Urinary 2

cdunbar4's version from 2016-10-30 02:42

Other urinary problems

Question Answer
Strictures d/t inflammation are usually secondary to surgery (adhesions), can affect entire length of ureter
short-term treatment nephrostomy tube or stent
long-term treatment progressively larger stents or urethroplasty
Renal trauma treatment depends on severity; supportive care & monitor while healing
Renal trauma could result indialysis or surgery
Nephrosclerosissclerosis of arteries feeding the kidney; tx is similar to HTN
Renal Artery Stenosispartial occlusion of one or both renal arteries
Cause of secondary HTNrenal artery stenosis
Diagnosisrenal U/S, CT, MRI, arteriogram is the best
Goal of renal artery stenosiscontrol BP and protect kidneys
splenic artery anastomosissurgical revascularization of renal arteries
renal vein thrombosisd/t trauma/compression; pain and hematuria
Tx renal vein thrombosisanticoagulation or surgical thrombectomy

Bladder Cancer

Question Answer
Who is at risk? 60-70yo; men 3x>women; cigs; chornic use of analgesics with phenacetin; hx of radiation for cervical cancer; hx of prostate cancer; chronic stones & UTIs
Where is phenacetin still found in? A cutting agent for cocaine
S/S? either chronic or intermittent gross, painless hematuria; bladder irritability with dysuria, frequency and urgency
Treatment Surgery then chemo
Tx: transurethral resection with fulguration electrocautery for superficial lesions
Tx: Laser photocoagulation superficial lesions (advantages: ↓ RF bladder perforation, reduced need for urinary catheter)
Tx: Open loop resection snaring of polyp-type lesions with fulguration (for large superficial tumors and/or multiple lesions
Tx: Segmental cystectomy segmental resection of bladder
Tx: partial cystectomy resect portion of bladder wall with margin of normal tissue
Tx: radical cystectomy complete removal of bladder (M: prostate, seminal vesicles) (W: uterus, cervix, urethra & ovaries)
Post-Op Care Fluids, no alcohol, sitz baths, Teach urine observation (red→pink→period of brown after 10-11 days when scabs fall off; Coping!

Incontinence & Retention

Question Answer
Is it normal with aging? NO, 80% can be cure or improved
Causesanything that interferes with bladder and/or urethral sphincter control including: confusion, depression, infection, meds, restricted mobility
Muscarinic REceptor antagonists & anticholinergics ↓ overactive bladder contractions in urge urinary incontinence & overactive bladder: oxybutynin
alpha-adrenergic antagonists reduce urethral sphincter resistance to urinary outflow: doxazosin, terazosin
5a-reductase inhibitors androgen suppression that results in epithelial atrophy and a decrease in total prostate size: finasteride, dutasteride
alpha-adrengeric agonistsincrease urethral resistance: phenylpropanolamine
Tricyclic antidepressants reduce sensory urgency and burning pain of interstitial cystitis: imipramine, amitriptyline
Calcium Channel Blockers reduce smooth muscle contraction strength, may reduce burning pain of interstitial cystitis: nifedipine, diltiazem, verapamil
Hormone Replacement Therapy local application reduces urethral irritation and increases host defenses against UTI
Prostate problems are no "F.U.N." Manifestations Frequency, Urgency, Nocturia (also hematuria, infections, less stream, more residual urine)
TURPTransurethral resection of the prostate
CBIContinuous Bladder Irrigation for TURP
Complications of TURP hemorrhage: bleeding should ↓ to light pink in 24hrs. →maintain catheter patency; infections (↑ fluids); DVT SCD's, heparin, don't sit for long periods
Indications for urinary catheterization indwelling obstruction, paralysis, can't void; bladder decompression preop; measurements; terminal illness or severe impariment
indications for straight cath anatomic structures, urodynamic testing, collection of sterile urine samples, meds
Suprapubic catheters via abd wall, care is similar to indwelling, watch skin around insertion site

Incontinence & Retention

Question Answer
nephrostomy tube catheter inserted into pelvis of kidneys; temporary when complete outflow obstruction: care is same as suprapubic (irrigate with no more than 5cc)
intermittent caths neurogenic bladders, patients can do at home be sure to TEACH
ileal conduit ureters implanted into part of ileum or colon that has been resected from intestinal tract. Abd stoma is created
cutaneous ureterostomy ureters excised from bladder and brought through abd wall, stoma is created: stomas may be created from both ureters or the ureters can be brought together
Kock Pouch part of bowel becomes "bladder"
Stress incontinence loss or leaking of urine during exercise, sneezing, laughing, coughing or lifting; F>M; Tx: perineal muscle exercises (Kegel's) & wt. loss
Overflow incontinence pressure of urine in overfull bladder overcomes sphincter control: leakage of little bits of urine; M>F; Tx: decompress bladder with catheterization
Urge incontinence aka overactive bladder: random, involuntary urination: tx underlying cause
Reflex incontinence occurs when no warning or stress precedes periodic involuntary urination; urination is frequent, moderate in volume & occurs equally during day & night. Commonly caused by spinal cord lesions from S2 that interferes with CNS: tx focuses on relaxing internal sphincter via drugs or self-caths
Functional incontinence loss of urine from pt. immobility; maybe can't get to bathroom in time; tx focused on modifying env't to facilitate regular, easy access to toilet

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