geriatic urology problems

8/9/2019 geriatic urology problems

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Urological Diseases

Male

$UT

#ematuria

Incontinence

ED

%emale

Incontinence#ematuria

$UT

DU


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aturia

Pre-renal

Renal

Post-renal


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Hematuria

Blood in the urine -Dangerous symptomology

Types:

Macroscopic Gross hematuria Microscopic hematuria (the presence of ! red "lood cells per

high po#er microscopic field$

%ainless or painful

&nitial ' Terminal ' Total

lots ) &f so type of clots)


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Timing o& #ematuria

Total hematuria

&rom !ladder or uppertract

Terminal hematuria

!ladder neck or prostaticurethra

Initial hematuria

&rom urethra


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Hematuria

auses

Urological (surgical$

*ephrological (medical$

+, Glomerular

, *onglomerular!, Blood dyscrasias.

/, &nterstitial nephritis

0, 1eno2ascular

disease


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#ematuria' Common UroCauses

(. )ladder cancer

*. +idney cancer

,. Ureteral cancer

-. Urethral cancer

. Prostate cancer

/. tones

0. Pyelonephritis

1. Cystitis 2Prostatitis

3. )P#(4.Radiation cystitis

((.Chemical cystitis

(*.Drug induced

(,. Parasiticin&estations


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5ork up

History esp, drug history () 343 ) 531631&*$

78amination

&n2estigation :

3ll patients

Urine culture and cytology

1enal U4

&9U or computed tomography (T$ scan

ystoscopy


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Urine Cytology

screening &or urothelial cancer

%reshly 6oided postam!ulant 7hole6oid specimen

Microscopic e8amination o& Papstained cells o!tained !ycentri&ugation o& an ali9uot o& urine:at least (4 m$;


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)ladder Cancer

Most common urological cancer

Transitional cell carcinoma :TCC;

Risk &actors' smoking Urethral di2erticulum> %ost surgery for ?stress@ incontinence pel2ic masses (e,g,. o2arian masses$


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Acute urinary retention

Initial Management :

Urethral catheterisation

4uprapu"ic catheter ( 4%$

Late Management:

Treating the underlying cause


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hronic urinary retention

;"struction de2elops slo#ly. the "ladder is

distended (stretched$ 2ery gradually o2er

#ee=s'months. so pain is not a feature ,

%resentation:

Urinary dri""ling

;2erflo# incontinence

%alpa"le lo#er suprapu"ic mass


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Etiology

)P#

Dia!etic cystopathy

@eurogenic !ladder Parkinosinism Multiple sclerosis

pinal cord injury patients


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Chronic urinary retention

Usually associated #ith

1educed renal function,

Upper tract dilatation

Treatment is directed to renal support,

Bladder drainage under slo# rate to a2oid

sudden decompressionhematuria,

Treatment of cause


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5hat"s $UTK

LUTS Lower Urinary Tract Symptoms


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$UT

torage :irritati6e or?lling; symptoms

Urgency %re9uency

@octuria

Urge incontinence

oiding :o!structi6e; symptoms

#esitancy

5eak stream training to pass urine

Prolonged micturition

%eeling o& incomplete!ladder emptying

Urinary retention


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)P# > 7hat causes these symptomsK

Prostate gro7s 7ith age :androgendependent;

Pressure on the urethra restricts urine


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Indications &or treatment

!structi6e uropathy to renal

impairment

Bcute retention o& urine

Chronic retention o& urine

Urinary tract in&ection

)ladder stone &ormation

Urinary incontinence

#ematuria


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medication

First line of defense againstot!ersome urinar"s"mptoms

Manage the condition > don"t ?8 it

#$o ma%or t"pes&

(Alp!a''lo*er)> rela8 the

prostate and pro6ide a largerurethral opening :Tamsulosin6aporisation

Transurethral incision

Transurethral laser techni9ue:holmium


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TURP

Gold tandardHo& care &or )P#

Uses an electrical kni&eH to surgicallycut and remo6e e8cess prostate tissue

Eecti6e in relie6ing symptoms and

restoring urine Lo7

:transurethral resection o& the

prostate;


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Urinary Incontinence

Bects'

(F>,4F li6ing at

home

,4F > ,F in acutecare

N4F in RC%:residential care&acilities;

Nygaard I, et al. JAMA 2008, 300:1311.

