Urinary Tract Infection Alternative Treatment
Catheter-associated UTIs are associated with increased mortality and costs. Risk factors for catheter-associated UTIs include the duration of catheterization, lack of systemic antibiotic therapy, female gender, age older than 50 years, and azotemia. To help prevent infection, urinary catheters should be avoided when possible and used only as long as needed. The catheter should be inserted with strict aseptic technique by trained persons, and a closed system should be used at all times. Treatment of catheter-associated UTI depends on the clinical circumstances. Symptomatic patients (e.g., those with fever, chills, dyspnea, and hypotension) require immediate antibiotic therapy along with removal and replacement of the urinary catheter if it has been in place for a week or longer. In an asymptomatic patient, therapy should be postponed until the catheter can be removed. Patients with long-term indwelling catheters seldom become symptomatic unless the catheter is obstructed or is eroding...
Bladder infections, also known as cystitis, are one of the most common conditions among women of all ages. According to a new study at the University of Washington School of Medicine, an estimated 7 million episodes of acute cystitis occur annually in the United States with an annual cost of 1 billion. The study further showed the term honeymoon cystitis is still accurate in that having sexual intercourse increases the risk of developing the condition. Escherichia coli (E. coli) bacteria found in fecal material is responsible for up to 90 percent of all urinary tract infections (UTI). Fecal-contaminated bacteria gains access to the bladder through the urethra. Women are 30 times more likely to have cystitis than men due mostly to the different lengths of the urethra (women's urethras are just one-and-a-half inches long, while men have urethras about eight inches long). Men experience UTIs with obstructions like urinary stones or enlarged prostate. According to the National Bladder...
As discussed, UTIs are extremely common. However, there are certain risk factors that appear to increase an individual's chances of developing the condition. They include CVer-the-cou nter dipsticks are available that change color when you have a bladder infection. The tests detect about 90 percent of UTIs and may be especially useful for women who have acute infections. CVer-the-cou nter dipsticks are available that change color when you have a bladder infection. The tests detect about 90 percent of UTIs and may be especially useful for women who have acute infections.
Interstitial cystitis is a chronic, noninfectious bladder disorder predominantly diagnosed in women. Symptoms mimic those of a UTI (urgency, frequency) with the addition of chronic pelvic pain, dyspareunia, or both and varying with bladder filling. Although not associated with cellular change, epithelial inflammation and prolonged symptoms can lead to epithelial damage (Kahn et al., 2005). Two forms are identified classic interstitial cystitis, demonstrating inflammatory bladder wall changes identifiable on cystoscopy, and painful bladder syndrome, defined by the symptoms of interstitial cystitis in the absence of any objective cystoscopic findings (Marinkovic et al., 2009). The main impact of interstitial cystitis is on quality of life. Patients often express somatization and depression or anxiety as with other somatic pain syndromes, its pathogenesis is unclear. Differential diagnosis includes other somatic syndromes such as fibromyalgia, irritable bowel, and chronic pelvic pain, as...
Most UTIs manifest as acute uncomplicated bacterial cystitis, and women experience most of these episodes. Escherichia coli causes up to 90 of cases, with the rest probably caused by Staphylococcus saprophyticus. Other causative organisms include Proteus mirabilis, enterococci, and Klebsiella (Fihn, 2003). To have uncomplicated cystitis, women must have no underlying urinary tract abnormalities or immune compromise (Bent et al., 2002). Dysuria, frequency, and urgency are the classic clinical triad. The condition most commonly mimicking UTI is vaginitis. Other conditions have been described (see Dysuria). Patients may also experience back or flank pain and supra-pubic abdominal pain. Dipstick urinalysis may show leukocyte esterase or nitrite or may be heme positive. Microscopic analysis should assess for pyuria, hematuria, and bacteriuria. The gold standard for diagnosis is urine culture. Women presenting with at least one UTI symptom have a 50 chance of having a UTI. The combination...
The next step in improving continence is to ask your urologist to rule out a urinary tract infection that could be making the problem worse. This can be done readily by checking the urine. In cases of severe and persistent incontinence, the urologist may want to carry out additional tests, such as putting a dye in the bladder and then viewing the bladder by X-ray (a cystogram) or by placing a thin tube up the penis to view the bladder (a cystoscopy).
Recognize the signs and symptoms of urinary tract infections (UTIs) and how they differ in upper versus lower urinary tract disease. 3. Identify the organism responsible for the majority of uncomplicated UTIs. 4. Assess the laboratory tests that help in diagnosing patients with UTI. 5. Determine appropriate drug, dose, and duration for uncomplicated and complicated UTI prophylaxis and empiric treatment. 6. Evaluate and select therapy for uncomplicated and complicated UTIs based on specific urine culture results and patient characteristics. 7. Formulate appropriate monitoring and education information for patients with UTIs.
Genitourinary tract infections may be caused by a number of bacteria, including Escherichia coli, Klebsiella pneumonia, Enterococcus faecalis, Chlamydia trachomatis, and Ureaplasma urealyticum 36 , Genitourinary tract infection may originate in the kidney, bladder, epididymis, prostate, or urethra, and includes diagnoses such as prostatitis, epididymitis, orchitis, pyelonephritis, bacterial cystitis, and urethritis. These types of infections are associated with inflammation and increased leukocytes in the seminal fluid, which may lead to increased levels of ROS and OS 8 ,
Urinary tract infection is one of the most common infections of childhood. Factors predisposing to UTI include taking broad-spectrum antibiotics (e.g., amoxicillin, cephalexin), which are likely to alter gastrointestinal and periurethral flora incomplete bladder emptying or infrequent voiding voiding dysfunction and constipation. UTI in young children serves as a marker for abnormalities of the urinary tract. Imaging of the urinary tract is recommended in every febrile infant or young child with a first UTI to identify children with abnormalities that predispose to renal damage. Imaging should consist of urinary tract ultrasonography to detect dilation of the renal parenchyma. Voiding cystourethrogra-phy is often ordered but does not appear to improve clinical outcomes in uncomplicated UTIs (Alper and Curry, 2005).
Although the most common bacterial infection during pregnancy, the incidence of UTI in pregnancy is similar to that reported in sexually active nonpregnant women of childbearing age. Up to 40 of pregnant women with untreated bacteriuria in the first trimester develop acute pyelonephritis later in pregnancy. Premature births and perinatal mortality are increased in pregnancies complicated by UTI. Therefore, in pregnant women, asymptomatic bacteriuria should be actively sought and aggressively treated with at least one urinalysis, preferably toward the end of the first trimester. Nitrofurantoin, ampicillin, and the cephalosporins have been used most extensively in pregnancy and are the regimens of choice for treating asymptomatic or minimally symptomatic UTI. TMP-SMX should be avoided in the first trimester because of possible teratogenic effects and should be avoided near term because of a possible role in the development of kernicterus. Fluoroquinolones are avoided because of possible...
Recurrence of uncomplicated cystitis in reproductive-age women is common, and some form of preventive strategy is indicated if three or more symptomatic episodes occur in 1 year. However, risk factors specific to women with recurrent cystitis have received little study (Sen, 2008). Several antimicrobial strategies are available, but before initiating therapy, the patient should try such simple interventions as voiding immediately after sexual intercourse and using a contraceptive method other than a diaphragm and spermicide. Ingestion of cranberry juice has been shown to be effective in decreasing bacteriuria with pyuria, but not bacteriuria alone or symptomatic UTI, in an elderly population. Cranberry juice may be effective for preventing UTI in young, otherwise healthy women. A minority of patients have relapsing UTI, as evidenced by finding the same bacterial strain within 2 weeks after completion of antimicrobial therapy. Two factors can contribute to the pathogenesis of relapsing...
