DOCSLIB.ORG

Review and Update of Benign Prostatic Hyperplasia in General Practice

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Review and Update of Benign Prostatic Hyperplasia in General Practice CLINICAL Review and update of benign prostatic hyperplasia in general practice Manasi Jiwrajka, William Yaxley, IT IS COMMON FOR MEN to present to a apnoea) as the cause of symptoms. The use Marlon Perera, Matt Roberts, general practitioner (GP) with symptoms of a frequency–volume chart or voiding Nigel Dunglison, John Yaxley, suggestive of bladder outflow obstruction, diary, and International Prostate Symptom Rachel Esler which is often due to benign prostatic Score (IPSS) tools, help to assess symptom enlargement (BPE). Benign prostatic severity and bother affecting quality of life hyperplasia (BPH) is the histological (QoL; Table 2).4 Background cause of BPE, which often results in lower The aim of physical examination Benign prostatic hyperplasia (BPH) is the most common benign tumour in urinary tract symptoms (LUTS) related is to exclude a palpable bladder as 1 men. Although men with BPH often to voiding, storage or post-micturition. well as phimosis, meatal stenosis or need medical or surgical management Not all LUTS in men are due to BPE, other pathology, including balanitis. from a urologist at some point and other causes of voiding dysfunction A digital rectal examination (DRE) is throughout the timeline of their disease, require exclusion (Table 1).2 Management recommended to evaluate the size of the most men are initially assessed and of LUTS due to BPE depends on symptom prostate and exclude a grossly malignant managed by a general practitioner (GP) severity or complicating factors and or hard prostate nodule suggestive of in the primary healthcare setting. includes observation (for men with prostate cancer, tenderness suggestive Objectives minimal symptoms), medical therapy, of prostatitis, and constipation.5 The aim of this article is to highlight minimally invasive surgical procedures, the principles of the pathogenesis, endoscopic prostatectomy and, presentation, assessment and Initial investigations occasionally, abdominopelvic surgery management of BPH in a primary care setting. for very large prostates. Initial investigations aim to exclude sinister causes of LUTS or complications Discussion Important history and of bladder outflow obstruction that Between 2009 and 2011, BPH was examination features require immediate treatment. Such managed by GPs at approximately investigations (Table 3) include urinalysis 228,000 general practice visits per International guidelines highlight the (to exclude haematuria, proteinuria and annum in Australia. Several changes in pharmaceutical agents and surgical importance of determining the severity of pyuria), serum creatinine and estimated intervention have occurred over the past LUTS and identifying complicating factors glomerular filtration rate (eGFR).6 Urine decade. As a result, it is imperative that such as urinary retention, macroscopic cytology should be considered in the GPs remain up to date with assessment haematuria, urinary tract infection (UTI) presence of haematuria, risk factors and management of BPH, are aware of or a personal or family history of prostate for urothelial carcinoma, or significant new therapies and understand when to cancer. Men may describe (i) voiding storage symptoms. In patients with refer to a urologist. (bladder emptying) symptoms such as moderate-to-severe symptoms or an weak stream, hesitancy and intermittency abnormal serum creatinine, a renal tract of flow or (ii) storage (bladder filling) ultrasound will show bladder capacity and symptoms such as urgency, daytime post-void urine residual volume, allow frequency and nocturia. A predominance for assessment for hydronephrosis and of storage symptoms would require provide an estimation of prostate volume.5 exclusion of other conditions such as Computerised tomography is not routinely primary bladder pathology/malignancy, recommended unless complicating features diabetes mellitus, ischaemic heart disease are suspected.5,6 and medications with diuretic properties.3 Some men are concerned that their In cases where the primary complaint urinary symptoms may be due to an is nocturia, efforts should first be made underlying prostate cancer. Prostate- to exclude