DOCSLIB.ORG

Chronic Prostatitis Collaborative Research Network-2 (CPCRN-2) Randomized Clinical Trial #2 MANUAL of PROCEDURES (MOP)

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Chronic Prostatitis Collaborative Research Network-2 (CPCRN-2) Randomized Clinical Trial #2 MANUAL of PROCEDURES (MOP) Chronic Prostatitis Collaborative Research Network-2 (CPCRN-2) Randomized Clinical Trial #2 A Randomized, Placebo-Controlled Multicenter Clinical Trial to Evaluate the Efficacy and Safety of Pregabalin for the Treatment of Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS) MANUAL OF PROCEDURES (MOP) Chronic Prostatitis Collaborative Research Network- 2 Data Coordinating Center University of Pennsylvania Philadelphia, PA February 1, 2006 Version 1.0 INTRODUCTION The prostatitis classification system proposed by the National Institute of Diabetes, Digestive and Kidney (NIDDK) Diseases has become the reference standard for research studies in Prostatitis.1 This classification proposes the absence of demonstrable bacterial infection, as determined by conventional microbiological techniques, in the diagnosis of Category 3 prostatitis: Chronic abacterial prostatitis/chronic pelvic pain syndrome (CP/CPPS). Abnormalities in the expressed prostatic secretions (EPS) are the primary objective features of Category 3 prostatitis and chronic pain is the primary subjective symptom. Subtypes of this category include: 3A Inflammatory chronic pelvic pain syndrome, where white cells are found in the semen, EPS, or voided bladder urine-3 (VB-3). 3B Non-inflammatory chronic pelvic pain syndrome, where white cells are NOT found in the semen, EPS, and VB-3. The majority of participants with chronic prostatitis are Category 32 stressing the need for more research and larger clinical studies for this class of prostatitis. It was with this goal in mind that the NIDDK funded the Chronic Prostatitis Collaborative Research Network, effective October 1, 1997. The objectives of this original network, comprised of seven (7) Clinical Research Centers (CRCs) and the Data Coordinating Center (DCC) at the University of Pennsylvania were to address primary research questions encompassing the diagnosis, etiology, natural history and prognosis, and the development of treatment strategies focused on CP/CPPS. A number of accomplishments have been achieved by the CPCRN including: 1) the development of a longitudinal Chronic Prostatitis Cohort (CPC) Study, to which participants have been accrued and followed, 2) the development and validation of the NIH Chronic Prostatitis Symptom Index (NIH-CPSI), a symptom severity index for CP/CPPS that has subsequently been translated into Spanish and German and is now being used as a primary endpoint for clinical trials in CP, and 3) the completion of the network’s first NIH-funded multi-center RCT. A manuscript describing the results of this RCT, evaluating placebo, tamsulosin hydrochloride alone, ciprofloxacin alone, and the combination of tamsulosin hydrochloride and ciprofloxacin has recently been published in Annals of Internal Medicine.3 Further funding provided by the NIDDK to continue pursuing the network’s objectives for the next five years has resulted in the establishment of CPCRN-2, comprised of 11 sites (the majority of which participated in the first CPCRN) and the Data Coordinating Center at the University of Pennsylvania. The CPCRN-2 is currently recruiting participants for a randomized clinical trial (RCT#1) to evaluate the efficacy and safety of the alpha blocker pregabalin in the treatment of newly- diagnosed Chronic Prostatitis / Chronic Pelvic Pain Syndrome (CP/CPPS) participants. In this Manual of Procedures (MOP), we document the second randomized clinical trial (RCT#2) to be conducted by the CPCRN-2. This trial will focus on the recruitment of treatment-refractory Chronic Prostatitis / Chronic Pelvic Pain Syndrome (CP/CPPS) participants, with the objective to evaluate the efficacy and safety of pregabalin in the treatment of these participants. Pregabalin, a CPCRN-2 RCT#2 MOP Version 1.0- Effective February 2006 i structural derivative of the inhibitory neurotransmitter gamma-aminobutyric acid (GABA), is manufactured and marketed by Pfizer, Inc as Lyrica®. Lyrica® is a new prescription medication approved for the management of neuropathic pain associated with diabetic peripheral neuropathy (DPN), postherpetic neuralgia (PHN) and adjunctive treatment of partial onset seizures in adults with epilepsy.4 Because the defining symptom of CP/CPPS is pain, a proposed mechanism for the etiology and pathogenesis of this condition is that of a neurogenic origin. The hypothesis then is that CP/CPPS participants may benefit from medications used to treat neuropathic pain. CPCRN-2 RCT#2 MOP Version 1.0- Effective February 2006 ii Table of Contents 1 STUDY DESIGN, OBJECTIVES, AND ENDPOINTS .................................................... 