This is caused by a urinary tract infection, which is often ascending. It is more common in females than males because of the anatomy of the opening of the tract in relation to the anus - often caused by faecal contamination. An infection is more likely if a urinary obstruction is present or where trauma to the urinary tract has occurred. The animal will pass smaller amounts of urine more frequently, often showing signs of tenesmus and haematuria. Treat with antibiotics following a urinary bacterial culture and sensitivity test.
Urinary burning or pain most often represents UTI or vaginitis. It is common in middle-aged and or sexually active women. In men, it is more likely to occur as they grow older (Bremnor and Sadovsky, 2002). Both voiding history and sexual history are essential. Questions regarding vaginal symptoms are important in women. Also, use of medications and personal hygiene products should be reviewed. Dysuria significantly increases the chance that a patient has a UTI. However, there are many potential causes of dysuria (Box 40-1), and empiric treatment based on this symptom alone leads to unnecessary antibiotic use. Incorporating other symptoms increases the likelihood that a UTI is the Box 40-1 Differential Diagnosis of Dysuria Urethritis infectious, irritant, chemical, spondyloarthropathy Urinary tract infection cystitis, pyelonephritis, prostatitis Vaginitis allergic, atrophic, bacterial vaginosis, candidiasis, chemical Modified from Seller RH. Urethral discharge and dysuria. In...
Anything that irritates or inflames the prostate can increase the PSA, such as a urinary tract infection, prostatitis, prostate stones, a recent urinary catheter or cystoscopy (a look into the bladder through a specialized telescope-like instrument), recent prostate biopsy, or prostate surgery. Sexual intercourse may increase the PSA up to 10 , and a vigorous rectal examination or prostatic massage before the PSA blood test is drawn may also increase the PSA. Benign enlargement of the prostate (BPH) may also increase the PSA because more prostate cells are present, thus more PSA is produced (see Question 3).
Side effects of TRUS guided prostate biopsy include transient discomfort related to the ultrasound probe, the needle guide, and the biopsy itself. After the TRUS biopsy one may experience blood in the urine, the semen (ejaculate), and or in the stools. A urinary tract infection and or acute prostatitis may occur and would present with frequency of urination, burning, and perineal discomfort and, in some cases, a fever.
Because symptoms of diseases of the urinary bladder are conspicuous and painful, they were the subject of considerable medical interest. The Hyangyak chipsong pang discusses dysuria, ischuria, pol-lakiuria, urinary incontinence, hematuria, gross hematuria associated with high-fever diseases, and enuresis. Various symptoms of urinary problems are also discussed in connection with gonorrhea. Some of the disorders of urine might have been caused by tuberculosis of the urogenital system.
FLUTD is characterized by an increased frequency of urination, pain on attempting to pass urine and blood in the urine (cystitis). All cats may be affected but it is more common in overweight, inactive cats, especially those living indoors completely. FLUTD has many causes but the formation of irritant crystals and stones in the bladder is one major cause. Cats under the age of 7 are more at risk from developing FLUTD due to struvite crystals (magnesium ammonium phosphate). These crystals form best in alkaline urine and so all foods for cats under the age of 7 years should be designed to help prevent struvite bladder disease by producing fairly acidic urine (pH 6.2-6.4). However, the incidence of struvite bladder disease decreases with increasing age. Cats over the age of 7 years are at a greater risk of FLUTD due to calcium oxalate crystals and stones. These oxalate crystals form better in more acidic urine and so senior cat foods should be designed to produce less acidic urine (pH...
This residual urine may put some men at risk for bladder stones, bladder infections (UTI), and if the residual is significant, urinary leakage. Over the course of time, in some males, the bladder decom-pensates and acute urinary retention may occur, in which the male is unable to urinate. In some men, this is reversible with relief of the obstruction, in others, the bladder never recovers.
The need to initiate treatment for BPH is divided into absolute and relative indications. Absolute indications refer to objective medical reasons to intervene. These include impaired renal function because of prostatic obstruction, hydronephrosis or dilation of the ureters and kidneys, recurrent urinary tract infections, bladder stones, and inability to void (urinary retention). Recurrent UTIs
DAF has been shown to be a receptor for E. coli expressing Dr adhesins (Bernet-Camard et al., 1996 Nowicki et al., 1993 Pham et al., 1995 Pham et al., 1997). E. coli expressing fimbrial Dr, and afimbrial AFA-I, afimbrial AFA-III and fimbrial F1845 require CCP3 for attachment. Two dra-positive X strains (E. coli 8826 and E. coli 7372) bind CCP4 (Nowicki et al., 1990 Pham et al., 1995). DAF amino acid substitutions, S155A, C156A, and S165L (Hasan et al., 2002), completely block the binding of the Dr adhesin. Beyond DAF's CCPs, its GPI anchor appears to be involved in the Dr(+) E. coli internalization process (Selvarangan et al., 2000). Diseases of these bacteria include (gestational) pyelonephritis, cystitis, and diarrhea reviewed in (Nowicki et al., 2001) . One theory regarding the pathogenicity of E. coli bearing AFA Dr adhesins in the intestine is that the adhesin-DAF interaction induces PMN transepithelial migration, and in turn the production of TNF-a and which upregulates...
An analysis of the ratio of the costs to the benefits of one intervention compared to another aims to establish both the value of an intervention and priorities for the allocation of resources. Measures of total direct and indirect costs, including future costs and benefits beyond the time of the intervention, may be operationally difficult and costly to obtain. For example, to fully determine the cost-effectiveness of an intervention such as outpatient day care for patients with MS or stroke, data about expenses ought to be collected for visits to physician's offices and emergency rooms, hos-pitalizations, pharmaceutical purchases such as antibiotics for bladder infections, and additional durable medical equipment. A bibliography of rehabilitation studies that includes a cost-effectiveness analysis is found at www.aapmr. org memphys cebfinala.htm. Types of cost analyses include cost effectiveness, cost benefit, cost minimization, cost utility, and length of stay.225 The Cochrane...
An aseptic technique must be used to place the urinary catheter to avoid introducing infection into the bladder. The use of antibiotics in a patient with a urinary catheter in place is controversial. There is more likelihood of a urinary tract infection following catheterization if the patient is immuno-suppressed, if recurrent catheterization is necessary or if there is already trauma to the urinary tract. To avoid damaging the urethra the catheter should always be introduced with care and not forced into the urethra. In cases of urolithiasis and sediment in the urethra the catheter will not pass easily and an alternative means of treatment must be sought. If the catheter becomes blocked, flushing with sterile water or sterile saline may clear the blockage.
After the introduction of home glucose monitoring in the 1980s and the emphasis on self-management in the 1990s, DKA has become very uncommon among responsible patients. The occurrence of DKA in a patient known to be responsible indicates some failure in insulin administration or an occult or apparent stress, such as urinary tract infection, acute gastroenteritis, pneumonia, other viremia, or worse, a bacteremia.
