DOCSLIB.ORG

Lower Urinary Tract Disorders

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Lower Urinary Tract Disorders 37 Lower Urinary Tract Disorders Michael Perrotti Objectives 1. To discuss the evaluation and treatment options for men with benign prostatic hyperplasia and lower urinary tract symptoms (urinary frequency, nocturia, urgency, urinary retention). • Consider pertinent history and physical, diag- nostic tests 2. To outline the evaluation and treatment options for patients with urinary incontinence. 3. To describe the potential etiologies of hematuria. • Consider age, presence of pain, character of bleeding, trauma • Consider occult versus gross hematuria 4. To discuss the diagnostic modalities available for evaluation of hematuria including risks, indica- tions, and limitations. • Consider computed tomography (CT), cys- toscopy, intravenous pyelogram, ultrasound, cystourethrogram, and retrograde pyelography 5. To discuss the etiologies and diagnostic evalua- tion of a patient with dysuria. 6. To discuss the etiologies and workup of a patient with pneumaturia. Cases Case 1 A 67-year-old woman may have a history of stress incontinence fol- lowing the birth of her third child and reports a worsening at the time of menopause, but she seeks medical care at the present time because of inability to “hold my urine” 2 years after suffering a cerebral vas- cular accident. She has no other neurologic residua. 656 37. Lower Urinary Tract Disorders 657 Case 2 A 17-year-old boy is brought to the emergency department after sus- taining a bicycle accident. He is noted to have gross blood at the penile meatus. He has not voided since the time of his accident. Case 3 A 22-year-old college student complains of burning with urination. He has a clear urethral discharge and recently has engaged in unprotected intercourse. Introduction Lower urinary tract disorders are intended to include those complaints related to the function of voiding that prompt a patient to seek the care of a physician. Such complaints may be a result of a primary urinary tract etiology (i.e., urinary tract infection) or of a secondary urinary tract etiology (i.e., bladder hyperreflexia following cerebral vascular accident). Hence, a complete and accurate history and a complete and accurate physical examination remain of the utmost importance in the evaluation of such patients. This chapter discusses the presentation, workup, and treatment of common lower urinary tract disorders, including benign prostatic hyperplasia (BPH) and lower urinary tract symptoms (LUTS), urinary incontinence, hematuria, cystitis, dysuria, and pneumaturia. Benign Prostatic Hyperplasia (BPH) and Lower Urinary Tract Symptoms (LUTS) It is estimated that there are approximately 6 million patient visits annually among U.S. males for the evaluation of symptoms attribut- able to enlargement of the prostate gland. It is incumbent upon the evaluating physician to have a consistent approach to this disorder, to identify patients at increased risk of adverse event (i.e., acute urinary retention), and to initiate appropriate therapy in those patients in whom it is required. It also is important to detect disease states that can mimic the symptoms of BPH. The Agency for Health Care Policy and Research recommends that all males with lower urinary com- plaints be administered a Prostate Symptom Questionnaire (Table 37.1). This scoring system addresses six areas of voiding dysfunction that are scored from 0 (no symptoms) to 5 (severe symptoms), for a composite score ranging from 0 to 30. Differential Diagnosis It is important to rule out other etiologies of urinary symptoms in making the diagnosis of benign prostatic hyperplasia. The presence of prostate cancer must be ruled out since treatment of benign disease would be ineffective and would result in further disease 658 M. Perrotti Table 37.1. American Urologic Association Prostate Symptom Index. Symptom (each scored as 0–5) Scale Sense of incomplete emptying 0, not at all Frequency 1, less than 1 in 5 Intermittency 2, less than 50% of time Urgency 3, about half the time Straining 4, greater than 50% of time Nocturia 5, almost always progression. This can be accomplished with a well-performed digital rectal examination (DRE), a serum prostate-specific antigen (PSA) test, and reference to normal value ranges. It generally is recognized that a prostate biopsy is indicated in those men with either elevated serum PSA level (>4ng/mL) or a suspicious DRE finding before embarking upon a BPH treatment regimen (see Algorithm 37.1, Table 37.2). Irritative symptoms such as urinary frequency may be due to under- lying urinary tract infection, bladder malignancy, primary bladder disorder (i.e., radiation cystitis), or neurologic disease such as history of cerebral vascular accident, multiple sclerosis, or Parkinson’s disease (Table 37.3). Similarly, poor bladder emptying may be seen in primary neurologic disease and in the neuropathy associated with diabetes. In cases that are not diagnostically clear, urodynamic testing is performed to assess bladder function quantitatively. During this office procedure, the bladder is drained after voiding to measure postvoid residual, and then the bladder is filled at a determined rate and bladder pressure is Initial evaluation Hx, PE, DRE Urinalysis Serum PSA AUA-SI Refractory urine retention Abnormal DRE Hematuria Prostate Failed med management Elevated PSA Symptom Gross hematuria Index Bladder calculus Mild Mod/severe Surgical intervention R/O prostate cancer Renal US Watchful waiting Tx alternatives Urine cytology Cystoscopy Algorithm 37.1. Algorithm for the evaluation and treatment of benign prostate hyperplasia. AUA-SI, American Urologic Association Prostate Symptom Index; DRE, digital rectal exam; Hx, history; PE, physical examination; PSA, prostate-specific antigen; R/O, rule out; US, ultrasound. 37. Lower Urinary Tract Disorders 659 Table 37.2. Results of watchful waiting series for prostate cancer. Follow-up Overall Dz-specific CaP Level of Author n (years) mortality (%) mortality (%) progression (%) evidence Johanssona 223 10.2 56 8 34 III Whitmoreb 75 9.5 39 15 69 III Hanashc 179 15 55 45 NA III Georged 120 7 44 4 83 III Madsene 50 10 52 6 18 III a Johansson J-E, Adami H-O, Andersson S-O, et al. High 10-year survival rate in patients with early, untreated pros- tatic cancer. JAMA 1992;267:2191–2196. b Whitmore WF, Warner JA, Thompson IM. Expectant management of localized prostatic cancer. Cancer (Phila) 1991;67:1091–1096. c Hanash KA, Utz DC, Cook EN, et al. Carcinoma of the prostate: a 15-year follow-up. J Urol 1972;107:450–453. d George NJR. Natural history of localized prostatic cancer managed by conservative therapy alone. Lancet 1988;494–497. e Madsen PO, Graverson PH, Gasser TC, et al. Treatment of localized prostatic cancer: radical prostatectomy versus placebo: a 15-year follow-up. Scand J Urol Nephrol Suppl 1988;110:95–100. Source: Reprinted from Presti JC Jr. Urology. In: Norton JA, Bollinger RR, Chang AE, et al, eds. Surgery: Basic Science and Clinical Evidence. New York: Springer-Verlag, 2001, with permission. measured. While performing this study, record is made of the bladder’s response to filling (i.e., sensation, compliance, stability, capacity) and the peak strength of bladder pressure generation during voiding. The peak bladder voiding pressure is correlated with the electronically measured voiding urine flow measurement. Cases of mixed disease states pose a management challenge. A patient may have poor bladder contractility secondary to diabetic nephropathy aggravated by bladder obstruction secondary to BPH. In such patients, results of BPH management often are suboptimal. In men with Parkinson’s disease and bladder outlet obstruction secondary to BPH, transurethral resection of the prostate (TURP) is associated with a high rate of incontinence and is avoided, and maximal medical man- agement is utilized. Treatment It generally is recommended that a discussion of treatment options be initiated in those men with moderate (8 to 19) or severe (≥20) symptom scores (Table 37.4). Treatment may include surveillance alone, medical management, or surgical intervention, the gold stan- dard being electrosurgical TURP. After hearing a discussion of the potential risks and benefits of available therapies, most patients want medical management in an attempt to avoid a surgical procedure if possible. Medical Management Medical management consists primarily of a-receptor blockade or 5a- reductase inhibition (Table 37.5). Alpha-blocker agents (i.e., Cardura, Hytrin, Flomax) have been shown to decrease the tone of the a- innervated muscle of the prostatic stroma and bladder neck regions. These agents decrease the symptom score and improve urinary flow rates. As a result, the alpha-blockers are Food and Drug Administration 660 M. Perrotti Table 37.3. Urodynamic findings in selected