1 1.1 STUDY DESIGN AND OBJECTIVES..................................................................................... 1 1.2 STUDY TIME LINE AND ENDPOINTS (INCLUDE TELEPHONE VISITS).................................. 1 1.3 GENERAL PROTOCOL POLICY .......................................................................................... 2 1.3.1 Changing the Protocol............................................................................................ 2 1.3.2 Initiating a Protocol Change .................................................................................. 2 2 PARTICIPANT ENROLLMENT....................................................................................... 3 2.1 PARTICIPANT POPULATION AND RECRUITMENT............................................................... 3 2.1.1 Participant Population............................................................................................3 2.2 PRE-SCREENING............................................................................................................... 4 2.3 INFORMED CONSENT........................................................................................................ 5 2.3.1 Administration of Informed Consent....................................................................... 5 2.3.2 Confidentiality......................................................................................................... 7 2.4 ASSIGNMENT OF PARTICIPANT ID.................................................................................... 7 2.5 STUDY ELIGIBILITY CRITERIA.......................................................................................... 8 2.5.1 Inclusion Criteria.................................................................................................... 8 2.5.2 Exclusion Criteria................................................................................................... 9 2.6 DEFERRAL CRITERIA...................................................................................................... 10 2.6.1 Deferral Criteria................................................................................................... 10 2.7 SCREENING FAILURES.................................................................................................... 11 2.8 RANDOMIZATION PROCEDURE ....................................................................................... 11 2.8.1 Back-up Manual Randomization........................................................................... 12 2.9 PARTICIPANT WITHDRAWAL AND WITHDRAWAL CONSENT .......................................... 12 2.10 PARTICIPANT TRANSFERS .............................................................................................. 13 2.10.1 Transfer of a Participant during the Screening Phase ......................................... 13 2.10.2 Transfer of a Participant during the Treatment/Follow-up Phase....................... 14 2.11 STUDY AND PARTICIPANT DOCUMENTS......................................................................... 14 3 VISIT SCHEDULING AND ADMINISTRATION......................................................... 17 3.1 SCREENING/BASELINE PHASES ...................................................................................... 17 3.1.1 Screening Visit #1 ................................................................................................. 17 3.1.2 Screening Visit #2 ................................................................................................. 18 3.1.3 Reporting of Pre-Existing Conditions and Adverse Events .................................. 20 3.2 TREATMENT/FOLLOW-UP PHASE ................................................................................... 22 3.2.1 Participant Follow-Up Contact Schedule............................................................. 23 3.2.2 Missed Study Contacts .......................................................................................... 23 3.2.3 Visit #3 – Week Two (2)- Telephone Contact ....................................................... 24 3.2.4 Visit #4 – Week Four (4)- Telephone Contact ...................................................... 25 3.2.5 Visit # 5 - Week Six (6)- Primary Endpoint Visit.................................................. 25 3.2.6 Visit #6 – Week Seven (7)...................................................................................... 27 3.2.7 Visit #7 – Week Seven (7)...................................................................................... 28 3.2.8 Visit #8 – Week Eight (8) ...................................................................................... 28 3.2.9 Visit # 9 - Week Twelve (12) ................................................................................. 29 CPCRN-2 RCT#2 MOP Version 1.0- Effective February 2006 iii 3.2.10 Visit #10 – Week Thirteen (13) ............................................................................