More than 15 years passed until the case of Theda Parker in 1972. Her third labor was induced at 38 weeks gestation at her request. The birth went well, but she had a postpartum hemorrhage, and her obstetrician had to perform a hysterectomy. During the course of the operation, she needed a blood transfusion, but unfortunately she was given blood that had been cross-matched for another patient. She survived the ordeal, but in the long term she developed hematuria due to cystitis, and her marriage eventually broke down. In 1976, she and her husband sued her obstetrician for inducing her labor too soon (for convenience rather than for
The most common side effect, occurring in one-third to one-half of all men who take MUSE, is pain. This pain may be present in the penis, urethra, testis, or perineum. The intensity of the pain varies according to the dose taken. Thus, as the dose increases, the intensity of the pain may likewise increase. Hypotension and syncopal episodes (temporary loss of consciousness caused by decreased blood flow to the brain) have been reported in 1.2 to 4 of men who took MUSE, with their frequency depending on the dose used. Other side effects include urethral bleeding (in 4 to 5 of men who took MUSE), dizziness (in 1 ), and urinary tract infection (in 0.2 ). Prolonged erections and penile fibrosis (scarring) rarely occur. Ten percent of female partners experience vaginal irritation or vaginitis.
Dysfunctional voiding, a term used to describe impairments of micturition, encompasses a wide array of symptoms and can lead to significant morbidity. The typical patient is a school-age girl who may be enuretic or have recurrent UTIs. Parents will often give a history that the child holds her urine or demonstrates urgency with infrequent voiding. Vincent's curtsy is a well-known posture assumed by these girls to help alleviate the pressure of a full bladder, which can result in a non-neurogenic neurogenic bladder. The dysfunctional voiding scoring system (DVSS) is a validated tool instrument that can be used to diagnose and evaluate children with dysfunctional voiding (Farhat et al., 2000). Urodynamic studies, cystoscopy, and imaging studies are available in the workup of voiding dysfunction, if indicated by the history and physical examination. Treatment is designed to improve bladder tone by placing the patient on a timed voiding schedule.
Acute bacterial prostatitis should be suspected in men presenting with symptoms of UTI. Age and immunodeficiency contribute to men having UTIs, so prostatitis is more likely in otherwise healthy men with these symptoms (Lipsky, 1999). Patients may have UTI symptoms (e.g., dysuria, frequency, urgency) and typically systemic symptoms of acute illness, such as fever, chills, and myalgias. Local discomfort in the form of pelvic or back pain is also typical. Examination reveals a tender, boggy prostate. Most experts have recommended against prostate massage in acute prostatitis because it would be very uncomfortable and theoretically could disseminate the infection (Benway and Moon, 2008 Wagenlehner and Naber, 2003).
Chronic bacterial prostatitis may manifest with irritative voiding symptoms, prostatitic obstruction, or recurrent UTIs (Lipsky, 1999). Patients may have microscopic pyuria but negative cultures. Other symptoms include hemospermia, penile discharge, and systemic symptoms.
Urethritis may present as a urethral discharge or simply dys-uria. Family physicians should suspect urethritis in patients with symptoms of UTI, pyuria, presence of leukocyte esterase, and negative urine culture. N. gonorrhoeae and C. trachomatis are the most important causative organisms. Gonococcal urethritis is typically symptomatic. Chlamydia causes most cases of nongonococcal urethritis (CDC, 2006). Various treatment options exist (see Table 40-10). Fluoroquinolones are no longer recommended as a treatment option due to resistance rates (del Rio et al., 2007). Patients with gonorrhea who are not ruled out for chlamydia should be treated for it because co-infection is common (CDC, 2006).
Approximately 5 of reproductive-age women have asymptomatic bacteriuria (Bent et al., 2002). It is also common in older adults. This is important for understanding the community risk of UTI when evaluating a patient with UTI symptoms. However, although asymptomatic bacteriuria may conceptually place a patient at risk for UTI, identification and treatment do not appear to affect morbidity or mortality (Gartlehner et al., 2004 Lin and Fajardo, 2008). Thus, bacteriuria screening is not recommended (USPSTF, 2008a).
Complicated UTIs are characterized by signs and symptoms of upper tract (i.e., renal) involvement or by factors that predispose to upper tract involvement. UTIs with signs of renal or systemic involvement are also called pyelonephritis. Most cases of pyelonephritis are caused by ascending bacterial infection from the bladder (Ramakrishnan and Scheid, 2005). Symptoms include fever, flank pain, nausea, vomiting, and costovertebral angle tenderness. Findings such as pyuria are typical, and urine culture is usually positive. White cell casts may be present on urine microscopy. Hospitalized patients with UTIs are best managed based on culture results. E. coli is the typical pathogen for uncomplicated outpatient UTIs and pyelonephritis. E. coli is still the most common isolate in hospitalized patients, but now to a lesser extent, as Table 40-11 Treatment Options for Acute Uncomplicated UTIs Table 40-12 Antibiotics for Uncomplicated UTI Prophylaxis Table 40-11 Treatment Options for Acute...
Any woman in the reproductive age group who is sexually active and misses her menstrual period should be considered pregnant until proven otherwise. Even if she presents with symptoms not directly related to the abdomen, she should be evaluated for pregnancy. A sexually active woman in the reproductive age group may have a history of 2 years of amenorrhea (loss of menstrual periods) but can be pregnant nonetheless. Whatever the cause of the amenorrhea was 2 years ago, it may be different now. ''Think pregnancy'' should be your motto in the evaluation of such patients. This is extremely important because the diagnosis or treatment of a woman's medical or surgical problem may be deleterious to the developing fetus if she is pregnant. As discussed later in this chapter, many of the symptoms of pregnancy are nonspecific and can be interpreted erroneously if the pregnancy is not recognized. For example, the urinary frequency that is common in early pregnancy might easily be mistaken for...
Pre-renal, e.g. haemolytic anaemia, azotaemia, multiple myeloma and congestive heart failure Renal, e.g. acute and chronic renal failure, pyelonephritis and amyloidosis Post-renal, e.g. cystitis, urolithiasis, prostatitis and vaginitis Cystitis, associated infection of the urinary tract, urolithiasis and acute nephritis
Urinary retention and urinary tract infection (UTI) Sepsis Urinary retention and urinary tract infection (UTI) Both men and women are at increased risk of UTI postoperatively, predominantly due to urinary tract instrumentation. Males who have any prostatic symptoms preoperatively are at risk of developing postoperative urinary retention preoperative bladder catheterisation should be considered. Urinary catheters are commonly inserted before major surgery to ensure accurate measurement of postoperative urine output. This aids the monitoring of fluid balance and makes nursing care of the patient easier. Catheters should be inserted under an aseptic technique. Patients with catheters in situ are at risk of urinary infections but might be asymptomatic because of the
Changes in urine flow include frequency and incontinence. Urinary frequency is the most common symptom of the genitourologic system. Frequency is defined as passing urine more often than normal. Nocturia is urinary frequency at night. There are several causes of frequency decreased bladder size, bladder wall irritation, and increased urine volume. If an obstructed bladder cannot be completely emptied at each voiding, its effective capacity is diminished. The following questions, in addition to the ones pertaining to dysuria, should be asked to help define the problem. Prostatic hyperplasia is the most common cause of reduced usable bladder capacity in men. Symptoms include frequency of urination, nocturia, urgency, weak stream, intermittent stream, and a sensation of incomplete emptying. Long-standing prostatic hypertrophy can lead to a complete inability to urinate, necessitating catheterization (a condition known as urinary retention) to urinary tract infections or to bladder...