nocturnal polyuria (then specific antigen (PSA) testing remains associated factors such as obstructive sleep controversial both in Australia and © The Royal Australian College of General Practitioners 2018 REPRINTED FROM AJGP VOL. 47, NO. 7, JULY 2018 | 471 CLINICAL REVIEW AND UPDATE OF BENIGN PROSTATIC HYPERPLASIA internationally. The Royal Australian Medical therapy in men considering cataract surgery, College of General Practitioners (RACGP) given the increased risk of floppy iris recommends against PSA screening, Men with bothersome symptoms in syndrome.3,12 but acknowledges that the PSA debate the absence of complicating factors remains unclear and open to individual are appropriate candidates for a trial of 5-alpha reductase inhibitors interpretation.7 The Prostate Cancer medical therapy.6 Monotherapy is usually Foundation of Australia and Cancer initiated with an alpha-adrenoceptor 5-ARIs inhibit the conversion of Council Australia guidelines from 2016 antagonist. Combined therapy with a testosterone to dihydrotestosterone recommend PSA testing every two years 5-alpha reductase inhibitor (5-ARI) may (DHT) to reduce prostate growth and for men aged 50–69 years at average risk further improve symptoms in men with prostate volume.13 The most common of prostate cancer.8 This recommendation large prostate volumes. 5-ARIs prescribed on the Australian is supported by the Urological Society of Pharmaceutical Benefits Scheme (PBS) are Australia and New Zealand (USANZ). Alpha-adrenoceptor antagonists dutasteride and finasteride. Dutasteride inhibits type 1 and type 2 isoenzymes of Management Alpha-1 adrenoceptor blockade results in 5-alpha reductase, as opposed to type 2 smooth muscle relaxation in the prostate inhibition alone with finasteride.14 5-ARIs Treatment is mostly determined by and bladder neck.3 Uroselective agents, are most effective when prostate volume bother of symptoms, effect on QoL or such as alfuzosin, silodosin, tamsulosin is >40 mL.5 whether any complicating features are and terazosin, have been shown to The most common side effects of identified. A conservative approach, produce comparable improvement in 5-ARIs are erectile dysfunction, decreased with reassurance and behavioural symptom score and maximal urinary flow libido, decreased ejaculate and decreased modification, can be considered in men rate with fewer systemic side effects.3,11 sperm count.15 In contrast to the rapid with mild, non-bothersome LUTS and Prazosin is cheaper than other agents and onset of action of alpha-adrenoceptor normal baseline investigations, as their is commonly used but has a less favourable antagonists, 5-ARIs can take several risk of progression is low.9,10 Behavioural side-effect profile and requires multiple months before maximum improvement modifications include reducing diuretics daily dosing; thus, it is not recommended in symptoms is obtained.1 Men should be (caffeine, alcohol), bladder irritants by international BPH guidelines.3 warned that 5-ARI therapy can decrease (acidic, spicy foods), evening fluid intake Men should be warned of the PSA levels by approximately 50% after and constipation.9,10 Bladder training and side effects of alpha-adrenoceptor 6–12 months of treatment.16,17 As a result, pelvic floor exercises may improve bladder antagonists, including retrograde in men on a 5-ARI, an increase in PSA capacity and reduce storage symptoms. ejaculation (higher with uroselective above the nadir should prompt closer A yearly GP review of symptoms, with agents), erectile dysfunction, nasal evaluation of PSA levels to exclude an urinalysis and creatinine/eGFR, is congestion, hypotension, dizziness and upward trend suggestive of prostate suggested to monitor for progression.2 tachycardia.1 Caution is also required cancer, rather than waiting for the PSA to be elevated outside the reference range before considering urological evaluation. Table 1. Differential diagnoses for lower urinary tract symptoms Combination therapy Benign and neoplastic Neurological Other causes of lower conditions of the lower conditions urinary tract symptoms Since 2016, tamsulosin plus dutasteride urinary tract has been available to GPs to prescribe as a • Urinary tract infection • Parkinson’s disease • Polyuria from renal or combined formulation without specialist • Prostatitis • Stroke/cerebrovascular cardiac dysfunction