinary catheter lubricated with financial relationships with, or financial interest in, any commercial 2% viscous xylocaine to relieve bladder distention (the xylocaine organizations pertaining to this educational activity. does not notably reduce the initial pain of catheterization, but is Reprints: Matthew Steimle, DO, Division of Pediatric Emergency Medicine, intended to lessen subsequent dysuria and avoid a repeated cycle University of Utah School of Medicine, 295 Chipeta Way, SLC, UT 84108 (e‐mail: [email protected]). of urinary retention). The volume of total urinary drainage should Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved. be noted. The urine should be sent for urinalysis and for culture ISSN: 0749-5161 if indicated. 544 www.pec-online.com Pediatric Emergency Care • Volume 32, Number 8, August 2016 Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved. Pediatric Emergency Care • Volume 32, Number 8, August 2016 Point-of-Care Ultrasound to Assess Anuria FIGURE 1. Bladder ultrasound imaging and measurement. Left image shows transverse view with width and depth (length) measurements; right image shows sagittal view with height measurement. Also note volume as calculated by computed algorithm. In some cases of urinary retention, point-of-care US may also Imaging is the usual preferred means of assessing for urinary suggest evidence for a suspected cause of dysuria, as for example, obstruction, and US is often the first modality of choice. Point- bladder wall thickening in cystitis. of-care US will suggest the relative level of the obstruction, In any case of bladder distention, point-of-care US of the ure- distinguishing distention of the bladder from that of the ureter ters and kidneys is suggested. Importantly, the presence of hydro- or kidney. nephrosis or hydroureter or both suggests that bladder distention If obstruction is suggested by point-of-care US, further imag- is not acute. Urologic consultation may be helpful and is also sug- ing and documentation may follow. Computed tomography may gested if catheterization is contraindicated or unsuccessful. be indicated, for example, in patients with acute flank pain and Less common causes of urine retention in children may in- suspected nephrolithiasis, or where visualization of the ureters clude neurologic emergencies (eg, spinal cord dysfunction) as is required.10 well as medication side effects or toxicity. In many cases, quantification of bladder volume is helpful (Fig. 1). Measurement of bladder wall thickness can also be re- Specific Scenarios vealing. Table 1 contains examples of formulas and normal values Beyond the common questions of artifactual anuria, possible for these measurements. dehydration, or suspected urinary retention, other presentations Even when bladder volume is the chief question, experts sug- gest US screening of the kidneys and ureters. This additional ex- amination takes little time and may discover important associated findings, such as upper tract distention in cases of vesicoureteral TABLE 1. Bladder Measurements, Calculation, and Normal Values reflux. It may also reveal incidental findings that affect care, such as preexisting hydronephrosis or polycystic kidney. Although up- Calculated Bladder Volume* per tract obstruction can cause anuria with a single kidney or Length (front to back)  width x height  0.53†3 collecting system, a detailed discussion of the causes and US find- ‡ Estimated normal bladder capacity in children ings of upper tract abnormalities is beyond the scope of this re- 4 1,7–9 (Age
Load more

Recommended publications
  • Hemorrhagic Anuria with Acute Kidney Injury After a Single Dose of Acetazolamide: a Case Study of a Rare Side Effect
    Open Access Case Report DOI: 10.7759/cureus.10107 Hemorrhagic Anuria With Acute Kidney Injury After a Single Dose of Acetazolamide: A Case Study of a Rare Side Effect Christy Lawson 1 , Leisa Morris 2 , Vera Wilson 3 , Bracken Burns Jr 4 1. Surgery, Quillen College of Medicine, East Tennesse State University, Johnson City, USA 2. Trauma, Ballad Health Trauma Services, Johnson City, USA 3. Pharmacy, Ballad Health Trauma Services, Johnson City, USA 4. Surgery, Quillen College of Medicine, East Tennessee State University, Johnson City, USA Corresponding author: Bracken Burns Jr, [email protected] Abstract Acetazolamide (ACZ) is a relatively commonly used medication in critical illness, glaucoma and altitude sickness. ACZ is sometimes used in the intensive care unit to assist with the treatment of metabolic alkalosis in ventilated patients. This is a case report of a patient who received two doses of ACZ, one week apart, for metabolic alkalosis and subsequently developed renal colic and dysuria that progressed to hemorrhagic anuria and acute kidney injury. This is an incredibly rare side effect of ACZ therapy, and has been reported in a few case reports in the literature, but usually is associated with a longer duration of therapy. This case resolved entirely within 24 hours with aggressive fluid therapy. Clinicians using ACZ therapy for any reason should be aware of this rare but significant side effect. Categories: Trauma Keywords: acetazolamide, hemorrhagic anuria, acute kidney injury Introduction Acetazolamide (ACZ) is a carbonic anhydrase inhibitor. It works to cause an accumulation of carbonic acid in the proximal kidney, preventing its breakdown, and causes lowering of blood pH and resorption of sodium, bicarbonate, and chloride with their subsequent excretion into the urine [1].
