1. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 1 Problems with Urination CAPT Mike Hughey, MC, USNR

2. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 2 Cystitis Pain, burning, frequency, tender bladder Treat on the basis of symptoms Confirm cure with culture Bactrim, Gantrisin, Keflex, Macrodantin Pyridium 200 mg PO TID x 2 days Video

3. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 3 Gonorrheal Urethritis Burning, frequency, tender urethra Purulent discharge from urethra/Skene's GC culture Cephtriaxone 250 mg IM, plus Doxycycline 100 mg PO BID x 7 days Treat partner

4. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 4 Non-Gonorrheal Urethritis Burning, frequency, tender urethra, bladder They don't improve on antibiotics Negative urine culture Treat on basis of suspicion Doxycycline 100 mg BID x 7 days, or Clindamycin 150 mg TID x 7-10 days Treat sexual partner

5. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 5 Herpes Vulvitis Severe pain when urine passes over the vulva Multiple tiny blisters/ulcers Zovirax 200 mg PO Q4 hours while awake x 10 days May need Foley cather Try urinating into bathtub Will resolve within 5-10 days

6. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 6 Causes of Urinary Frequency Bladder infection (with dysuria) Excessive fluid intake (particularly at night) Increased stress Pelvic mass Pregnancy Naval Hospital Camp LeJeune

7. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 7 Evaluation of Urinary Frequency Palpate for bladder tenderness (inf) Palpate for pelvic mass Urine culture (dipstick OK) Pregnancy test

8. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 8 Blood in the urine Usually due to cystitis If it persists or returns, then Urology consultation necessary to r/o: -Renal stones -Bladder tumors -Endometriosis Microscopic hematuria most commonly due to exercise in this age group

9. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 9 Bad odor to the urine Either cystitis or vaginitis Look for: -Lost and forgotten tampon -Yeast -Trichomonas -Bacterial vaginosis -Asparagus eating -Ampicillin intake

10. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 10 Can't Urinate Put in Foley catheter Drain about 500 cc, then wait 5-10 minutes before draining another 500 cc...and then another 500 cc Leave Foley in place for 1-2 days to allow the bladder to regain its' tone Rule out: -pregnancy -pelvic mass -pelvic trauma -herpes Video

11. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 11 Forms of Urinary Incontinence Stress incontinence Irritable bladder Loss of urine at unpredictable times

12. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 12 Stress Urinary Incontinence Anatomic problem -Loss of urethrovessicle angle -UV junction exteriorized Loss of urine with cough, sneeze, exercise Mild, Mod & Severe Surgery Kegel Exercises Double-voiding Caffeine, tobacco, alcohol, antibiotics

13. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 13 Irritable Bladder Local problem Sudden urge to urinate Eliminate caffeine, tobacco and alcohol Double voiding Antibiotics Will need consultation

14. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 14 Urethral Diverticulum Local problem Unexpected loss of urine on rising Will need consultation Surgery is curative Nothing else helps

15. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 15 Unpredictable Urine Loss If not associated with urgency or activity, suggests neurologic cause such as: -multiple sclerosis -spinal cord tumors -spinal disc compression If single episode, reassure patient If recurring problem or worsening, evaluate for neurologic disease or injury

16. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 16 Pyelonephritis Severe flank pain and tender kidney(s) Fever (typically quite high) May or may not have urinary symptoms Treat with IV antibiotics This patient is very ill and may need MEDEVAC

17. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 17