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HCR240-Chapter23UrologicalDisorders.pptx

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Chapter 23

Urological Disorders

Ureter, bladder, urethra, also prostate

Obstructive uropathy (blockage) may lead to hydronephrosis

Fluid buildup in kidneys

Lower UTI’s

More common in women

Urolithiasis

Stones

Benign prostatic hyperplasia (BPH)

Urological Disorders (continued)

Adequate urine volume and unimpeded urine flow are essential for kidney health

Oliguria

Reduced urine output: less than 400 ml per day

Urologic System

Bladder

Detrusor

Major muscle of the bladder

Innervated by:

Sympathetic

Relax detrusor, tighten internal sphincter

Parasympathetic

Contract detrusor; relax internal sphincter

Bladder usually holds 300–400 mL urine

Bladder (continued)

Micturition reflex: urination

Stretch of bladder walls send signal to spinal cord

Activation of parasympathetic system

Cerebral cortex: voluntary control of voiding

Obstructive Uropathy

Most common pathophysiological problem in urinary tract

Renal calculi: kidney stones

Most common obstruction

After age 60 in men: BPH common cause

Prolonged obstruction results in increased hydrostatic pressure in nephrons decreasing GFR

Progressive damage results

Hydronephrosis and Hydroureter

Dilation of structures due to obstruction

Hydronephrosis: renal calyces and pelvis

Hydroureter: ureter

In children, may result from anatomic abnormalities

Vesicoureteral reflux, urethral stricture, stenosis

Acute hydronephrosis is reversible with full recovery

Lower Urinary Tract Infection (UTI’s)

Most commonly caused by E. coli, originating from bowel

Proteus, Pseudomonas, and Klebsiella also

Proteus more commonly associated with catheterization or use of urinary instrumentation

Women at higher risk

Healthy urinary tract

Bacteria in urethral opening only

Stagnant urine increases infection risk

Female Risk Factors for Lower UTI

Improper perineal hygiene

Tight, restrictive clothing

Chronic dehydration

Diabetes

Use of irritating bath products

Sexual intercourse

Urinary catheterization

Use of contraceptive diaphragms and spermicides

Pregnancy commonly causes asymptomatic bacteriuria (ASB)

Male Risk Factors for Lower UTI

Chronic dehydration

Diabetes

BPH which obstructs free flow of urine

Bladder cancer

Urinary catheterization

UTI is very uncommon in young, adult males, thus should be investigated as to cause.

Hospital-Acquired UTI

Catheterization

Multi-drug resistant pathogens

Polymicrobial infection

Symptoms of Lower Urinary Tract Infection

Increased frequency, dysuria, and urgency

Hematuria (not all cases)

Fever not present with lower UTI

Diagnosis

Urinalysis

RBC’s

Positive leukocyte esterase, which indicates WBC’s

Nitrates, which indicate bacteria

Urine culture

Greater than 100,000 colony-forming units (CFU)/mL

Treatment of UTI

Antibiotics

Nitrofurantoin or trimethoprim-sulfamethoxazole (Bactrim)

Fluoroquinolones

Phenazopyridine (Pyridium)

Pain relief

Can turn urine a red/orange color

Hydration important

Cranberry juice shown to decrease bacterial adherence

Types of Urinary Incontinence

Stress incontinence

Most common

Women more at risk due to loss of muscle support in pelvic floor

Childbirth, abdominopelvic surgery

Low estrogen (menopause) contributes to weakness of pelvic floor

Overactive bladder (OAB)

Detrusor muscle overactivity

Types of Urinary Incontinence (continued)

Overflow incontinence

Chronic overdistention and urinary retention in bladder

Detrusor muscle loses strength and elasticity

BPH most frequent cause in men

Neurogenic bladder

Spinal cord disorders

Functional incontinence

Inability to hold urine (stroke, delirium)

Urinary Incontinence Risk Factors

Increasing age

Pregnancy

Childbirth

Obesity

Diabetes

Stroke

Neurological impairment

Prostate disease and its treatments

Diagnosis of Urinary Incontinence

X-ray of the kidney, ureter, and bladder

Ultrasound

CT scan

IVP

Urodynamic testing

Cystoscopy may be necessary

Measurement of postvoid residual volume in bladder

Diagnosis of Urinary Incontinence (continued)

Simple urinary cough test

Patient asked to forcefully cough with a full bladder in the standing position

Cotton swab test

Assesses mobility and strength of the bladder sphincter

Sterile cotton swab lubricated with lidocaine and inserted transurethrally into the bladder

Patient asked to cough

Angle of the cotton swab can indicate stress incontinence

Treatments for Urinary Incontinence

Kegel exercises

Anticholinergic drug that decreases bladder activity

Incontinence pessary

Transvaginal mesh surgical insertion

Botox injections into overactive bladder

MODULE 7

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