    [Show full text]
  • Current Current
    CP_0406_Cases.final 3/17/06 2:57 PM Page 67 Current p SYCHIATRY CASES THAT TEST YOUR SKILLS Chronic enuresis has destroyed 12-year-old Jimmy’s emotional and social functioning. The challenge: restore his self-esteem by finding out why can’t he stop wetting his bed. The boy who longed for a ‘dry spell’ Tanvir Singh, MD Kristi Williams, MD Fellow, child® Dowdenpsychiatry ResidencyHealth training Media director, psychiatry Medical University of Ohio, Toledo CopyrightFor personal use only HISTORY ‘I CAN’T FACE MYSELF’ during regular checkups and refer to a psychia- immy, age 12, is referred to us by his pediatri- trist only if the child has an emotional problem J cian, who is concerned about his “frequent secondary to enuresis or a comorbid psychiatric nighttime accidents.” His parents report that he wets disorder. his bed 5 to 6 times weekly and has never stayed con- Once identified, enuresis requires a thorough sistently dry for more than a few days. assessment—including its emotional conse- The accidents occur only at night, his parents quences, which for Jimmy are significant. In its say. Numerous interventions have failed, including practice parameter for treating enuresis, the restricting fluids after dinner and awakening the boy American Academy of Child and Adolescent overnight to make him go to the bathroom. Psychiatry (AACAP)1 suggests that you: Jimmy, a sixth-grader, wonders if he will ever Take an extensive developmental and family stop wetting his bed. He refuses to go to summer history. Find out if the child was toilet trained and camp or stay overnight at a friend’s house, fearful started walking, talking, or running at an appro- that other kids will make fun of him after an acci- priate age.
    [Show full text]
  • Overactive Bladder: What You Need to Know Whiteboard Animation Transcript with Shawna Johnston, MD and Emily Stern, MD
    Obstetrics and Gynecology – Overactive Bladder: What You Need to Know Whiteboard Animation Transcript with Shawna Johnston, MD and Emily Stern, MD Overactive bladder (OAB) is a symptom-based disease state, which includes urinary frequency, nocturia, and urgency, with or without urgency incontinence. Symptoms of a urinary tract infection (UTI) are similar but additionally include dysuria (painful voiding) and hematuria. OAB tends to be a chronic progressive condition, while UTI symptoms are acute and may be associated with fever and malaise. In patients whose symptoms are unclear, urinalysis and urine culture may help rule out infection. If symptoms point to OAB, you should rule out: 1. Neurological disorders, such as multiple sclerosis, dementia, parkinson’s disease, and stroke. 2. Medical disorders such as diabetes, and 3. Prolapse, as women with obstructed voiding, usually from advanced prolapse, can have symptoms that mimic those of OAB. It is important to delineate how OAB symptoms affect a patient’s quality of life. Women with OAB are often socially isolated and sleep poorly. On history, pay attention to lifestyle factors such as caffeine and fluid intake, environmental triggers, and medications that may worsen symptoms like diuretics. Cognitive impairment and diabetes can influence OAB symptoms. Estrogen deficiency worsens OAB symptoms, so menopausal status and hormone use are important to note. Physical exam includes a screening sacral neurologic exam, an assessment for pelvic organ prolapse and a cough stress test to rule out stress urinary incontinence. On pelvic exam, look for signs of estrogen deficiency. Investigations include urinalysis, urine culture, and a post-void residual volume measurement.