Acu-points, 5-8, 10, 15, 18-20, 38-39, 238-241 anxiety, 205-206, 211 arthritis, 78-79 asthma, 138-139 back pain, 82-85 balance, 252 Bell's palsy, 104 bladder infections, 182-184 breathing, 126 bronchitis, 121 Bronze Man, 25 bursitis, shoulders, 70-71 cancer, 151-153 151-153 chemotherapy, 149-150 herbal medicines, 153-154 immune systems, 151 pain, 150-151 CFIDS, 221 childbirth, 160-162 choosing, 243-244 constipation, 187-189 cystitis, 181-184 dental pain, 62-64 depression, 208-209 diagnosis acupressure, 4, 9-10, 19, 21-24, 27-29, 74, 86, 128-131, 239-241 acu-points, 5-7, 63-64, 238 allergies, 116-117 anxiety 210-211 arthritis, 78-79 asthma, 118-120 back pain, 82-85 bladder infections, 182-184 bronchitis, 121 bursitis, shoulders, 70-71 cancer, 151-153 carpal tunnel syndrome, 76-77 colds, 124-125 constipation, 188-189 dental pain, 62-64 diarrhea, 190 dysmenorrhea, 169-170 eczema, 196-197 elbow pressure, 30-31 electrical currents, 8 endometriosis, 177-179 facelifts, 199-200 feet,...
Some of the important considerations in the history include the patient's age, time of onset of symptoms (if any), associated problems (e.g., fever, weight loss, dysuria), past medical history, and sexual history. Congenital urinary tract anomaly Acute glomerulonephritis Acute urinary tract infection Acute urinary tract infection Kidney stone Bladder tumor Acute urinary tract infection Acute urinary tract infection Kidney stone Bladder tumor Acute urinary tract infection Acute urinary tract infection Epididymitis is the most common cause of acute scrotal swelling. It accounts for more than 600,000 visits to physicians annually in the United States. It occurs in young, sexually active men and in older men with associated genitourinary problems. Patients usually complain of recent onset of testicular pain that is associated with fever, dysuria, and scrotal swelling. On examination, the epididymis is tender and indurated. The testis may also be enlarged and tender this variant is called...
The immediate toxicities associated with administration of BEP chemotherapy are well documented and may include hematologic toxicity (9 ), mucositis (25 ), sensory neuropathy (20 ), ototoxicity (10 ), fatigue (39 ), and acute pulmonary toxicity (13 ) 57 . Salvage chemotherapy regimens that include ifosfamide additionally carry the risk of hemorrhagic cystitis and acute central nervous system toxicity 58,59 . In
It is tnie that recent studies have shown that urinary infections in infancy are less frequent in circumcised boys. But urine infection is an uncommon disease in boys (about 1 percent of boys in the first year of life). And there is no doubt that cancer of the penis is prevented by circumcision but this is a very rare disease, causing only 150 deaths a year in the United States. Should you circumcise the two million baby boys, who are bom in the United States each year, to prevent those 150 deaths later in life Different parents may answer differently.
In cases of locally advanced pelvic malignancy, urinary diversion may be indicated without cystectomy. The remainder of patients include those with neurogenic bladder with chronic catheterization, refractory hemorrhagic cystitis, or other conditions in which the bladder may be left in situ while urinary flow is diverted. Radiation cystitis (2), TCC(1)
The incidence of urinary tract infection (UTI) is reduced with circumcision in some populations. If a population has a baseline UTI incidence of 3 or higher and circumcision complication rate less than 2 , circumcision is helpful in reducing UTIs. In normal infants the risk of UTI is 1 or less, in those with prior UTI 10 , and in those with vesicoureteral reflux 30 (Singh-Grewal, 2005). The main risk is bleeding, followed by infection. Actual rates of hemorrhage in medically indicated or ritual hospital-based circumcision range from 0.2 to 3 (Bocquet et al., 2010).
Complications from radical prostatectomy include blood loss, stricture formation, incontinence, lymphocele, fistula formation, anesthetic risk, and impotence. Nerve-sparing radical prostatectomy can be performed in many patients 50 to 80 regain sexual potency within the first year. Acute complications from radical prostatectomy and radiation therapy include cystitis, proctitis, hematuria, urinary retention, penoscrotal edema, and impotence (30 incidence).15 Chronic complications include proctitis, diarrhea, cystitis, enteritis, impotence, urethral stricture, and incontinence. Since radiation and prostatectomy have significant and immediate mortality when compared with observation alone, many patients may elect to postpone therapy until symptoms develop.
Exercise (1) Ms X, a 25-year old sexually active female presents with a 3-day history of burning sensation on urination. Physical exam was unremarkable. Estimate the pre-test probability that she has a urinary tract infection (UTI). Exercise 2 If you set the pre-test probability of UTI in exercise 1 at 80 , what would the pre-test odds be Exercise (3) Continuing the scenario in exercise (2), estimate the post-test odds of UTI in the following scenarios (a) her urine dipstick nitrite is positive (b) her urine dipstick is negative. Note Study shows that urine dipstick nitrite has an LR(+) 3.0 and an LR(-) 0.518. Answers Exercise (1) Depending on the details of the history, estimates of the probability of UTI may vary. A reasonable estimate might be around 80 . Exercise (2) If you set the pre-test probability at 80 , pre-test odds will be 80 20 or 4 1. Exercise (3) For scenario (a) with urine dipstick result positive, post-test odds 4.0 x 3.0 12. For scenario (b) with urine dipstick...
Numerous etiologies have been linked to hemorrhagic cystitis (Table 99-11) 45 Of these, the oxazaphosphorine alkylating agents (cyclophosphamide and ifosfamide) are most frequently implicated. Incidence rates vary considerably, but generally range between 18 and 40 with ifosfamide and 0.5 to 40 with high-dose cyclophosphamide in the absence of prophylactic measures.46 Chronic, low-dose oral cyclophos- phamide as typically used in autoimmune disorders and chronic lymphocytic leukemia is also infrequently associated with hemorrhagic cystitis. Table 99-11 Primary Causes of Hemorrhagic Cystitis Twenty percent of patients receiving pelvic irradiation may experience hemorrhagic cystitis, especially with concurrent cyclophosphamide. Viral infections commonly associated with this condition most frequently occur in bone marrow transplant recipients who may also receive cyclophosphamide. Patients with hemorrhagic cystitis from treatment may present with dysuria, anuria, or hematuria. Diagnosis...
Hemorrhagic Cystitis High-dose cyclophosphamide causes moderate to severe hem-orrhagic cystitis acrolein, a metabolite of cyclophosphamide, is the putative bladder toxin. Preventive measures to lower the risk of hemorrhagic cystitis include vigorous hydration, continuous bladder irrigation, and or concomitant use of the uroprotectant mesna. The American Society of Clinical Oncology (ASCO) Guidelines for the Use of Chemotherapy and Radiotherapy Protectants recommends the use of mesna plus saline diuresis or forced saline diuresis to lower the incidence of urothelial toxicity with
I get a great deal of satisfaction when I hear how acupuncture and Oriental Medicine have helped turn someone's life around who has been struggling with chronic bladder infections. The U.S. Census Bureau estimates that there will be a 12-percent increase in the number of bladder diseases over the next 15 years, with a dramatic 28-percent increase among women and men 40-59 years of age. Oriental Medicine can help us understand why this may be happening when we look at the characteristic causes of UTIs. They include Diet. Eating excessive amounts of sugar, dairy, and greasy or spicy foods can cause UTIs. I have found that acupuncture is a great treatment for bladder infections, whether they are chronic or acute. Often an antibiotic can be avoided if you get to your acu-pro in time. I suggest staying in close communication with your physician so that you can be sure your treatments are effective. Women who come in for chronic cystitis are particularly pleased when the cycle of pain and...