Load more

Recommended publications
  • Departmentof UROLOGY
    DEPARTMENT of UROLOGY UPDATE New Treatments for Benign Prostatic Hyperplasia Expanded Choices Provide Relief for a Common Condition FALL 2008 Vol.19 | No.2 The symptoms of an enlarged prostate include a weak stream, trouble starting and gland, called benign prostatic hyper- stopping, the frequent feeling of needing to Clinical Update p. 4 plasia (BPH), are familiar to a substantial urinate, and the sense that the bladder isn’t Kidney Cancer Vaccine p. 5 proportion of men older than 50. empty after urination. About half of men in their 50s and 80-90 percent Erectile Dysfunction Research p. 5 “To some degree, BPH affects all men as they of those older than 80 have enlarged prostates, age,” says Allan Pantuck, MD, MS, associate Clinical Trials p. 6 caused by changes in hormone balance and cell professor and physician in the UCLA Integrative growth. As their prostate begins to squeeze or Profile: Oscar Rivera, LVN p. 8 Urology Program, which combines the best partially block the surrounding urethra — the of preventative approaches, medical counseling, Kudos p. 9 tube that carries the urine from the bladder out nutritional science, and complementary medical of the body — many of these men experience Donor Notes p. 9 approaches for patients interested in the bothersome urinary symptoms, which can prevention and treatment of urologic conditions. Profile: Arthur Schapiro p. 9 “The prostate forms a channel that the urine passes through as it comes out of the bladder. As the prostate enlarges, there is increased resistance to the bladder’s ability to empty. This tends to also lead to changes in the bladder, including a decreased ability to hold urine.” BPH can wreak havoc with quality of life — in addition to the discomfort, some men are forced to get up several times during the night.
    [Show full text]
  • GERONTOLOGICAL NURSE PRACTITIONER Review and Resource M Anual
    13 Male Reproductive System Disorders Vaunette Fay, PhD, RN, FNP-BC, GNP-BC GERIATRIC APPRoACH Normal Changes of Aging Male Reproductive System • Decreased testosterone level leads to increased estrogen-to-androgen ratio • Testicular atrophy • Decreased sperm motility; fertility reduced but extant • Increased incidence of gynecomastia Sexual function • Slowed arousal—increased time to achieve erection • Erection less firm, shorter lasting • Delayed ejaculation and decreased forcefulness at ejaculation • Longer interval to achieving subsequent erection Prostate • By fourth decade of life, stromal fibrous elements and glandular tissue hypertrophy, stimulated by dihydrotestosterone (DHT, the active androgen within the prostate); hyperplastic nodules enlarge in size, ultimately leading to urethral obstruction 398 GERONTOLOGICAL NURSE PRACTITIONER Review and Resource M anual Clinical Implications History • Many men are overly sensitive about complaints of the male genitourinary system; men are often not inclined to initiate discussion, seek help; important to take active role in screening with an approach that is open, trustworthy, and nonjudgmental • Sexual function remains important to many men, even at ages over 80 • Lack of an available partner, poor health, erectile dysfunction, medication adverse effects, and lack of desire are the main reasons men do not continue to have sex • Acute and chronic alcohol use can lead to impotence in men • Nocturia is reported in 66% of patients over 65 – Due to impaired ability to concentrate urine, reduced
    [Show full text]
  • Prostatitis Explained Prostatitis
    Prostate information Prostatitis Explained Prostatitis Prostatitis (prost-a-ty-tus) is the most common prostate problem for men under 50, but it can affect men of all ages. In fact, almost 1 out of 2 men between 18 and 50 may have at least one bout of prostatitis in their lifetime. Prostatitis is often described as an infection of the prostate but it can also mean that the prostate is inflammed or irritated. If you have prostatitis, you may have a burning feeling when passing urine, pass urine more often, be in a lot of pain, have a fever and chills and feel very tired. Once your doctor has diagnosed your symptoms as prostatitis, then the outlook tends to be good. There are many treatments available and your doctor will work with you to find the treatment(s) most suitable for you depending on the type of prostatitis you have. So, it may take slightly longer for some men to see an improvement in their symptoms. However, even when you feel your symptoms are starting to improve you should still continue with your treatment or medication. It may be reassuring to know that prostatitis is neither connected with cancer nor does it mean there is an increased risk of developing prostate cancer in the future, but it can cause worrying symptoms. Table of contents Page Types of prostatitis 3 Acute bacterial prostatitis 5 Chronic bacterial prostatitis 8 Chronic pelvic pain syndrome 9 Treatment for CBP and CPPS 13 Coping with pain 14 Tips to relieve prostatitis 16 Prostatitis There are different types of prostatitis.