    [Show full text]
  • Topic Objectives Physical Examination
    LECTURE MODULE 3; PHYSICAL EXAMINATION OF URINE Topic Objectives 1. Identify the colors which commonly associated with abnormal urine. 2. State two possible causes for urine turbidity in a sample that is not fresh. 3. Identify possible causes for abnormal urinary foam. 4. Identify the odors commonly associated with abnormal urine. 5. Differentiate between the following abnormalities of urine volume: Polyuria Oliguria Anuria Nocturia 6. Define specific gravity of urine. 7. Define refractive index of a solution. 8. Identify possible causes of abnormal specific gravities of urine. 9. Compare and contrast Diabetes Mellitus with Diabetes Insipidus. Physical Examination Appearance Color Transparency Foam Odor Specific Gravity Volume 1 Color • When an examiner first receives a urine specimen, color is observed and recorded. • Normal urine usually ranges from a light yellow to a dark amber color. • The normal metabolic products which are excreted from the body contribute to this color. • Urochrome is the chief urinary pigment. • Urinary color may vary, depending on concentration, dietary pigments, drugs, metabolites, and the presence or absence of blood. • A pale color generally indicates dilute urine with low specific gravity. • Occasionally, a pale urine with high specific gravity is seen in a diabetic patient. Color In many diseases, urinary color may drastically change. In liver disease, bile pigments may produce a yellow-brown or greenish tinge in the urine. Pink, red, or brown urine usually indicates the presence of blood, but porphyrins may also cause a pink or red urine. Since drugs, dyes and certain foods may alter urine color, the patient’s drug list and diet intake should be checked.
    [Show full text]
  • Dysuria White Paper
    CASE STUDY SUMMARY Management of Dysuria for BPH Surgical Procedures Ricardo Gonzalez, M.D. Medical Director of Voiding Dysfunction at Houston Metro Urology, Houston, Texas Dysuria following Benign Prostatic approach, concentrating on one area without Hyperplasia (BPH) Procedures ‘jumping around.’ Keep the laser at .5 mm away from the tissue when using the GreenLight PV® Transient dysuria following surgical treatment system; and 3 mm or less for the GreenLight of benign prostatic hyperplasia (BPH) is not an HPS® and GreenLight XPS® systems. Care must uncommon occurrence regardless of treatment. also be taken at the bladder neck: Identify Many factors may contribute to dysuria after the UOs and trigone, use lower power these procedures, including irritation from the (60-80 watts) and avoid directing energy introduction of the cystoscope; the degree of into the bladder.” tissue necrosis; the surgical modality utilized; the surgical technique employed; and the patient’s condition. This paper will focus on Pre-and Post-Operative Management both pre-procedural as well as post-procedural of Dysuria management of irritative symptoms related to Dr. Ricardo Gonzalez is an expert in the surgical BPH procedures. treatment of BPH with the GreenLight Laser System. “I spend considerable time Contributors to Dysuria educating patients on what to expect after Ricardo Gonzalez, M.D., Medical Director of surgical treatment of BPH, including dysuria,” Voiding Dysfunction at Houston Metro Urology says Dr. Gonzalez. “Proper patient education states, “Inefficient surgical technique can encour- will prevent many unnecessary phone calls age coagulative necrosis, which may increase from patients.” inflammation. This is more likely to be the case Dr.