neurologic disorders. Common urodynamic Disorder finding Suprapontine lesions Cerebral aneurysm DH Brain abscess DH Olivopontocerebellar degeneration DH Multiple system atrophy DH, DA, ISD Parkinson’s disease DH, DSD, ISD Senile dementia DH Cerebral palsy DH Cerebral vascular disease DH, DA (acute) Cerebellar ataxia DH Bilateral lesions of the putamen DH, DA Normal pressure hydrocephalus DH, DA Huntington’s chorea DH Hereditary ataxias DH Shy-Drager DA, ISD Spinal lesions Multiple sclerosis DH, DA, DSD Syringomyelia DH, DSD Herniated disk (cervical, thoracic) DH, DSD Herniated disk (lumbosacral) DA, DH Hereditary spastic paraparesis DH Tropical spastic paraparesis DH Myelomeningocele DA, DH, DSD, ISD Anterior spinal artery syndrome DH, DA (nl sensation) Sacral
Load more

Recommended publications
  • Emphysematous Pyelonephritis Presenting As Pneumaturia and the Use of Point-Of-Care Ultrasound in the Emergency Department
    Hindawi Case Reports in Emergency Medicine Volume 2019, Article ID 6903193, 5 pages https://doi.org/10.1155/2019/6903193 Case Report Emphysematous Pyelonephritis Presenting as Pneumaturia and the Use of Point-of-Care Ultrasound in the Emergency Department Natasha Brown,1,2 Paul Petersen ,1,2 David Kinas ,1,2 and Mark Newberry1,2 1Mount Sinai Medical Center, 4300 Alton Rd., Miami Beach, FL 33140, USA 2FIU Herbert Wertheim College of Medicine, 11200 SW 8th St., Miami, FL 33199, USA Correspondence should be addressed to Paul Petersen; [email protected] Received 3 April 2019; Revised 24 June 2019; Accepted 29 July 2019; Published 2 September 2019 Academic Editor: Vasileios Papadopoulos Copyright © 2019 Natasha Brown et al. is is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Emphysematous pyelonephritis (EPN) is a rare form of pyelonephritis causing a severe infection of the renal system that includes gas in the renal parenchyma, collecting system and surrounding tissue oen presenting with sepsis. We report the case of a 60-year-old male with poorly controlled insulin dependent diabetes mellitus who presented with abdominal pain, nausea, vomiting, and “peeing air.” CT scan revealed air extending from the le renal parenchyma, perinephric fat and into the bladder, consistent with emphysematous pyelonephritis. Bedside point-of-care ultrasound (POCUS) subsequently revealed dirty shadowing and reverberation artifacts in the le kidney and the bladder consistent with gas in the urinary collecting system. By understanding the identifying artifacts seen with EPN, reective shadow and reverberation artifact, the emergency physician may be alerted to the diagnosis sooner.
    [Show full text]
  • A 37-Year-Old Patient Presenting with Pneumaturia: a Case Study
    æCASE STUDY A 37-year-old patient presenting with pneumaturia: a case study Anuj Mishra1*, Mohamed Azzabi2, Mohamed Hamadto2, Seeraj Bugren2, Wael Hresha2, Saleh Addalla2 and Ehtuish F. Ehtuish2 1Department of Radiology, Libyan National Organ Transplant Program, Tripoli, Libya; 2Department of General Surgery, Tripoli Central Hospital, University of Al-Fateh, Tripoli, Libya Received for publication: 20 April 2009; Accepted in revised form: 11 July 2009; Published: 11 January 2010 Case presentation with pericolic inflammation and a SVF. Colonoscopy 37-year-old male patient presented to the surgical (Fig. 4) revealed fleshy, indurated masses and small outpatients department with undefined lower diverticuli in the sigmoid colon. The biopsies from the Aabdomen pain for a period of seven months site revealed inflammatory changes and were negative for associated with mucoid diarrhea. For the last two malignancy. In Fig. 5, excised specimen is the inflamed months, he had severe dysuria with suprapubic pain, sigmoid colon segment (black arrow) and the bladder and he also noticed air in the urine during micturition. dome (white arrow) with SVF (double arrow). The He was admitted to the urology department two months patient had smooth recovery and was discharged in ago for urinary tract infection which was treated with good general condition. Histopathological examination antibiotics. He also gave a history of perianal abscess of the surgical specimen confirmed the imaging diagnosis. drainage one year ago. The patient admitted to taking a course of antibiotics whenever he had an attack of The diagnosis is urinary tract infection. There was no history of diabetes, Diverticulitis complicated by SVF. hypertension, or any other chronic illness.