    [Show full text]
  • Chronic Bacterial Prostatitis Treated with Phage Therapy After Multiple Failed Antibiotic Treatments
    CASE REPORT published: 10 June 2021 doi: 10.3389/fphar.2021.692614 Case Report: Chronic Bacterial Prostatitis Treated With Phage Therapy After Multiple Failed Antibiotic Treatments Apurva Virmani Johri 1*, Pranav Johri 1, Naomi Hoyle 2, Levan Pipia 2, Lia Nadareishvili 2 and Dea Nizharadze 2 1Vitalis Phage Therapy, New Delhi, India, 2Eliava Phage Therapy Center, Tbilisi, Georgia Background: Chronic Bacterial Prostatitis (CBP) is an inflammatory condition caused by a persistent bacterial infection of the prostate gland and its surrounding areas in the male pelvic region. It is most common in men under 50 years of age. It is a long-lasting and Edited by: ’ Mayank Gangwar, debilitating condition that severely deteriorates the patient s quality of life. Anatomical Banaras Hindu University, India limitations and antimicrobial resistance limit the effectiveness of antibiotic treatment of Reviewed by: CBP. Bacteriophage therapy is proposed as a promising alternative treatment of CBP and Gianpaolo Perletti, related infections. Bacteriophage therapy is the use of lytic bacterial viruses to treat University of Insubria, Italy Sandeep Kaur, bacterial infections. Many cases of CBP are complicated by infections caused by both Mehr Chand Mahajan DAV College for nosocomial and community acquired multidrug resistant bacteria. Frequently encountered Women Chandigarh, India Tamta Tkhilaishvili, strains include Vancomycin resistant Enterococci, Extended Spectrum Beta Lactam German Heart Center Berlin, Germany resistant Escherichia coli, other gram-positive organisms such as Staphylococcus and Pooria Gill, Streptococcus, Enterobacteriaceae such as Klebsiella and Proteus, and Pseudomonas Mazandaran University of Medical Sciences, Iran aeruginosa, among others. *Correspondence: Case Presentation: We present a patient with the typical manifestations of CBP.
    [Show full text]
  • Sexually Transmitted Infections Treatment Guidelines, 2021
    Morbidity and Mortality Weekly Report Recommendations and Reports / Vol. 70 / No. 4 July 23, 2021 Sexually Transmitted Infections Treatment Guidelines, 2021 U.S. Department of Health and Human Services Centers for Disease Control and Prevention Recommendations and Reports CONTENTS Introduction ............................................................................................................1 Methods ....................................................................................................................1 Clinical Prevention Guidance ............................................................................2 STI Detection Among Special Populations ............................................... 11 HIV Infection ......................................................................................................... 24 Diseases Characterized by Genital, Anal, or Perianal Ulcers ............... 27 Syphilis ................................................................................................................... 39 Management of Persons Who Have a History of Penicillin Allergy .. 56 Diseases Characterized by Urethritis and Cervicitis ............................... 60 Chlamydial Infections ....................................................................................... 65 Gonococcal Infections ...................................................................................... 71 Mycoplasma genitalium .................................................................................... 80 Diseases Characterized
    [Show full text]
  • Reference ID: 4555351 See 17 for PATIENT COUNSELING INFORMATION and Medication Guide
    HIGHLIGHTS OF PRESCRIBING INFORMATION 5 mg dapagliflozin/1000 mg metformin HCl extended-release (3) These highlights do not include all the information needed to use 10 mg dapagliflozin/500 mg metformin HCl extended-release (3) XIGDUO XR safely and effectively. See full prescribing information for 10 mg dapagliflozin/1000 mg metformin HCl extended-release (3) XIGDUO XR. ------------------------------ CONTRAINDICATIONS ----------------------------- ® XIGDUO XR (dapagliflozin and metformin HCl extended-release) Severe renal impairment: (eGFR below 30 mL/min/1.73 m2), end-stage tablets, for oral use renal disease or dialysis. (4, 5.1) Initial U.S. Approval: 2014 History of serious hypersensitivity to dapagliflozin or hypersensitivity to metformin HCl. (4, 6.1) WARNING: LACTIC ACIDOSIS Metabolic acidosis, including diabetic ketoacidosis. (4, 5.1) See