    [Show full text]
  • Download PDF (Inglês)
    ORIGINAL ARTICLE Vol. 47 (1): 73-81, January - February, 2021 doi: 10.1590/S1677-5538.IBJU.2019.0448 A comparison of the effi cacy and tolerability of treating primary nocturnal enuresis with Solifenacin Plus Desmopressin, Tolterodine Plus Desmopressin, and Desmopressin alone: a randomized controlled clinical trial _______________________________________________ Parvin Mousavi Ghanavati 1, Dinyar Khazaeli 2, Mohammadreza Amjadzadeh 2 1 Golestan Hospital, Iran, Tehran, Republic of Islamic; 2 Ahvaz Jundishapur University, Ahvaz, Khuzestan, Iran, Tehran, Republic of Islamic ABSTRACT ARTICLE INFO Introduction: Nocturnal enuresis (enuresis) is one of the most common developmental Parvin Mousavi Ghanavati problems of childhood, which has often a familial basis, causes mental and psychological https://orcid.org/0000-0001-9255-6468 damage to the child and disrupts family solace. Objectives: In this study, we compared therapeutic effi cacy and tolerability of treating Keywords: primary nocturnal enuresis (PNE) with solifenacin plus desmopressin, tolterodine plus Nocturnal Enuresis; Solifenacin desmopressin, and desmopressin alone. Because we don’t have enough information Succinate; desmopressin, about this comparison especially about solifenacin plus desmopressin. valyl(4)-glutaminyl(5)- [Supplementary Concept] Patients and Methods: This clinical trial study was performed on 62 patients with enuresis aged 5-15 years who referred to the urology clinic of Imam Khomeini Int Braz J Urol. 2021; 47: 73-81 Hospital in Ahwaz in 2017-2018. Patients were randomly assigned to one of the three different therapeutic protocols and any participants were given a specifi c code. After that, we compared the therapeutic response and the level of satisfaction of each _____________________ therapeutic group in different months. Data were analyzed using SPSS 22 software Submitted for publication: and descriptive and analytical statistics.
    [Show full text]
  • Urinary System Diseases and Disorders
    URINARY SYSTEM DISEASES AND DISORDERS BERRYHILL & CASHION HS1 2017-2018 - CYSTITIS INFLAMMATION OF THE BLADDER CAUSE=PATHOGENS ENTERING THE URINARY MEATUS CYSTITIS • MORE COMMON IN FEMALES DUE TO SHORT URETHRA • SYMPTOMS=FREQUENT URINATION, HEMATURIA, LOWER BACK PAIN, BLADDER SPASM, FEVER • TREATMENT=ANTIBIOTICS, INCREASE FLUID INTAKE GLOMERULONEPHRITIS • AKA NEPHRITIS • INFLAMMATION OF THE GLOMERULUS • CAN BE ACUTE OR CHRONIC ACUTE GLOMERULONEPHRITIS • USUALLY FOLLOWS A STREPTOCOCCAL INFECTION LIKE STREP THROAT, SCARLET FEVER, RHEUMATIC FEVER • SYMPTOMS=CHILLS, FEVER, FATIGUE, EDEMA, OLIGURIA, HEMATURIA, ALBUMINURIA ACUTE GLOMERULONEPHRITIS • TREATMENT=REST, SALT RESTRICTION, MAINTAIN FLUID & ELECTROLYTE BALANCE, ANTIPYRETICS, DIURETICS, ANTIBIOTICS • WITH TREATMENT, KIDNEY FUNCTION IS USUALLY RESTORED, & PROGNOSIS IS GOOD CHRONIC GLOMERULONEPHRITIS • REPEATED CASES OF ACUTE NEPHRITIS CAN CAUSE CHRONIC NEPHRITIS • PROGRESSIVE, CAUSES SCARRING & SCLEROSING OF GLOMERULI • EARLY SYMPTOMS=HEMATURIA, ALBUMINURIA, HTN • WITH DISEASE PROGRESSION MORE GLOMERULI ARE DESTROYED CHRONIC GLOMERULONEPHRITIS • LATER SYMPTOMS=EDEMA, FATIGUE, ANEMIA, HTN, ANOREXIA, WEIGHT LOSS, CHF, PYURIA, RENAL FAILURE, DEATH • TREATMENT=LOW NA DIET, ANTIHYPERTENSIVE MEDS, MAINTAIN FLUIDS & ELECTROLYTES, HEMODIALYSIS, KIDNEY TRANSPLANT WHEN BOTH KIDNEYS ARE SEVERELY DAMAGED PYELONEPHRITIS • INFLAMMATION OF THE KIDNEY & RENAL PELVIS • CAUSE=PYOGENIC (PUS-FORMING) BACTERIA • SYMPTOMS=CHILLS, FEVER, BACK PAIN, FATIGUE, DYSURIA, HEMATURIA, PYURIA • TREATMENT=ANTIBIOTICS,
    [Show full text]
  • Chapter 31: Lower Urinary Tract Conditions in Elderly Patients
    Chapter 31: Lower Urinary Tract Conditions in Elderly Patients Damon Dyche and Jay Hollander William Beaumont Hospital, Royal Oak, Michigan As our population ages, the number of patients pre- uroflow/urodynamic studies, and cystoscopy. Com- senting to their primary care physicians with uro- mon transurethral treatment modalities include re- logic problems is significantly increasing. Urologic section, laser ablation, and microwave or radiofre- issues are the third most common type of complaint quency therapy. in patients 65 yr of age or older and account for at There are two major approaches of medical ther- least a part of 47% of office visits.1 One of the most apy for prostatic outflow obstruction: relaxing the predominant urologic problems in elderly persons, prostate smooth muscle tissue or decreasing glan- ␣ and the focus of this chapter, is lower urinary tract dular volume. 