The treatment of hemorrhagic cystitis first involves discontinuation of the offending agent. Agents such as anticoagulants and inhibitors of platelet function should also be discontinued. IV fluids should be aggressively administered to irrigate the bladder. Blood and platelet transfusions may be necessary to maintain normal hematologic values. Pain should be managed with opioid analgesics. Local intravesicular therapies may be necessary if hematuria does not resolve (Fig. 99-3). A number of local or systemic agents are utilized in the treatment of hemorrhagic cystitis.45 Local (direct instillation into the bladder), one-time administration of hemostatic agents such as alum, prostaglandins, silver nitrate, and formalin may be used however general anesthesia is required, especially with formalin due to pain. Systemic agents including estrogens, vasopressin, and aminocaproic acid may be used in patients who are refractory to local therapy, although they introduce the risk of systemic...
What are externalbeam and conformal externalbeam radiation therapies What are the side effects of EBRT
The side effects of EBRT or conformal EBRT can be either acute (occurring within 90 days after EBRT) or late (occurring 90 days after EBRT). The severity of the side effects varies with the total and the daily radiation dose, the type of treatment, the site of treatment, and the individual's tolerance. The most commonly noted side effects include changes in bowel habits, bowel bleeding, skin irritation, edema, fatigue, and urinary symptoms, including dysuria, frequency, hesitancy, and nocturia. Less commonly, swelling of the legs, scrotum, or penis may occur. Late side effects include persistence of bowel dysfunction, persistence of urinary symptoms, urinary bleeding, urethral stricture, and erectile dysfunction. The genitourinary symptoms of dysuria, frequency, hesitancy, and nocturia are related to changes that occur in the bladder and urethra that result from radiation exposure. The bladder may not hold much urine because of the irritation and scarring, and irritation of the...
Chronic urinary tract infection. y , 4 The most common gram- negative bacilli causing meningitis in the older adult are E. coli, Klebsiella pneumoniae, H. influenzae, Pseudomonas organisms, Enterobacter species, and Serratia species.y y y Listeria monocytogenes is an important causative organism of neonatal meningitis and of meningitis in patients that are diabetic, alcoholic, elderly, or immunosuppressed, especially transplant recipients. 2 Infection with L. monocytogenes may be acquired through the consumption of soft cheeses, raw vegetables, seafood, cole slaw, and undercooked chicken and delicatessen meats. The staphylococci are the etiological organisms of meningitis primarily in the neurosurgical patient. S. aureus and coagulase-negative staphylococci are the predominant organisms causing infections in patients with CSF shunts or subcutaneous Ommaya reservoirs.
The patient's clinical history, general appearance, and uri-nalysis are often suggestive of acute bacterial prostatitis. A urine culture is commonly positive for a urinary tract infection. A digital rectal examination will usually identify a very tender prostate. In rare cases, fluctuance may be palpable in the prostate, if there is a prostatic abscess. In men who appear toxic or who fail to improve with antibiotic therapy, a transrectal ultrasound may be obtained to rule out a prostatic abscess. An assessment of postvoid residual is performed. The classic diagnostic maneuver for bacterial prostatitis is the three-glass test. The patient is asked to void and collect his first 10 ml of urine. This is sent for culture
Associated neurologic findings may include lower extremity atrophy, weakness, radicular pain, or numbness. Urologic signs may include an abnormal voiding pattern in an infant, new incontinence after toilet training, or a urinary tract infection in a child of any age. Orthopaedic findings may include cavovarus foot deformities, clawtoes, leg-length discrepancy, and scoliosis. Diagnosis is often delayed until adolescence or adulthood, due to absent initial neurologic or urologic findings. Early identification is paramount because prophylactic surgery is usually indicated to preserve neurologic function.
Bladder outlet obstruction, urinary incontinence, and rectal ulceration and bleeding. In addition, in some patients a benign increase in the PSA may occur after interstitial seed therapy. Urinary symptoms occur earlier with palladium because it releases high energy earlier than iodine. Individuals may develop urinary frequency, dysuria, or urinary retention. Urinary symptoms, if they are not associated with urinary retention, are often treated with nonsteroidal anti-inflammatories and an alpha-blocker, such as doxazosin (Cardura), terazosin (Hytrin), alfu-zosin (Uroxatral), tamsulosin (Flomax) and silodosin (Rapaflo). They often resolve over 1 to 4 months, but may persist for 12 to 18 months.
Several different types of infections can occur with this surgery. A skin infection (cellulitis) may occur at the incision, an abscess may occur under the skin or deep in the pelvis, or a urinary tract infection may occur. A skin infection at the incision typically presents with redness, swelling, tenderness, and occasionally, drainage at the incision. In the absence of pus, this usually can be treated successfully with oral antibiotics rarely, intravenous antibiotics are indicated. Urinary tract infections result from the catheter, which drains the bladder during the healing process. The risk of a urinary tract infection increases with the number of days that the catheter is in place. Because most urologists leave the catheter in for 1 to 2 weeks after the surgery, your urologist may have you drop a urine sample off at the lab 2 to 3 days before the catheter is removed so that they can detect whether any bacteria is present and if so, treat the bacteria to prevent an infection after...
Clear urethral discharge and or dysuria. Up to 10 of these men may be asymptomatic. Women may also develop urethritis, which may only cause dysuria with pyuria but not bacteruria and can be misdiagnosed as a urinary tract infection. Chlamydial cervicitis in women is almost always asymptomatic. Women may develop pelvic inflammatory disease with upper genital tract infection. Men may develop epididymitis.
TURP is frequently performed in very elderly men. These patients have a high incidence of concomitant disease, especially of the respiratory tract and cardiovascular system. There is a risk of septicaemia in those patients with urinary tract infection, stones in the bladder or an indwelling catheter. These patients should have intravenous antibiotics, as should any patient with a joint prosthesis or valvular heart disease.
Uncomplicated Cystitis Uncomplicated cystitis represents the most common of UTIs, is frequently managed in the outpatient setting, and occurs in women of childbearing age. E. coli is the most frequent causal organisms in this setting, but in a minority of cases may be caused by S. saprophyticus, K. pneumoniae, P. mirabilis, Enterococcus spp., and a small percentage of other organsims.9-12 As such, treatment in the outpatient setting is frequently relegated to a urinalysis and empiric therapy without a urine culture.31 2 Patients are subsequently followed up for resolution of signs and symptoms. One significant benefit of treatment in the setting of uncomplicated cystitis is that treatment duration can be less than 7 days, and often may be 3 days or even 1 day. Although treatment duration of 1 day is advantageous because it strictly limits adverse events and drug interactions, and increases compliance, health care providers should know that 3-day courses of fluoroquinolones and...