    [Show full text]
  • Surgical Treatment of Urinary Incontinence in Men
    CHAPTER 19 Committee 15 Surgical Treatment of Urinary Incontinence in Men Chairman S. HERSCHORN (CANADA) Co-Chair J. THUROFF (GERMANY) Members H. BRUSCHINI (BRAZIL), P. G RISE (FRANCE), T. HANUS (CZECH REPUBLIC), H. KAKIZAKI (JAPAN), R. KIRSCHNER-HERMANNS (GERMANY), V. N ITTI (USA), E. SCHICK (CANADA) 1241 CONTENTS IX. CONTINUING PEDIATRIC I. INTRODUCTION AND SUMMARY PROBLEMS INTO ADULTHOOD: THE EXSTROPHY-EPISPADIAS COMPLEX II. EVALUATION PRIOR TO SURGICAL THERAPY X. DETRUSOR OVERACTIVITY AND REDUCED BLADDER CAPACITY III. INCONTINENCE AFTER RADICAL PROSTATECTOMY FOR PROSTATE CANCER XI. URETHROCUTANEOUS AND RECTOURETHRAL FISTULAE IV. INCONTINENCE AFTER XII. THE ARTIFICIAL URINARY PROSTATECTOMY FOR BENIGN SPHINCTER (AUS) DISEASE V. SURGERY FOR INCONTINENCE XIII. NEW TECHNOLOGY IN ELDERLY MEN XIV. SUMMARY AND VI. INCONTINENCE AFTER RECOMMENDATIONS EXTERNAL BEAM RADIOTHERAPY ALONE AND IN COMBINATION WITH SURGERY FOR PROSTATE REFERENCES CANCER VIII. TRAUMATIC INJURIES OF THE URETHRA AND PELVIC FLOOR 1242 Surgical Treatment of Urinary Incontinence in Men S. HERSCHORN, J. THUROFF H. BRUSCHINI, P. GRISE, T. HANUS, H. KAKIZAKI, R. KIRSCHNER-HERMANNS, V. N ITTI, E. SCHICK ry, other pelvic operations and trauma is a particular- I. INTRODUCTION AND SUMMARY ly challenging problem because of tissue damage outside the lower urinary tract. The artificial sphinc- ter implant is the most widely used surgical procedu- Surgery for male incontinence is an important aspect re but complications may be more likely than in of treatment with the changing demographics of other areas and other surgical approaches may be society and the continuing large numbers of men necessary. Unresolved problems from the pediatric undergoing surgery for prostate cancer. age group and patients with refractory incontinence Basic evaluation of the patient is similar to other from overactive bladders may demand a variety of areas of incontinence and includes primarily a clini- complex reconstructive surgical procedures.
    [Show full text]
  • Urinary Tract Infection
    Urinary Tract Infection Urinary tract infection (UTI) is a term that is applied to a variety of clinical conditions ranging from the asymptomatic presence of bacteria in the urine to severe infection of the kidney with resultant sepsis. UTI is one of the more common medical problems. It is estimated that 150 million patients are diagnosed with a UTI yearly, resulting in at least $6 billion in healthcare expenditures. UTIs are at times difficult to diagnose; some cases respond to a short course of a specific antibiotic, while others require a longer course of a broad-spectrum antibiotic. Accurate diagnosis and treatment of a UTI is essential to limit its associated morbidity and mortality and avoid prolonged or unnecessary use of antibiotics. Advances in our understanding of the pathogenesis of UTI, the development of new diagnostic tests, and the introduction of new antimicrobial agents have allowed physicians to appropriately tailor specific treatment for each patient. EPIDEMIOLOGY Approximately 7 million cases of acute cystitis are diagnosed yearly in young women; this likely is an underestimate of the true incidence of UTI because at least 50% of all UTIs do not come to medical attention. The major risk factors for women 16–35 years of age are related to sexual intercourse and diaphragm use. Later in life, the incidence of UTI increases significantly for both males and females. For women between 36 and 65 years of age, gynecologic surgery and bladder prolapse appear to be important risk factors. In men of the same age group, prostatic hypertrophy/obstruction, catheterization, and surgery are relevant risk factors.