approval.18 This fixed-dose combination • Bladder calculi accident • Nocturnal polyuria and is subsidised by the PBS and therefore sleep apnoea • Interstitial cystitis • Multiple sclerosis available at a lower cost than both agents • Iatrogenic from 2 • Urethral stricture • Cerebral atrophy separately. medications • Phimosis • Head injury Two randomised controlled trials of more than 3000 men compared • Overactive bladder • Spinal cord injury/ syndrome surgery or degenerative combination therapy with monotherapy. disc disease • Prostate cancer Overall, combination therapy was • Prior pelvic surgery superior to either alpha-adrenoceptor • Urothelial carcinoma of the bladder including antagonist or 5-ARI therapy alone carcinoma in situ in improving LUTS and reducing 12 • Urethral cancer progression. For men with a prostate volume of >40 mL and a PSA of >1.5, 472 | REPRINTED FROM AJGP VOL. 47, NO. 7, JULY 2018 © The Royal Australian College of General Practitioners 2018 REVIEW AND UPDATE OF BENIGN PROSTATIC HYPERPLASIA CLINICAL
Load more

Recommended publications
  • The Male Reproductive System
    Management of Men’s Reproductive 3 Health Problems Men’s Reproductive Health Curriculum Management of Men’s Reproductive 3 Health Problems © 2003 EngenderHealth. All rights reserved. 440 Ninth Avenue New York, NY 10001 U.S.A. Telephone: 212-561-8000 Fax: 212-561-8067 e-mail: [email protected] www.engenderhealth.org This publication was made possible, in part, through support provided by the Office of Population, U.S. Agency for International Development (USAID), under the terms of cooperative agreement HRN-A-00-98-00042-00. The opinions expressed herein are those of the publisher and do not necessarily reflect the views of USAID. Cover design: Virginia Taddoni ISBN 1-885063-45-8 Printed in the United States of America. Printed on recycled paper. Library of Congress Cataloging-in-Publication Data Men’s reproductive health curriculum : management of men’s reproductive health problems. p. ; cm. Companion v. to: Introduction to men’s reproductive health services, and: Counseling and communicating with men. Includes bibliographical references. ISBN 1-885063-45-8 1. Andrology. 2. Human reproduction. 3. Generative organs, Male--Diseases--Treatment. I. EngenderHealth (Firm) II. Counseling and communicating with men. III. Title: Introduction to men’s reproductive health services. [DNLM: 1. Genital Diseases, Male. 2. Physical Examination--methods. 3. Reproductive Health Services. WJ 700 M5483 2003] QP253.M465 2003 616.6’5--dc22 2003063056 Contents Acknowledgments v Introduction vii 1 Disorders of the Male Reproductive System 1.1 The Male
    [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]
  • Assessment of Lower Urinary Tract Symptoms in Younger Men
    MEN’S HEALTH ASSESSMENT OF LOWER URINARY TRACT SYMPTOMS IN YOUNGER MEN Lower urinary tract symptoms (LUTS) are common in the ageing male and represent a significant burden on both the patient and the healthcare system worldwide. 1,2 Accordingly, the majority of clinical trials and guidelines focus on the older patient, despite the fact that men below these ages will also present with many of the same symptoms. In this review, the authors explore the challenges of assessing and managing men below 50 years with LUTS. Dr Odunayo The aetiology of LUTS is multifactorial with causes How common are LUTS Kalejaiye attributed to dysfunction of the bladder and its in younger men? Urology SpR outlet – including the prostate, urethra and sphincter; The EPIC study, 3 a population-based survey which the neurological innervation of the lower urinary recruited men aged over 18 years, found that the Professor tract, and medical co-morbidities.1,2 It is important prevalence of LUTS increased with age, from 51.3% Raj Persad to consider all these aspects when assessing patients. in men aged 18-39 years to 62% in those aged 40-59 While in older men, benign prostatic enlargement years. This is compared with a prevalence of 80.7% Consultant is the commonest cause of male LUTS, in younger in men aged 60 years or older. Storage symptoms Urologist; men this is unusual, and other diagnoses should be were commonest in men 39 years or younger, with a Honorary considered more likely. prevalence of 37.5%, compared with a prevalence of Professor of 19.9% for voiding symptoms in this age group.