VN is a 23-year-old female who presents to a local urgent care center with complaints of painful urination and frequent need to urinate especially at night which began 3 days ago. She denies vomiting, fever, nausea, or flank pain. Upon questioning she does admit that she is sexually active with only one partner and uses a diaphragm. What symptoms are suggestive of urinary tract infection (UTI) Does she have risk factors for UTI
A very pleasant 73-year-old white female with a 48-hour history of hematochezia and hemoptysis presents to the ED. She denies any recent travel, exotic foods, raw foods, or sick contacts. She does note that she ate cold-cut sandwiches at a fundraiser approximately 3 days before her symptoms started. She also noticed that she has three friends who developed bloody diarrhea who also ate at this same fundraiser. She denies any fevers, shakes, chills, cough, sore throat, shortness of breath, chest pain, nausea or vomiting, dysuria, hematuria, edema, or night sweats. On her initial presentation, she had a CT that showed pan-colitis and terminal ileitis. She was started on antibiotic therapy including ciprofloxacin and metronidazole. Fecal leukocytes were negative. A stool culture was sent and was positive for Stx. The final culture result was positive for Escherichia coli O157 H7.
KG is an HIV-positive male who complains of the appearance of a sore on his penis. He reports having unprotected sexual intercourse with another male approximately 5 to 7 days prior to the appearance of the lesion. He denies pain or itching at the site of the lesion, dysuria, or frequent urination. Additionally, there appears to be no vesicles in the genital area.
Although there is limited data in the literature and sometimes conflicting results, several nonpharmacologic therapies have been proposed for prevention of UTIs. The intake of large volumes of cranberry juice can decrease the number of UTIs over a year period in patients with recurrent UTIs but uncertain efficacy in the general popula- women which may decrease the growth of certain pathogenic bacteria. Topical estrogen replacement therapy significantly decreases the incidence of UTIs in post- menopausal women compared to placebo. Methenamine hippurate and methenam-ine mandalate have no antimicrobial properties but decrease the incidence of UTIs when used for prophylaxis. Patient education of common risk factors is important.
There are several other host factors that inhibit what are known as bacterial virulence factors. These virulence factors are mechanisms that bacteria utilize to cause infection and or ensure their survival. The first is glycosaminoglycan, a compound produced by the body that coats the epithelial cells of the bladder. This compound bacterial adhesion. A second compound known as TammHorsfall protein is secreted into the urine, and prevents E. coli from binding to receptors present on the surface of the bladder. Other factors implicated in contributing to host defense mechanisms against UTIs include immunoglobulins, specifically IgA.
Bacteria may be introduced into the bladder via the catheter in several ways including direct infection introduction during catheterization (via colonization and subsequently traveling the length of the catheter through bacterial motility or capillary action). UTIs as a result of an indwelling catheter are common and occur at a rate of 5 per day of catheter presence.43
Herpes genitalis also has the incubation period of several days following exposure to infection. It may be subclinical, especially in women having lesions only in the vagina or the cervix rather than on the vulva. Herpetic infection is more obvious in men with localized pain, erythema, and the development of one or a group of vesicles on the glans, prepuce, or elsewhere on the penis. The inguinal lymph nodes may be swollen and tender. Urethral involvement in both sexes is manifested by dysuria (painful or difficult urination), and a discharge may be noted in male patients. Pelvic pain accompanying the dysuria is common in women. (The virus can be isolated from the urethra of both sexes. Primary infection with HSV-2 virus often is accompanied by systemic symptoms during the first several days (see Figure VIII.64.3). Complications of primary infection reveal a generalized infection, especially as aseptic meningitis and other indications of viral invasion of the central nervous system.
All patients had negative surgical margins. Pathologic staging comprised pTa-pT1 13 , pT2 59 , pT3 11 , and pT4 1 , and tumor grades were grade 1 1 , grade 2 13 , and grade 3 17 . Seven patients had positive lymph nodes numbers of retrieved nodes were not reported. Median surgical time was 4.3 hours a median blood loss was 550 cc median hospital stay was 12 days, with requiring parenteral narcotics for 24 hours postoperatively in 58 of patients. Urinary diversion was reconstructed extracorporeally with orthotopic bladder in 51 and ileal conduit in 33 patients. Postoperative complications were reported in 15 patients, including urinary tract infection 8 , pelvic hematoma 3 , urinary fistula 2 , pulmonary embolism 1 , and pyelonephritis 1 .
A grossly enlarged hydronephrotic kidney, especially in the presence of infection should be drained, either with stent or preferably nephrostomy tube placement, at least 4 weeks prior to ablative surgery. The resulting reduction in size facilitates dissection. A delay of at least six weeks in the infected kidney will permit much of the associated inflammation to settle, thus facilitating the dissection. Urine from the obstructed kidney, collected at the time of drainage, should be sent for culture, and antibiotics commenced as appropriate. Mid-stream specimen of urine test is unreliable as a predictor of upper urinary tract infection in the presence of upper urinary tract obstruction (8). Uncomplicated hydronephrosis may be drained with a ureteric catheter at the time of laparoscopic nephrectomy to decompress the kidney and facilitate ureteric identification (9), however this maneuver is not essential (10).
Patients undergoing a robotic-assisted pyeloplasty should be subjected to preoperative evaluation and preparation as if they were undergoing an open operative intervention. This includes a search for any comorbidity that may increase the risk of anesthesia. Any urinary infection should be treated, and sterile urine should be ensured at the time of definitive intervention. If upper tract infection cannot be cleared because of obstruction, an internal stent or percutaneous nephrostomy drainage should be placed.
All patients should undergo routine laboratory testing including a complete blood count, platelet count, serum electrolytes, coagulation profile, urinalysis, and a type and screen. Any coagulopathy or urinary infection should be treated prior to proceeding with surgery. An electrocardiogram and chest radiograph should be obtained if indicated. All necessary radiologic tests (i.e., sonogram, computed tomography, and magnetic resonance imaging) should be made available for reference during the operation.
Complications such as ileus, fever, urinary tract infection, urinary retention, atelectasis, pneumonia, cellulitis, renal insufficiency, neuromuscular injury, incisional hernia, transfusion, recurrence of cyst, persistence of pain, deep venous thrombosis, and pulmonary embolism can occur following laparoscopic renal cyst ablation.
In addition, upper urinary tract infection or renal calculi formation secondary to inadequate urinary drainage can also prompt surgical intervention. Asymptomatic individuals, in whom the physiologic significance of obstruction is indeterminate based on radiologic imaging studies, may reasonably be observed and followed with routine monitoring.
Passive filling and poor drainage of urine from the diverticulum lead to focal urinary stasis, which may result in urinary tract infection and calculus formation, and therefore intermittent or persistent flank pain and gross hematuria. Recurrent infections or hematuria should be localized to the side of the lesion, prior to definitive intervention. Rarely, large calyceal diverticula may cause ischemic or obstructive renal damage, and nephrectomy may be required (2).
The presence of malignancy within the urinary bladder is a contraindication to bladder flap reimplantation. Neurogenic bladder dysfunction as well as urinary tract infection should be managed preoperatively. Cases of diminished bladder capacity are unsuitable for this procedure because a healthy flap of adequate length cannot be made.
Sitz baths and antibacterial ointment promote healing and minimize discomfort. If the child has difficulty voiding, she should be encouraged to void in a bath of warm water to reduce dysuria. Consider sexual abuse in all children with genital injuries.