    [Show full text]
  • 1 Physical Examination
    PART I Clinical Decision Making Evaluation of the Urologic Patient: History and 1 Physical Examination Sammy E. Elsamra, MD he evaluation of a patient must always begin with a thorough emotions, attitudes, and affect (Silverman and Kinnersley, 2010). and appropriate history and physical examination. By using an In fact, studies have shown that patients may reveal more or less Torganized system of information accrual, the urologist can gather information based on level of eye contact and physician posture information pertinent to the cause (or contributing factors) of a during the encounter (Byrne and Heath, 1980). disease and obtain information salient to its treatment. To do so In addition to establishing an optimal setup, the physician must reliably for every patient, a reproducible system of history and physical appreciate the patients’ level of comprehension. Whether this entails examination has been developed and is taught routinely at all medical assessing their ability to communicate in interview language or their schools, usually in the preclinical years. Laboratory and radiologic ability to comprehend complex matters, the physician must assess examinations should be performed based on the findings of history level of comprehension by reading nonverbal cues or asking patients and physical examination to narrow the differential diagnosis and to summarize the discussion. Further, the patient encounter may arrive at an accurate diagnosis. A proper history and physical examina- be enhanced by the presence of a family member or friend. Often tion also allow for the development of rapport and trust between patients may not be as aware of pertinent historical details that family physician and patient, which can prove invaluable in counseling members may be able to supply.
    [Show full text]
  • Lower Urinary Tract Symptoms’’
    MedicineHx–Genitourinary System History of ‘’Lower Urinary Tract Symptoms’’ A. Overview: • Lower urinary tract symptoms (LUTS) are either storage, voiding orpost micturition symptoms affecting the lower urinary tract. Prevailing guidelines suggest that the pathogenesis of LUTS is multifactorial and can include one or several diagnoses, commonly benign prostatic obstruction, nocturnal polynocturia and detrusor muscle instability. • Pain in the urinary tract is either due to distention or inflammation. (e.g. urinary retention, ureteric obstruction). Severity of pain is usually related to rapidity of distention rather than the degree of distention. (Chronic distention is usually painless) Different types according to the site 1. Ureteral Pain (Usually acute and secondary to obstruction, the site of obstruction e.g. ureteral stones ) (Mid ureter, lower ureter) can be determined by site of referred pain and/or associated symptoms (LUTS) 2. Vesical pain (Most often by over distention of the UB) • Constant Suprapubic (SP) (Pain that is not related to Acute Urinary Retention is seldom of Urologic origin) • Intermittent SP (Pain is usually related to inflammatory conditions (e.g. Acute Cystitis, Interstitial Cystitis), Worse when the bladder is full and partially relieved by bladder emptying) • Bacterial Cystitis (Pain may be referred to distal Urethra) 3. Prostatic pain • Usually secondary to inflammatory conditions and in the perineum (e.g. Acute Prostatitis) • Referred to lumbosacral spine, inguinal canals or lower extremities. Associated Irritative lower urinary tract symptoms ± Urinary retention 4. Penile and testicular pain • Flaccid Penis: Pain is usually 2ndy to inflammation of Venereal diseases or Paraphimosis. • Erect Penis: Usually due to Peyronie’s disease or Priapism • Primary Acute Testicular Pain arises with acute intrascrotal pathology e.g.
    [Show full text]
  • Urology 2002
    UROLOGY Dr. S. Herschorn Ryan Groll, Alexandra Nevin and David Rebuck, chapter editors Gilbert Tang, associate editor HISTORY AND PHYSICAL . 2 PENIS AND URETHRA . .26 Peyronie's Disease KIDNEY AND URETER . 2 Priapism Renal Stone Disease Phimosis Stone Types Paraphimosis Benign Renal Tumours Penile Tumours Malignant Renal Tumours Erectile Dysfunction Carcinoma of the Renal Pelvis and Ureter Urethritis Renal Trauma Urethral Syndrome Urethral Stricture BLADDER . 9 Urethral Trauma Bladder Carcinoma Neurogenic Bladder HEMATURIA . .30 Incontinence Urinary Tract Infections (UTI) INFERTILITY . .31 Recurrent/Chronic Cystitis Interstitial Cystitis PEDIATRIC UROLOGY . .32 Bladder Stones Congenital Abnormalities Urinary Retention Hypospadias Bladder Trauma Epispadias-Exstrophy Bladder Catheterization Antenatal Hydronephrosis Posterior Urethral Valves PROSTATE . 16 UPJ Obstruction Benign Prostatic Hyperplasia (BPH) Vesicoureteral Reflux (VUR) Prostate Specific Antigen (PSA) Urinary Tract Infection (UTI) Prostatic Carcinoma Enuresis Prostatitis/Prostatodynia Nephroblastoma Cryptorchidism / Ectopic Testes SCROTUM AND CONTENTS . .21 Ectopic Testes Epididymitis Ambiguous Genitalia Orchitis Torsion SURGICAL PROCEDURES . .35 Testicular Tumours Hematocele REFERENCES . .36 Hydrocele Spermatocele/Epididymal Cyst Varicocele Hernia MCCQE 2002 Review Notes Urology – U1 HISTORY AND PHYSICAL HISTORY ❏ pain: location (CVA, genitals, suprapubic), onset, quality (colicky, burning), severity, radiation ❏ associated symptoms: fever, chills, weight loss, nausea, vomiting