full prescribing information for complete boxed warning. ----------------------- WARNINGS AND PRECAUTIONS ---------------------- Postmarketing cases of metformin-associated lactic acidosis have Lactic Acidosis: See boxed warning (2.3, 4, 5.1) resulted in death, hypothermia, hypotension, and resistant Hypotension: Before initiating XIGDUO XR, assess and correct volume bradyarrhythmias. Symptoms included malaise, myalgias, status in the elderly, patients with renal impairment or low systolic blood respiratory distress, somnolence, and abdominal pain. Laboratory pressure, and in patients on diuretics. Monitor for signs and symptoms abnormalities included elevated blood lactate levels, anion gap during therapy. (5.2, 6.1) acidosis, increased lactate/pyruvate ratio; and metformin plasma Ketoacidosis: Assess patients who present with signs and symptoms of levels generally >5 mcg/mL. (5.1) metabolic acidosis for ketoacidosis regardless of blood glucose level. If Risk factors include renal impairment, concomitant use of certain suspected, discontinue XIGDUO XR, evaluate and treat promptly.
    [Show full text]
  • A Systematic Review and Meta-Analysis Lei Zhang1*, Yi Wang1*, Zhiqiang Qin2*, Xian Gao3, Qianwei Xing4, Ran Li1, Wei Wang1, Ninghong Song1, Wei Zhang1
    Journal of Cancer 2020, Vol. 11 177 Ivyspring International Publisher Journal of Cancer 2020; 11(1): 177-189. doi: 10.7150/jca.37235 Research Paper Correlation between Prostatitis, Benign Prostatic Hyperplasia and Prostate Cancer: A systematic review and Meta-analysis Lei Zhang1*, Yi Wang1*, Zhiqiang Qin2*, Xian Gao3, Qianwei Xing4, Ran Li1, Wei Wang1, Ninghong Song1, Wei Zhang1 1. Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210009, China. 2. Department of Urology, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, China. 3. Department of Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210009, China. 4. Department of Urology, The Affiliated Hospital of Nantong University, Nantong, 226001, China. *These authors contributed equally to this work. Corresponding authors: Wei Zhang, Department of Urology, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, China. E-mail: [email protected], TEL: +08613901595401; Qianwei Xing, Department of Urology, The Affiliated Hospital of Nantong University, Nantong, 226001, China. E-mail: [email protected], TEL: +08615240552009. © The author(s). This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/). See http://ivyspring.com/terms for full terms and conditions. Received: 2019.06.02; Accepted: 2019.09.27; Published: 2020.01.01 Abstract Background: No consensus has been reached on the definite associations among prostatitis, benign prostatic hyperplasia (BPH) and prostate cancer (PCa). Hence, this meta-analysis was conducted to explore their triadic relation by summarizing epidemiological evidence. Methods: Systematical and comprehensive retrieval of online databases PubMed, PMC, EMBASE and Web of Science was performed to acquire eligible studies, up to April 1st, 2019.
    [Show full text]
  • Post Colonoscopic Acute Bacterial Prostatitis: a Case Report
    International Journal of Research in Medical Sciences Rashid RA et al. Int J Res Med Sci. 2021 May;9(5):1482-1484 www.msjonline.org pISSN 2320-6071 | eISSN 2320-6012 DOI: https://dx.doi.org/10.18203/2320-6012.ijrms20211889 Case Report Post colonoscopic acute bacterial prostatitis: a case report Rahim A. Rashid*, Ramalakshmi Karthikeyan Primary Healthcare Corporation, Doha, Qatar Received: 02 April 2021 Revised: 19 April 2021 Accepted: 20 April 2021 *Correspondence: Dr. Rahim A. Rashid, E-mail: [email protected] Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. ABSTRACT Colonoscopy is a common procedure for diagnosing a wide range of conditions and symptoms affecting the large bowel. Research has shown that the examination itself may induce transient bacterial infections. Specifically acute bacterial prostatitis (ABP) has little mention in medical literature as a recognized complication of this procedure. Here we discuss a 37 year old male presenting with symptoms suggesting lower urinary tract infection after having undergone colonoscopy followed by recurrent episodic haematuria and lower urinary tract symptoms (LUTS). Physicians and endoscopists should be aware of the risk of acute bacterial prostatitis as a potential complication of colonoscopy in order to minimize misdiagnosis as well as the complications associated with the delayed treatment of it. In addition male patients and the immunocompromised should be fully counselled regarding this risk prior to undertaking this procedure.