The presence of stone(s) in a bladder diverticulum can be a cause of recurrent urinary tract infection, or outflow of obstruction and may require diverticulectomy. In a large diverticulum, with history of infection or in a location close to ureter, bilateral ureteral catheterization or double J stenting is preferred. The dissection is started from the most prominent part of the diverticulum, proceeding toward the diverticulum neck. However, sometimes it is difficult to expose the diverticulum. Traction with a grasping forceps at the edge of the diverticulum mouth helps in subsequent dissection with the twist-and-roll technique. It should be kept in mind that course of the ureter is distorted, increasing chances of injury. Stones from inside the diverticular cavity are removed and diverticular wall is excised. The bladder is closed with interrupted intracorporeal 2-0 Vicryl sutures.
This was performed in three patients, two with radiation cystitis and one with transitional cell carcinoma. Still early in the learning curve, the mean operative time was 11.5 hours. Mean blood loss was 250 mL. Similar to the technique described by Gill et al., the stoma was created first, and Bricker-type ureteroileal anastomoses were created using the DaVinci robot.
Secondary to dysuria, or the edema may induce meatal occlusion, leading to urinary retention or obstruction. Common etiologies include overgrowth of normal bacterial flora secondary to poor hygiene (pediatric patients), sexually transmitted diseases (adolescents and adults), and candidal infections (the elderly or immunocompromised).
The most common method for bacteria to spread to the spine is by the hematogenous route. Common sources of infection include infected catheters, urinary tract infection, dental caries, intravenous drug use, and skin infections. The second most common route is local extension from an adjacent soft tissue infection or paravertebral abscess. The third most common route is direct inoculation via trauma, puncture, or following spine surgery. The nucleus pulposus is relatively avascular, providing little or no immune response, and thus is rapidly destroyed by bacterial enzymes.
Possible causes Local soreness or severe constipation are possible causes. In some cases, a urinary infection (opposite) may be causing pain on passing urine, and your child may be reluctant to try to pass urine again. A child who feels a strong urge to pass urine but is unable to do so needs urgent medical help.
Centre may be affected by the stroke itself whereas in cortical infarctions the dysfunction of the brainstem results from displacement and herniation caused by vasogenic oedema and raised intracranial pressure (ICP). General predictors of an early death include Age, AF cardiac failure and ischaemic heart disease, diabetes, fever, incontinence, previous stroke and a depressed conscious level (e.g. Glasgow Coma Scale
Pression.19 A randomized trial in the United Kingdom compared stroke management on general wards with that on a stroke unit starting 2 weeks poststroke. The investigators detected medical complications in 60 of 245 patients, which included one-third with aspiration, another third with musculoskeletal pain, and nearly a third with urinary tract infections and with depression.20 Urinary tract infection
Surgery or radiation involving lower urinary tract within past 6 months Two or more symptomatic urinary infections in past 6 months More than five red blood cells per high-power field ( 5 RBCs hpf) on repeated urinalysis in the absence of infection Postvoid residual volume greater than 200 mL
Renal stones are frequently idiopathic but may be caused by hypercalciuria arising from sarcoidosis, malignancy, renal tubular acidosis, hyperparathyroidism, Cushing's syndrome or administration of adrenal corticosteroids. All these diseases may have anaesthetic implications and should be investigated at preoperative assessment. Patients with recurrent urinary tract infection related to bladder malfunction, e.g. neurological diseases or congenital abnormalities, form stones. This type of stone may be large and grow to become a staghorn calculus in the renal pelvis.
Neisseria gonorrhoeae infection may be asymptomatic in both men and women. The current USPSTF recommendation is for screening women at risk. Men with penile gonorrhea typically present with purulent penile discharge and dys-uria with N. gonorrhoeae infection. Mucopurulent discharge, dysuria, pelvic pain, and dyspareunia are typical symptoms in women. In patients who engage in anal intercourse, anal discharge, rectal pain, and bleeding can be presenting symptoms. Gonococcal pharyngitis is within the differential of exudative pharyngitis in sexually active patients. When symptomatic, throat pain, tonsillar exudates, and anterior cervical adenopathy may be present.
Patient Encounter 2 Part 2 Medical History Physical Examination Diagnostic Tests and Creating a Care Plan
ROS (+) nocturnal incontinence 5 nights week or more (-) vaginal itching, UTIs, urgency, frequency, dysuria, lower abdominal fullness In the absence of an identified cause and comorbidities, monosymptomatic nocturnal enuresis is present which can be amenable to nonpharmacologic and pharma-cologic therapies (Fig. 53-1). Nonpharmacologic therapy should be utilized initially, provided that the patient and family are sufficiently motivated. Use of one nonpharmacologic method at a time is reasonable, provided that each is given an adequate trial period. If response is suboptimal after 6 months, a different method should be substituted or added. There is some evidence to justify combination therapy. There is no consensus as to when pharmacologic therapy should be added to or substituted for nonpharmacologic therapy. Considering that pharmacotherapy is inferior to select nonpharmacologic treatment modalities in pediatric enuresis, pharmacotherapy will be most valuable in patients who are not...
ROS (+) dysuria, urinary frequency (-) fever, nausea, vomiting, flank pain PE Antimicrobial therapy is the cornerstone of treatment in UTIs. Antimicrobials should ideally be well tolerated, narrow in antimicrobial spectrum, lend itself to patient compliance (low total number of doses), have adequate concentrations at the site of the infection, and have good oral bioavailability. Table 79-2 reviews oral and IV antibiotics frequently used to treat UTIs with comments on their use, and Table 79-3 reviews frequency, duration, and doses of oral antibiotics used commonly for outpatient treatment of UTIs.
Psychological and social adjustment after SCI appear to be stronger predictors for long-term survival than antecedent medical complications. Using the Life Situation Questionnaire, one prospective study found that boredom, depression, loneliness, lack of transportation, conflicts with attendants, inability to control their lives, and alcohol and drug abuse characterized those who died in the last 4 years of a 15-year follow-up.242 Personality and mood disorders associated with self-destructive behaviors such as getting little exercise, letting bladder infections and skin sores go without attention, and abusing tobacco, alcohol, narcotics, and sedatives contributes to this mortality. In one survey, 70 of people with traumatic SCI reported substance abuse before or after injury. Although 16 believed they needed treatment, only 7 received specific
Common side effects of cryotherapy include perineal pain, transient urinary retention, penile and or scrotal swelling, and hematuria. Urinary retention occurs in roughly 3 of individuals. Anti-inflammatories seem to help, but individuals may require a catheter or suprapu-bic tube for a few weeks post-treatment. Penile and or scrotal swelling is common in the first or second post-procedure weeks and usually resolves within 2 months of cryotherapy. Penile paraesthesia may occur and usually resolves within 2 to 4 months postprocedure. Long-term complications of cryotherapy include fistula formation, incontinence, erectile dysfunction, and urethral sloughing. The risk of permanent incontinence (i.e., need to wear a pad) is reported to range from 1 to 8 . However, in individuals undergoing salvage cryotherapy after radiation failure, the incidence of urinary incontinence may be as high as 43 . Similarly, with total prostate gland cryotherapy, the ice ball extends beyond the capsule of the...