Tennstedt S, et al. Am J Epidemiol 2008,1!:3"0.Sa# o$n N% et al A in Trends 2001 ' :1)


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,ontinene re-uires'

Bde9uate mo!ility

Mentation

Moti6ation

Manual de8terity Intact lo7er urinary tract &unction


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edial,ompliations

as!es Pressure ulers

#1

Falls Fratures


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Ps"!osoialompliations

Em!arrassment

tigmatisation

Isolation

Depression Institutionalisation

risk


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BGEI@G )$BDDER C#B@GE )ladder capacity decreases

)ladder compliance decreases

B!ility to postpone 6oiding decreases

Urethral closing pressure decreases in 7omen Prostate enlarges in men

In6oluntary !ladder contractions increase

Post>6oid residual 6olume increases :4>(44ml;

Also: Increased Luid e8cretion at night

Bge associated sleep disorders

Detrusor muscle changes


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#ransient 1nontinene

,ommon e.g. 302 ommunit" d$ellers

+02 of inpatients

D ' Delirium1 ' 1nfetion

A ' Atrop!i ret!ritis/vaginitis

P ' P!armaeutials

P ' Ps"!ologial (rare) ' essive urine output

' estrited moilit"

S ' Stool impation


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rinar" trat auses ofinontinene'

Detrusor overativit"

Detrusor underativit"

5enuine stress inontinene

(lo$ uret!ral resistane) 6strution

(!ig! uret!ral resistane)


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Urinary Incontinence E6aluation

GB$'

In6estigate and treat transient andesta!lished causes.

Bssess patient@s en6ironment and

support

To detect uncommon !ut seriousunderlying conditions'

>)rain lesions> pinal cord lesions> Carcinoma !ladder2prostate> )ladder stones> Decreased !ladder compliance


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Drug #reatment of 6A7

Anti'!olinergi (anti'musarinis)

6"ut"nin

Solifenain

Darifenain

#olterodine

7est as ad%unts toladder drill.

Dose esalation "titration

Ne$er ones ettertolerated


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Pel6ic Loore8ercises

aginal cones

Urethral plugs )io&eed!ack

Dulo8etine

urgery i& all &ails

GI > ID

U l i l t i


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Urological ymptoms inParkinsons

%re9uency

Urgency

Urge incontinence

@octuria

5eak stream2dri!!ling

ensation o& incomplete6oiding2Dou!le 6oiding

ED


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Drug Induced


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UDE Pattern


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Management

PD is slo7ly progressi6e &or 7hichonly symptomatic treatment isa6aila!le.

PD treatment may alter GU &unctionitsel& parado8ically.

Treat PD related symptoms

Treat non PD related symptoms:prostatic enlargement


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Dia!etes = UI

O Detrusor dys&unction uninhi!ited contractions< cystopathy

O #yperglycemia > osmotic diuresis and polyuria

O Medications

O Constipation

O %unctional impairment amputation

O Cogniti6e impairment 6ascular dementia


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Dia!etic cystopathy

(. decreased !ladder sensation

*. decreased !ladder contractility

,. increased !ladder capacity

-. detrusor o6eracti6ity

. urinary incontinence


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5hat is Erectile Dys&unction

ynonym' Impotence

Ina!ility to attain and maintain anerection sucient &or satis&actory

se8ual per&ormance

)enign

igni?cant impact on 9uality o& li&e


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Epidemiology

Incidence and pre6alence is high7orld7ide

Eects up to *F o& men :-4>04yrs;

teep age>related increase.Complete impotence &rom F o& -4yrolds to (F o& 04yr olds

nly (4>*4F solely psychogenic

Ri k & t E d th li l


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Risk &actors Endothelial

Dys&unction

urrogate marker &or ED'

edentary li&estyle

!esity

moking

#ypercholesterolaemia

Meta!olic syndrome Dia!etes mellitus


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Betiology

rganic

#ormonal

Bnatomical

Drugs

Psychogenic


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rganic causes

ascular &actors :CD


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acuum de6ices

Third line treatment Penile


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Third>line treatment > Penile

Prostheses

emi>rigid rods

* piece inLata!le prosthesis

, piece inLata!le prosthesis 7ith a!dominalreser6oir

Risks In&ection

Destroys corpora ca6ernosa

Erosion and e8trusion

Mechanical &ailure

P il P th i


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Penile Prosthesis


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#:AN;

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