    [Show full text]
  • Chronic Prostatitis: a Possible Cause of Hematospermia
    pISSN: 2287-4208 / eISSN: 2287-4690 World J Mens Health 2015 August 33(2): 103-108 http://dx.doi.org/10.5534/wjmh.2015.33.2.103 Original Article Chronic Prostatitis: A Possible Cause of Hematospermia Gilho Lee Department of Urology, Dankook University Medical College, Cheonan, Korea Purpose: While hematospermia is mainly caused by genitourinary inflammatory disorders, very few studies have been published on prostatitis-associated hematospermia (PAH) diagnosed using robust prostatitis evaluation methods. Therefore, we have evaluated the incidence of PAH by using systematic methods for evaluating prostatitis. Materials and Methods: We evaluated 37 hematospermia patients from a single hospital over the last five years. We classified the patients into PAH versus hematospermia without any evidence of prostatitis (HWP) by using a NIH-Chronic Prostatitis Symptom Index questionnaire and expressed prostatic secretion studies. Results: The mean age was 55.89±14.87 years, and the patients were grouped into two groups: one group had 12 HWP patients and the other 25 PAH patients. PAH patients were further sub-classified: chronic bacterial prostatitis (3 patients), chronic nonbacterial prostatitis (10 patients), prostadynia (7 patients), and asymptomatic prostatitis (5 patients). We found Enterococcus faecalis in the three chronic bacterial prostatitis patients. We could not find any statistically significant difference between the PAH and the HWP groups in terms of the age interval, serum prostate-specific antigen level, and prostate volume. Even though there was no statistically significant difference in the items about urination between the two groups, we found a statistically significant difference in the quality of life (QoL) impact for the patients in this study.
    [Show full text]
  • Sexual Health Information for Gay & Bisexual
    Sexual Health Information for Gay & Bisexual Men When we talk about sexual health, we often focus on HIV and other STIs, but there are a number of other illness and issues that can affect men’s sexual health. These can include erectile dysfunction (finding it difficult to get or keep an erection), testicular problems, anal pain and discomfort and other infections affecting the genital or anal area. Balanitis Balanitis is a condition where the end of the penis (or the glans) becomes inflamed, leading to redness, irritation and soreness. Men who experience this can sometimes mistake this for symptoms of an STI. Possible causes of balanitis are: a build up of yeast infection, urine, sweat or other debris under the foreskin an allergic reaction to some soaps, washing powders or cleansing products an allergic reaction to condoms phimosis – a condition where the foreskin is tight and does not pull back over the glans another sexually transmitted infection Treatments depend on the cause of balanitis, but could include: an anti-yeast cream or tablets (e.g.canesten) a steroid cream to reduce inflammation advising the use of non-latex condoms circumcision (if the man has phimosis) regular washing of the glans with water and a bland soap treatments for any STIs present Testicular Cancer This is the most common form of cancer affecting young men between the ages of 15 and 40. Men with an un- descended or partially descended testicle (one or both testicles don’t come down into the scrotum) are more likely to develop testicular cancer as do men with a family history of this cancer.