1-adrenergic blockade relaxes the symptoms (LUTS). There are several disease pro- smooth muscle fibers of the prostatic stroma and cesses that can lead to LUTS, as well as a number of can significantly improve urine flow. Because ␣ consequences. In this chapter, we will give a brief blockade can also have significant cardiovascular ␣ overview of the major issues as they relate to elderly side effects, 1 selective medications were devel- persons. oped to specifically target the urinary system. Com- mon nonselective agents include terazosin and dox- azosin; selective medications are tamsulosin and BENIGN PROSTATIC HYPERPLASIA AND alfuzosin. 5-␣ reductase inhibitors block the con- LUTS version of testosterone 3 DHT, which is a potent stimulator of prostatic glandular tissue. This reduc- The prostate surrounds the male urethra between tion in local androgen stimulation results in a pro- the bladder neck and urinary sphincter like a gressive decrease in prostatic volume over a period doughnut.
    [Show full text]
  • Urinary Retention in Women Workshop Chair: David Castro-Diaz, Spain 07 October 2015 08:30 - 11:30
    W16: Urinary Retention in Women Workshop Chair: David Castro-Diaz, Spain 07 October 2015 08:30 - 11:30 Start End Topic Speakers 08:30 08:45 Urinary retention in women: concepts and pathophysiology David Castro-Diaz 08:45 08:50 Discussion All 08:50 09:05 Evaluation Tufan Tarcan 09:05 09:10 Discussion All 09:10 09:30 Conservative management Cristina Naranjo-Ortiz 09:30 09:35 Discussion All 09:35 09:55 Medical and surgical management Christopher Chapple 09:55 10:00 Discussion All 10:00 10:30 Break None 10:30 11:20 Typical clinical cases discussion All 11:20 11:30 Take home messages David Castro-Diaz Aims of course/workshop Urinary retention in women is rare and diverse. Diagnostic criteria are not agreed and epidemiology is not well known. Forms of urinary retention in women include: complete retention, incomplete or insufficient emptying and elevated post-void residual. It may be acute or chronic, symptomatic or asymptomatic. Etiology is multifactorial including anatomic or functional bladder outlet obstruction and bladder dysfunction related to neurological diseases, diabetes mellitus, aging, pharmacotherapy, pain and infective/inflammatory disease and idiopathic or unknown aetiology. This workshop will analyse and discuss physiopathology, evaluation and management of urinary retention in women from an integral, practical and evidence based approach. Learning Objectives 1. Identify urinary retention in women, its etiology and risk factors. 2. Carry out proper diagnosis of urinary retention in women as well as its relationship with risk and influent factors. 3. Properly manage female acute and chronic acute and chronic urinary retention with the different approaches including conservative, medical and surgical therapies.
    [Show full text]
  • Office Evaluation of Overactive Bladder: 4 Easy Steps
    ■ OBGMANAGEMENT BY MICKEY KARRAM, MD, and STEVE KLEEMAN, MD Office evaluation of overactive bladder: 4 easy steps Urgency, frequency, and urge incontinence can usually be diagnosed and managed without sophisticated urodynamic testing. 66-year-old woman complains of uri- Revised terminology nary urgency, frequency, and inconti- ne of the most notable changes in the Anence, and estimates that she voids 15 Oterms used to describe lower urinary tract or more times within a typical 24-hour period. dysfunction, proposed by the International So far, she has lost only small amounts of Continence Society,3 is organization of the ter- urine—because she hurries to void at the first minology into 3 categories: symptoms, signs, sense of urgency—but she is distressed and and urodynamic observations. worried that she will have a major accident. Symptoms are now defined to more closely Sound familiar? Overactive bladder affects 17 reflect the way the patient perceives her to 33 million US women.1 Thanks to greater problem, and are set forth without specifying awareness and openness, more women today are the volume of urine required for a diagnosis of seeking medical help for their troubling symptoms, “abnormal” sensation or urgency. although only a fraction have done so up to now.2 Signs can be observed by the physician, such Ob/Gyns who are prepared to quickly evaluate the as leakage of urine when the patient coughs. problem and initiate effective management can Urodynamic observations are made dur- help restore the quality of life these patients ing urodynamic studies. enjoyed before onset of symptoms. This article: Overall, the new and revised terms are • reviews the pathophysiology of “overactive relatively vague to allow for patient-to-patient bladder”; variability.
