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TO PEE OR NOT TO PEE THAT IS THE
QUESTION
Shawn McGlew PA-C, DFAAPAKennebec County UrologyManchester/Oakland, ME
Shawn McGlew PA-C, DFAAPAKennebec County UrologyManchester/Oakland, ME
Pre-Test T or F
Incontinence is natural part of aging for women not men.
Renal ultrasound is the best imaging study for stones.
A high sodium diet is the number one reason for stones.
Finasteride is a first line treatment for BPH.If CT sees a stone no further imaging is needed.Renal U/S is the most cost effective for hematuria.
• I can’t pee.• I pee to much. • It hurts.• I’m peeing blood.
• Prostate• Strictures• Poor pelvic floor relaxation• Other pathology
• Incomplete bladder emptying• Hesitancy• Nocturia• Urgency with or without leaking• Frequency• Pelvic pain
Evaluation:•U/A•PE / DRE•PSA•PVR•Cysto and/or UDS +\-
TREATMENT:•Conservative – voiding techniques•Alpha Blockers•5 Alpha Reductase Inhibitors•CIC•Foley•SP tube
Alpha Blockers:•Tamsulosin (Flomax)•Terazosin (Hytrin)•Doxazosin (Cardura)•Silodosin (Rapaflo)•Alfuzosin (Uroxatral)
5 Alpha Reductase Inhibitors:•Blocks Testosterone conversion to DHT in the prostate.•Not first line•Consider PSA (getting it and correction)•Side effects - breast tender/enlarge, low vol. ejaculate.
Others:•Combinations – Jalyn (Dutasteride / Tamsulosin•Tadalafil (Cialis) low dose daily•CIC•Foley, SP Tube•Surgery - TURP
CICClean Intermittent Catheterization
Foley Cath
SP Tube
History & physical – voiding history, foods, liquids, stress.PVR, U/A
Treatment: AUA Guidelines
Behavioral changes, Bladder training, Physical Therapy, Trial ACh medication
Work-up if not improved – Cysto, UDS, CT +/-
Other treatments: Beta 3 agonist, Neuromodulation, Botox
Anticholinergics:•Oxybutynin (Ditropan)•Tolterodine (Detrol)•Fesoterodine (Toviaz)•Trospium (Sanctura) •Solifenacin (Vesicare)•Darifenacin (Enablex)•Flavoxate (Urispas)
Beta 3 Agonist: •Mirabegron (Myrbetriq) –
Relaxes bladder during filling
Side Effects:•Dizziness•Dry mouth•Constipation•Urinary retention
•Contraindicated in narrow angle glaucoma
Leaking with cough, sneeze, laughing, getting up.
Treatments:•Behavior modification – timed voids, diet, fluids•Absorbent pads•Kegels•Periurethral bulking therapy•Surgery
Presentation: Classic, not so classicComposition: Ca, Ox, Phosphate, uric acid,
struvite (magnesium ammonium phosphate) Prevalence: 1 in 8 will develop stone by age 70 and usually before 50Think about stone with recurrent UTIs due to:
Klebsiella, Proteus, Pseudomonas, Enterococcus.
Work up: imaging > CT vs KUB vs RUSTreatment: Flomax, ESWL, Ureteroscopy, PNL, Prevention: 24 hour urines, hydration, low Na, low Ox, hydration.
Hydration, Hydration, Hydration….
Urine SG > 1.010
Gross: not disgusting… You can see it. Microscopic: more than 3 RBC /HPFSmokers: bladder cancer risk x5Etiology: Stones, infection, kidney disease, prostate, neoplasm.Pathology: benign, malignant.Work up: 3 C’s Follow up for negative evaluation: U/A micro, cytology 3 years