    [Show full text]
  • Management of Male Lower Urinary Tract Symptoms (LUTS), Incl
    Guidelines on the Management of Male Lower Urinary Tract Symptoms (LUTS), incl. Benign Prostatic Obstruction (BPO) M. Oelke (chair), A. Bachmann, A. Descazeaud, M. Emberton, S. Gravas, M.C. Michel, J. N’Dow, J. Nordling, J.J. de la Rosette © European Association of Urology 2013 TABLE OF CONTENTS PAGE 1. INTRODUCTION 6 1.1 References 7 2. ASSESSMENT 8 3. CONSERVATIVE TREATMENT 9 3.1 Watchful waiting - behavioural treatment 9 3.2 Patient selection 9 3.3 Education, reassurance, and periodic monitoring 9 3.4 Lifestyle advice 10 3.5 Practical considerations 10 3.6 Recommendations 10 3.7 References 10 4. DRUG TREATMENT 11 4.1 a1-adrenoceptor antagonists (a1-blockers) 11 4.1.1 Mechanism of action 11 4.1.2 Available drugs 11 4.1.3 Efficacy 12 4.1.4 Tolerability and safety 13 4.1.5 Practical considerations 14 4.1.6 Recommendation 14 4.1.7 References 14 4.2 5a-reductase inhibitors 15 4.2.1 Mechanism of action 15 4.2.2 Available drugs 16 4.2.3 Efficacy 16 4.2.4 Tolerability and safety 17 4.2.5 Practical considerations 17 4.2.6 Recommendations 18 4.2.7 References 18 4.3 Muscarinic receptor antagonists 19 4.3.1 Mechanism of action 19 4.3.2 Available drugs 20 4.3.3 Efficacy 20 4.3.4 Tolerability and safety 21 4.3.5 Practical considerations 22 4.3.6 Recommendations 22 4.3.7 References 22 4.4 Plant extracts - Phytotherapy 23 4.4.1 Mechanism of action 23 4.4.2 Available drugs 23 4.4.3 Efficacy 24 4.4.4 Tolerability and safety 26 4.4.5 Practical considerations 26 4.4.6 Recommendations 26 4.4.7 References 26 4.5 Vasopressin analogue - desmopressin 27 4.5.1
    [Show full text]
  • Phimosis Table of Contents
    Information for Patients English Phimosis Table of contents What is phimosis? ................................................................................................. 3 How common is phimosis? ............................................................................. 3 What causes phimosis? ..................................................................................... 3 Symptoms and Diagnosis ................................................................................. 3 Treatment ................................................................................................................... 4 Topical steroid .......................................................................................................... 4 Circumcision .............................................................................................................. 4 How is circumcision performed? .................................................................. 4 Recovery ...................................................................................................................... 5 Paraphimosis ........................................................................................................... 5 Emergency treatment ....................................................................................... 5 Living with phimosis ........................................................................................... 5 Glossary ................................................................................... 6 This information
    [Show full text]
  • EAU-Guidelines-On-Paediatric-Urology-2019.Pdf
    EAU Guidelines on Paediatric Urology C. Radmayr (Chair), G. Bogaert, H.S. Dogan, R. Kocvara˘ , J.M. Nijman (Vice-chair), R. Stein, S. Tekgül Guidelines Associates: L.A. ‘t Hoen, J. Quaedackers, M.S. Silay, S. Undre European Society for Paediatric Urology © European Association of Urology 2019 TABLE OF CONTENTS PAGE 1. INTRODUCTION 8 1.1 Aim 8 1.2 Panel composition 8 1.3 Available publications 8 1.4 Publication history 8 1.5 Summary of changes 8 1.5.1 New and changed recommendations 9 2. METHODS 9 2.1 Introduction 9 2.2 Peer review 9 2.3 Future goals 9 3. THE GUIDELINE 10 3.1 Phimosis 10 3.1.1 Epidemiology, aetiology and pathophysiology 10 3.1.2 Classification systems 10 3.1.3 Diagnostic evaluation 10 3.1.4 Management 10 3.1.5 Follow-up 11 3.1.6 Summary of evidence and recommendations for the management of phimosis 11 3.2 Management of undescended testes 11 3.2.1 Background 11 3.2.2 Classification 11 3.2.2.1 Palpable testes 12 3.2.2.2 Non-palpable testes 12 3.2.3 Diagnostic evaluation 13 3.2.3.1 History 13 3.2.3.2 Physical examination 13 3.2.3.3 Imaging studies 13 3.2.4 Management 13 3.2.4.1 Medical therapy 13 3.2.4.1.1 Medical therapy for testicular descent 13 3.2.4.1.2 Medical therapy for fertility potential 14 3.2.4.2 Surgical therapy 14 3.2.4.2.1 Palpable testes 14 3.2.4.2.1.1 Inguinal orchidopexy 14 3.2.4.2.1.2 Scrotal orchidopexy 15 3.2.4.2.2 Non-palpable testes 15 3.2.4.2.3 Complications of surgical therapy 15 3.2.4.2.4 Surgical therapy for undescended testes after puberty 15 3.2.5 Undescended testes and fertility 16 3.2.6 Undescended
    [Show full text]
  • Risk Factors for Squamous Cell Carcinoma of the Penis— Population-Based Case-Control Study in Denmark