    [Show full text]
  • Urogenital Disorders 12
    Urogenital disorders 12 In this chapter, five urogenital disorders are discussed that occur more often in patients with Sjögren's Table 12.1 Examples of causes of overactive syndrome than in the general population. These bladder symptoms disorders are: - detrusor overactivity 1. overactive bladder syndrome (overactive bladder syndrome, OAB) 2. interstitial cystitis/bladder pain syndrome - urinary tract infections 3. non-bacterial prostatitis - drugs (side-effects) 4. vulvodynia - bladder cancer; prostate cancer 5. dyspareunia - benign prostatic hyperplasia - stones in the bladder - constipation 1. Overactive bladder syndrome - pelvic organ prolapse - bladder injury Overactive bladder (OAB) syndrome is the term used to - nerve damage describe the symptom complex of urinary urgency with - neurological diseases (multiple sclerosis, or without urge incontinence, usually with frequency Parkinson’s disease, spinal cord lesions, spina and nocturia, in the absence of any sign of infection or bifida, stroke) other identifiable cause of the symptoms.36 Symptoms of overactive bladder may also have identifiable causes quality of life and patients may feel a sense of shame OAB with incontinence is currently referred to and embarrassment, in particular in OAB wet.9 as OAB wet, in contrast to OAB dry when there is no The diagnosis of OAB is based on symptoms and incontinence. does not require invasive tests. Careful questioning The symptoms of OAB are primarily due to about symptoms is important in achieving a differential involuntary contractions of the detrusor muscle during diagnosis (table 12.2). The most common differential the filling phase of the micturition cycle. These diagnosis is a urinary tract infection but in a small contractions, when observed during urodynamic number of cases bladder cancer is underlying the studies, are termed detrusor overactivity and are symptoms of OAB.
    [Show full text]
  • Treating Your Infection – Urinary Tract Infection (Uti)
    TREATING YOUR INFECTION – URINARY TRACT INFECTION (UTI) For women under 65 years with suspected lower urinary tract infections (UTIs) or lower recurrent UTIs (cystitis or urethritis) Possible urinary signs & symptoms The outcome Recommended care Types of urinary tract infection (UTI) Key signs/symptoms: All women: Self-care and pain relief. UTIs are caused by bacteria getting into your urethra Dysuria: Burning pain when passing urine (wee) If none or only one of: dysuria, • Symptoms may get better on their own. or bladder, usually from your gut. Infections may occur New nocturia: Needing to pass urine in the night new nocturia, cloudy urine; Delayed or backup prescription with in different parts of the urinary tract. Cloudy urine: Visible cloudy colour when passing urine AND/OR vaginal discharge self-care and pain relief. Kidneys (make urine) Other severe signs/symptoms: • Antibiotics less likely to help. Start antibiotics if symptoms: Infection in the upper urinary tract Frequency: Passing urine more often than usual • Usually lasts 5 to 7 days. • Get worse. • Pyelonephritis (pie-lo-nef-right-is). Urgency: Feeling the need to pass urine immediately • You may need a urine test to check • Do not get a little better with Not covered in this leaflet and Haematuria: Blood in your urine for a UTI. self-care within 48 hours. always needs antibiotics. Suprapubic pain: Pain in your lower tummy Non-pregnant women: Immediate antibiotics prescription Bladder (stores urine) Other things to consider: If 2 or more of: dysuria, new nocturia, plus self-care. Infection in the lower urinary tract Recent sexual history cloudy urine; OR bacteria detected • Cystitis (sis-tight-is).
    [Show full text]