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TO PEE OR NOT TO PEE THAT IS THE QUESTION
URINE TROUBLE TO PEE OR NOT TO PEE THAT IS THE QUESTION Shawn McGlew PA-C, DFAAPA Kennebec County Urology Manchester/Oakland, ME
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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.
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I can’t pee. I pee to much. It hurts. I’m peeing blood.
Urology Made Easy I can’t pee. I pee to much. It hurts. I’m peeing blood.
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Bladder Outlet Obstruction
Prostate Strictures Poor pelvic floor relaxation Other pathology
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Bladder Outlet Obstruction
Incomplete bladder emptying Hesitancy Nocturia Urgency with or without leaking Frequency Pelvic pain
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Bladder Outlet Obstruction
Evaluation: U/A PE / DRE PSA PVR Cysto and/or UDS +\-
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Bladder Outlet Obstruction
TREATMENT: Conservative – voiding techniques Alpha Blockers 5 Alpha Reductase Inhibitors CIC Foley SP tube
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Bladder Outlet Obstruction
Alpha Blockers: Tamsulosin (Flomax) Terazosin (Hytrin) Doxazosin (Cardura) Silodosin (Rapaflo) Alfuzosin (Uroxatral)
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Bladder Outlet Obstruction
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.
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Bladder Outlet Obstruction
Others: Combinations – Jalyn (Dutasteride / Tamsulosin Tadalafil (Cialis) low dose daily CIC Foley, SP Tube Surgery - TURP
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CIC Clean Intermittent Catheterization Foley Cath SP Tube
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I Gotta Peeee!!!
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Urinary Urgency Incontinence Frequency
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Urgency w/wo leaking 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
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Urgency w/wo leaking Anticholinergics: Oxybutynin (Ditropan)
Tolterodine (Detrol) Fesoterodine (Toviaz) Trospium (Sanctura) Solifenacin (Vesicare) Darifenacin (Enablex) Flavoxate (Urispas)
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Urgency w/wo leaking Beta 3 Agonist: Mirabegron (Myrbetriq) –
Relaxes bladder during filling
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Urgency w/wo leaking Side Effects: Dizziness Dry mouth Constipation
Urinary retention Contraindicated in narrow angle glaucoma
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Leaking with cough, sneeze, laughing, getting up.
Stress Incontinence Leaking with cough, sneeze, laughing, getting up.
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Stress Urinary Incontinence
Treatments: Behavior modification – timed voids, diet, fluids Absorbent pads Kegels Periurethral bulking therapy Surgery
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Mixed Incontinence
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Kidney Stones
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Kidney stones Presentation: Classic, not so classic
Composition: Ca, Ox, Phosphate, uric acid, struvite (magnesium ammonium phosphate) Prevalence: 1 in 8 will develop stone by age 70 and usually before 50 Think about stone with recurrent UTIs due to: Klebsiella, Proteus, Pseudomonas, Enterococcus. Work up: imaging > CT vs KUB vs RUS Treatment: Flomax, ESWL, Ureteroscopy, PNL, Prevention: 24 hour urines, hydration, low Na, low Ox, hydration.
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Hydration, Hydration, Hydration….
Kidney Stones Hydration, Hydration, Hydration…. Urine SG > 1.010
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Hematuria Gross: not disgusting… You can see it.
Microscopic: more than 3 RBC /HPF Smokers: bladder cancer risk x5 Etiology: 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
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THE END
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