    [Show full text]
  • Assessment of the Urological Patient : History and Examination
    1 Assessment of the urological patient : History and examination Assessment of the urological patient involves initial assessment of the patient’s age, built, taking a complete and detailed history, a thor- demeanour, intelligence and socio‐economic ough physical examination and analysis of a group and adapt your consultation style accord- urine sample. As with all history taking the ingly, based on your experience, in an attempt enquiry should include details of the presenting to make the patient feel comfortable. An ice- complaint and its history, the relevant past breaker such as ‘I hope you haven’t been medical history and a family and drug history. waiting too long’ or ‘Did you manage to park Th e examination should include the abdomen, easily?’ can help the patient to relax. Aim to external genitals and a digital rectal examination project a caring, experienced and open but in men and a vaginal examination in women, if professional image that will put the patient at clinically indicated. Th e urinalysis is most readily ease and facilitate communication. performed by dipstick testing; a formal micro- Then begin with, ‘How old is your patient scopic analysis may be required to investigate and what is his/her occupation? How can any abnormality. I help’, or ‘Your GP has written to us saying you have a problem with…please tell me about it’, which are good open questions to start the consultation. Look out for signs that the patient H istory may not be able to describe the problem due to anxiety or embarrassment or a language bar- Communication skills rier.
    [Show full text]
  • Clinical Practice Guidelines for the Antibiotic Treatment of Community
    Special Article Infection & https://doi.org/10.3947/ic.2018.50.1.67 Infect Chemother 2018;50(1):67-100 Chemotherapy ISSN 2093-2340 (Print) · ISSN 2092-6448 (Online) Clinical Practice Guidelines for the Antibiotic Treatment of Community-Acquired Urinary Tract Infections Cheol-In Kang1*, Jieun Kim2*, Dae Won Park3*, Baek-Nam Kim4*, U-Syn Ha5*, Seung-Ju Lee6, Jeong Kyun Yeo7, Seung Ki Min8, Heeyoung Lee9, and Seong-Heon Wie10 1Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul; 2Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, Hanyang University, Seoul; 3Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul; 4Division of Infectious Diseases, Department of Internal Medicine, Inje University Sanggye-Paik Hospital, Seoul; 5Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul; 6Department of Urology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon; 7Department of Urology, Inje University College of Medicine, Pusan; 8Department of Urology, National Police Hospital, Seoul; 9Center for Preventive Medicine and Public Health, Seoul National University Bundang Hospital, Seongnam; 10Division of Infectious Diseases, Department of Internal Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea Urinary tract infections (UTIs) are infectious diseases that commonly occur in communities. Although several international guide- lines for the management of UTIs have been available, clinical characteristics, etiology and antimicrobial susceptibility patterns may differ from country to country. This work represents an update of the 2011 Korean guideline for UTIs.
    [Show full text]
  • Emphysematous Cystitis: the Role of CT Imaging and Appropriate Treatment
    case report Emphysematous cystitis: The role of CT imaging and appropriate treatment Alper Eken, MD, FEBU;* Ergun Alma, MD† *Acıbadem Adana Hastanesi Urology Department, Adana, Turkey; †Ceyhan State Hospital, Adana, Turkey Cite as: Can Urol Assoc J 2013;7(11-12):e754-6. http://dx.doi.org/10.5489/cuaj.472 for these symptoms. She had a medical history of DM for Published online November 8, 2013. 14 years and extracorporeal shock wave lithotripsy (ESWL) for a kidney stone 2 years ago. Despite using oral antidia- Abstract betics, she had poor diabetic control (fasting blood glucose was between 250 and 350 mg/dL). She was conscious and Emphysematous cystitis is a relatively rare disease characterized interactive during the physical examination, which revealed by the presence of gas in the bladder wall and/or lumen. The an axillary temperature of 38.7ºC, arterial blood pressure primary risk factor is diabetes mellitus. Emphysematous cystitis of 130/70 mmHg, respiratory rate of 22 breaths per minute should be considered in cases of urinary tract infections in diabetic and oxygen saturation of 97%. There was no guarding or patients with unusual presentations. Imaging studies are neces- sary to detect emphysematous cystitis. Accurate diagnosis of the rebound to abdominal palpation, but minimal suprapubic disease and appropriate treatment typically results in a favourable tenderness and right side costovertebral angle tenderness prognosis and can improve the outcome. We present a case of was noted. emphysematous cystitis diagnosed by a computed tomography Laboratory testing revealed the following abnormal results: scan in a diabetic woman with poor glycemic control.