    [Show full text]
  • Urinary Retention in Adults: Diagnosis and Initial Management Brian A
    Urinary Retention in Adults: Diagnosis and Initial Management BRIAN a. SELIUS, DO, and rAJESH SUBEDI, MD, Northeastern Ohio Universities College of Medicine, St. Elizabeth Health Center, Youngstown, Ohio Urinary retention is the inability to voluntarily void urine. This condition can be acute or chronic. Causes of urinary retention are numerous and can be classified as obstructive, infectious and inflammatory, pharmacologic, neuro- logic, or other. The most common cause of urinary retention is benign prostatic hyperplasia. Other common causes include prostatitis, cystitis, urethritis, and vulvovaginitis; receiving medications in the anticholinergic and alpha- adrenergic agonist classes; and cortical, spinal, or peripheral nerve lesions. Obstructive causes in women often involve the pelvic organs. A thorough history, physical examination, and selected diagnostic testing should determine the cause of urinary retention in most cases. Initial management includes bladder catheterization with prompt and com- plete decompression. Men with acute urinary retention from benign prostatic hyperplasia have an increased chance of returning to normal voiding if alpha blockers are started at the time of catheter insertion. Suprapubic catheteriza- tion may be superior to urethral catheterization for short-term management and silver alloy-impregnated urethral catheters have been shown to reduce urinary tract infection. Patients with chronic urinary retention from neurogenic bladder should be able to manage their condition with clean, intermittent self-catheterization; low-friction catheters have shown benefit in these patients. Definitive management of urinary retention will depend on the etiology and may include surgical and medical treatments. (Am Fam Physician. 2008;77(5):643-650. Copyright © 2008 American Academy of Family Physicians.) rinary retention is the inabil- physician to make an accurate diagnosis ity to voluntarily urinate.
    [Show full text]
  • Microhematuria and Urinary Tract Infections
    1/30/2018 MICROHEMATURIA AND URINARY TRACT INFECTIONS ANEESA HUSAIN, PA-C USMD CANCER CENTER ARLINGTON - UROLOGY I HAVE NO FINANCIAL DISCLOSURES THAT WOULD BE A POTENTIAL CONFLICT OF INTEREST WITH THIS PRESENTATION. MICROHEMATURIA TOPICS OF DISCUSSION • DEFINITION • HISTORY • PHYSICAL EXAM • DIFFERENTIAL DIAGNOSES • WORK UP • TREATMENT • WHEN TO REFER? 1 1/30/2018 MICROHEMATURIA DEFINED AS.. • ≥3 RBCs per HPF (HIGH POWER FIELD) ON URINE MICROSCOPY • SHOULD NOT BASE SOLELY ON ONE DIPSTICK READING • CAN CORRELATE TO DIPSTICK URINE ANALYSIS • TRACE, SMALL, MODERATE, LARGE https://www.auanet.org/guidelines/asymptomatic-microhematuria-(2012-reviewed-and-validity-confirmed-2016) MICROHEMATURIA TOP DIFFERENTIAL DIAGNOSES • UTI/PROSTATITIS • KIDNEY STONES • URINARY TRACT OBSTRUCTION • URINARY TRACT MALIGNANCY • NEPHROLOGIC SOURCES MICROHEMATURIA HISTORY • NEW DIAGNOSIS OF MICROHEMATURIA? • PRIOR HISTORY OF GROSS OR MICROHEMATURIA? • PRIOR WORK UP • COMORBIDITIES • PELVIC RADIATION • SURGICAL HISTORY • FOR WOMEN, ASK ABOUT MENSES AND/OR MENOPAUSE • ANTICOAGULATION OR BLOOD THINNERS • SYMPTOMS 2 1/30/2018 MICROHEMATURIA HISTORY - SYMPTOMS • DYSURIA • FREQUENCY • URGENCY • DIFFICULTY VOIDING • INCONTINENCE – PAD USAGE • ABDOMINAL OR BACK PAIN • PERINEAL PAIN MICROHEMATURIA PHYSICAL EXAM • ABDOMINAL EXAM • CVA/FLANK TENDERNESS • GU EXAM • MALE – CONSIDER MEATAL STENOSIS, BALANITIS, TESTICULAR PAIN, PROSTATITIS, PROSTATE ENLARGEMENT • FEMALE – CONSIDER VAGINAL BLEEDING, YEAST INFECTION, ATROPHIC VAGINITIS MICROHEMATURIA DIFFERENTIAL DIAGNOSES • UTI/PROSTATITIS
    [Show full text]