    2683 Risk Factors for Squamous Cell Carcinoma of the Penis— Population-Based Case-Control Study in Denmark Birgitte Schu¨tt Madsen,1 Adriaan J.C. van den Brule,2 Helle Lone Jensen,3 Jan Wohlfahrt,1 and Morten Frisch1 1Department of Epidemiology Research, Statens Serum Institut, Artillerivej 5, Copenhagen, Denmark; 2Department of Pathology, VU Medical Center, Amsterdam and Laboratory for Pathology and Medical Microbiology, PAMM Laboratories, Michelangelolaan 2, 5623 EJ Eindhoven, the Netherlands;and 3Department of Pathology, Gentofte University Hospital, Niels Andersens Vej 65, Hellerup, Denmark Abstract Few etiologic studies of squamous cell carcinoma female sex partners, number of female sex partners (SCC) of the penis have been carried out in populations before age 20, age at first intercourse, penile-oral sex, a where childhood circumcision is rare. A total of 71 history of anogenital warts, and never having used patients with invasive (n = 53) or in situ (n = 18) penile condoms. Histories of phimosis and priapism at least 5 SCC, 86 prostate cancer controls, and 103 population years before diagnosis were also significant risk controls were interviewed in a population-based case- factors, whereas alcohol abstinence was associated control study in Denmark. For 37 penile SCC patients, with reduced risk. Our study confirms sexually tissue samples were PCR examined for human papil- transmitted HPV16 infection and phimosis as major lomavirus (HPV) DNA. Overall, 65% of PCR-examined risk factors for penile SCC and suggests that penile- penile SCCs were high-risk HPV-positive, most of oral sex may be an important means of viral transmis- which (22 of 24; 92%) were due to HPV16.
    [Show full text]
  • Sexual Function Considerations in Penile Reconstructive Surgery
    ARTICOLO ORIGINALE / ORIGINAL ARTICLE GIMSeR 2008;15:1-13 Sexual function considerations in penile reconstructive surgery Funzione sessuale: considerazioni in chirurgia ricostruttiva del pene G. GARAFFA, N. CHRISTOPHER, D.J. RALPH St. Peter’s Department of Andrology, The Institute of Urology, University College London Hospitals, Ground floor, Rosenheim Wing, London, England Key words: Peyronie’s disease, Penile cancer, Balanitis xerotica obliterans, Penile trauma, Penile amputation, Penile fracture Parole chiave: Malattia di La Peyronie, Cancro peniena, Balanite obliterante erotica, Trauma penieno, Amputazione peniena, Frattura peniena Summary The aim of this paper is to give a concise overview of surgical techniques used to manage Peyronie’s disease, penile squamous cell carcinoma, penile trauma, fracture and amputation of the penis, and balanitis xerotica obliterans. Our methodology involved a PubMed-based review of the last 20 years literature regarding the management of the above conditions. From the literature analysis we extrapolated the surgical strategies providing the best outcomes in terms if sexual function. Riassunto Scopo di questa minireview è fornire una panoramica delle tecniche chirurgiche utilizzate nel trattamento di: malattia di La Peyro- nie, carcinoma squamoso del pene, trauma e frattura peniene, amputazione del pene e balanitis xerotica obliterans. A questo scopo abbiamo valutato la letteratura degli ultimi 20 anni presente in PubMed relativa alla chirurgia delle patologie so- pramenzionate. Nell’ambito della nostra
    [Show full text]
  • Erection Disorders
    CHAPTER 11 ERECTION DISORDERS Despite the current rhetoric. about sex and intimacy’s involving more than penile-vaginal inter- course, the quest for a rigid erection appears to dominate both popular and professional interest. More- over, it seems likely that our diligence in finding new ways for overcoming erectile difficulties serves unwittingly to reinforce the male myth that rock-hard, ever-available phalluses are a necessary compo- nent of male identity. This is indeed a dilemma. 1 ROSEN AND LEIB L UM , 1992 GENE R A L CONSIDE R ATIONS The Problem A 49-year-old widower described erection difficulties for the past year. His 25-year marriage was loving and harmonious throughout but sexual activity stopped after his wife was diagnosed with ovarian cancer six years before her death. Their sexual relationship during the period of her illness had been meager as a result of her lack of sexual desire. Although he missed her greatly, he felt lonely since her death three years before and, somewhat reluctantly at first, began dating other women. A resumption of sexual activity soon resulted but much to his chagrin he found that in contrast to when he would awaken in the morning or masturbate, his erections with women partners were much less firm. He felt considerable tension, particu- larly because some months before, he had developed a strong attachment to one woman in particular and was fearful that the relationship would soon end because of his sexual troubles. As he discussed his grief over the loss of his wife and talked about his guilt over his intimacy with another woman, his erectile problems began to diminish.
    [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]