    [Show full text]
  • Voiding Dysfunction
    Voiding Dysfunction .. ! 1. Symptomatology and terminology of voiding dysfunction 2. International prostatic symptom scores (IPSS) 3. Hematuria : definition and causes 4. Investigation for patient with hematuria Voiding Dysfunction AB CDE E (Sign & Symptom) GH AB GHI J ! JADK KLLCJ G MNOHEDED LUTS (Lower Urinary Tract Symptom) CDE LUTS G Terminology ISGH B TLUIVNE J UMNMNA NE M J B LD W N D LUTS (lower urinary tract symptom Irritative symptom Obstructive symptom Frequency Weak stream Nocturia Urinary hesitancy Urgency Intermittency Dysuria Postvoid dribbling Straining Acute and chronic urinary Retention Interruption of the stream Sense of residual urine 1 Symptomatology and terminology of voiding dysfunction Frequency KJDE IVE GHJJDEGHC ED BH MNaJJ I K NMbD LK 5-6 f DE g D f LG 300-400 cc. KJDEGIC W N D - Polyuria !E K !Bf ID D 2000 ./ LGICL IJGH WDW N J TOEWDHUIE OEIJLO (Diabetes Insipidus) OE ELI L GH OHfUM I jW N - Decreased bladder capacity GgGHUMN IKG ID D IKEE J D (Partial cystectomy), g Neurogenic bladder - Decreased functional capacity ! !E IKELLIDI D GH GJ M IK (irritation) ID M cystitis OENDIG jELUMNI KJDEW N Nocturia KJDEGHI !BfME O L GHI!NEWN J f MNUD Nocturnal frequency LOHE!BfKJN WDI 2 f DEO M l Na LUIVNE l I GH J frequency E NIE U - Frequency GHI !BfISE g WDG nocturia GICGHI GHIOHE J psychogenic IG - Nocturia without frequency ELI MNaGHIV congestive heart failure G peripheral edema IOHE L ED supine UMN intravascular volume I H!Bf - Nocturia MN EC renal concentrating
    [Show full text]
  • The Urinary System Al Sham Private University Pr
    The urinary system Al Sham Private University Pr. Hussam Shebli Presentation by: Joudy Alkabbani, Asmaa Aljeala, Noor Elkhechi, Abbas Mazeh, Hiba Assaf, Tarek Gherli The urinary system: 1 The kidneys 2 The ureters 3 The bladder 4 The urethra Anatomical introduction Introduction • Two reddish-brown bean-shaped organs about the • located posteriorly in the abdomen, retroperitoneally on either side of the spine at the T12–L3 level kidneys: • The right kidney is lower than the left Kidney because of the liver Histological introduction • Cortex (renal corpuscle, proximal convoluted tubule, distal convoluted tubules and collecting tubules) • Medulla (renal pyramids, minor calyces and major calyces) • Simple cuboidal epithelium Physiological introduction • Filtration • Reabsorption • Secreting hormones (Renin and Erythropoietin) • Maintaining homeostasis The ureters Introduction • The ureters are bilateral thin (3 to 4 mm) tubular structures • They connect the kidneys to the urinary bladder about: (transporting urine from the renal pelvis into the bladder) • Transitional epithelium The bladder • Muscular organ that stores urine • It sits on the pelvic floor • The bladder can hold between 300 and 500 ml • Transitional epithelium The urethra • A tube that connects the urinary bladder to the urinary meatus to remove the urine from the body • Females use their urethra only for urination • But males use their urethra for urination and ejaculation • The structure of the urethra is fibrous and muscular Kidney’s hormones Hormones that are secreted from
    [Show full text]