The urinary system filters wastes from the blood, eliminating them together with excess water as urine. It also regulates body fluid levels and maintains the body's acid-alkali balance. The system consists of a pair of kidneys the bladder the ureters, which connect each kidney to the bladder and the urethra, the tube through which urine leaves the body. The kidneys are red-brown, bean-shaped organs lying at the back of the abdomen, one on either side of the spine. They contain units called nephrons that filter the blood circulating through the kidneys and produce urine, which then passes down the ureters into the bladder. The bladder is kept closed by a ring of muscle (a sphincter) around its lower opening. This muscle can be relaxed voluntarily to allow urine to be expelled through the urethra. The male urethra is longer than the female urethra and also provides an outlet for semen (fluid that contains sperm and that is released during sexual activity). Because the female urethra is...
Nitrogen mustards lead to reactive carbonium ion formation. These carbonium ions then react with electrophilic regions of DNA. They include cyclophosphamide, melphalan, ifosfamide, chlorambucil, and mechlorethamine. Toxicities include fatigue, myelosuppression, nausea and vomiting, pneumonitis, and pulmonary fibrosis. Cyclophosphamide is associated with hemor-rhagic cystitis. Cyclophosphamide has shown some activity in recurrent malignant brain tumors, but the activity of other nitrogen mustards against nervous system tumors has been minimal.
Most of the albumin filtered through the kidneys is reabsorbed, so significant urinary albumin is a sign of abnormal renal function. Large amounts ( 300 mg dL) of albumin can be detected on standard urine dipsticks. Microalbuminuria is defined as a persistent increase of urinary albumin that is below the detectable range of the standard dipstick test. Microalbuminuria is a marker for early diabetic nephropathy and also predicts macrovascular disease. Urinary albumin can be assayed from a spot urine specimen, which is corrected by the urine creatinine, or a 24-hour urine collection. A 24-hour urinary albumin excretion in mg day equates to the same numeric value for the spot urine albumin (mg) creatinine (g) ratio. Therefore the reference ranges for each test are normal 300. Factors that may interfere with the test accuracy include strenuous or prolonged exercise, upright posture, hematuria, menses, genital or urinary infections, congestive heart failure, uncontrolled hypertension or...
Infections Abscesses, endocarditis, tuberculosis (TB), complicated urinary tract infection (UTI). Infections Malaria, hepatitis, pneumonia bronchitis, UTI pyelonephri-tis, dysentery, dengue fever, enteric fever, TB, rickettsial infection, acute human immunodeficiency virus (HIV) infection, amebic liver abscess.
Because tetanus toxin does not affect sensory nerves or cortical function, the patient unfortunately remains conscious, in extreme pain and in anxious anticipation of the next tetanic seizure. These seizures are characterized by sudden, severe tonic contractions of the muscles, with fist clenching, flexion and adduction of the arms and hyperextension of the legs. Without treatment, the seizures range from a few seconds to a few minutes with intervening respite periods, but as the illness progresses the spasms become sustained and exhausting. The smallest disturbance by sight, sound or touch may trigger a tetanic spasm. Dysuria and urinary retention result from bladder sphincter spasm forced defecation may occur. Fever, with temperatures occasionally as high as 40 C, is common because of the substantial metabolic energy consumed by spastic muscles. Notable autonomic effects include tachycardia, arrhythmias, labile hypertension, diaphoresis, and cutaneous vasoconstriction. The tetanic...
The Clinical Outcomes Uti izing Revascularization ir Aggressive Drug Fvalua tion (COURAGE) trial was designed to determine whether PCI coupled with optimal medical therapy reduces the risk of death and nonfatal myocardial infarction in patients with stable coronary artery disease, as compared with opti trial medical therapv alone, and demonstrated that
During inpatient care, the physician explores the small personal matters that mean much to patients. These issues include interference with sleep. For example, do medications or blood draws taken too early in the morning or late in the evening awaken the patient Is insomnia associated with anxiety or depression, a noisy roommate, and pain at rest or with certain movements Sleep deprivation may thwart rehabilitation efforts by preventing the consolidation of skills learning and experience-dependent gains in the performance of motor and perceptual procedural memory tasks.12 Other daily discussions may center on the regularity of bowel movements, symptoms that point to a urinary tract infection, phlebitis or aspiration, as well as caloric and fluid intake, short-term therapy goals, how the patient and family are coping with unexpected burdens, and plans for discharge and outpatient care. The physician also reinforces the therapeutic approaches made by the team at its weekly conferences....
If you have urinary symptoms, your doctor may order a urinalysis or a urine culture (or both) to check for a urinary tract infection. If you have noticed involuntary leakage of urine (urinary incontinence), you should alert your doctor to this symptom. Involuntary loss of urine is sometimes related to anatomic changes at the bladder neck. Urinary stress incontinence is the most common type of urinary incontinence, occurring in up to 20 percent of women. Stress incontinence is the inadvertent loss of urine that occurs when there is an increase in intraabdominal pressure, such as when you sneeze, cough, laugh, or exercise. It is more likely to happen when the bladder is full and happens more frequently and inconveniently when the normal mechanism of the bladder and urethra is impaired. Often stress incontinence is also associated with genitourinary prolapse, a relaxation and dropping of the pelvic or urinary organs (or both).
Prostatitis refers to an inflammation of the prostate gland that can be manifested in a variety of ways. Symptoms of acute bacterial prostatitis include urinary frequency, urgency dysuria or painful urination, nocturia, perineal pain, low back pain, fever, and or chills. Some men with acute bacterial prostatitis may present with inability to urinate and will require a catheter or supra-pubic tube placement until the inflammation and pain have resolved. Some men with acute prostatitis may develop a prostatic abscess that will require drainage. Chronic bacterial prostatitis may present in a similar manner, but men are typically less toxic in appearance.
The first step is to treat intercurrent urinary tract infection. Systemic antimicrobial drugs for prophylaxis, such as trimethoprim, and acidifying and alkaliniz-ing agents do not clearly reduce the incidence of infection over the long run.28 Of interest, 300 mL of cranberry juice did reduce the frequency of bacteriuria with pyuria in elderly women,29 so prophylaxis might be tried after a stroke in older patients.
Enlargement or hypertrophy of the prostate gland is associated with older dogs and results from hormonal stimulation. The gland pushes upwards, causing pressure on the rectum and consequent faecal tenesmus. The gland may become infected by ascending infection from the urethra, which runs through the centre of the gland. The patient may show signs of cystitis and, in severe cases, pyrexia, anorexia and weight loss. Cysts and neoplasia may also develop inside the prostate gland. Diagnosis is confirmed by rectal palpation, radiography and the use of ultrasound.
Patients are educated about how slow movements and daily passive range of motion stretches reduce motion sensitive symptoms of spasticity. Noxious stimuli exacerbate hyper-tonicity and may trigger flexor and extensor spasms. Even ordinarily innocuous stimuli, such as tight clothing or a sunburn, can abruptly increase tone, much as they can cause autonomic dysreflexia in patients with cervi-cothoracic SCI. Treatable noxious sources include bowel and bladder distention, irritation from an indwelling catheter, urinary tract infection, rectal fissure or abcess, gastrointestinal gas, epididymitis, joint inflammation or pain especially on range of motion, or unrecognized vertebral fractures, pressure sores, ingrown toenails, and deep vein thrombosis.
The clinical manifestations include fever, diarrhea, cramping abdominal pain, anemia, and weight loss. Initial symptoms may include arthralgias suggesting an arthritis, gynecological difficulties, urinary symptoms (frequency, dysuria), or a combination of severe loss of appetite, weight loss, and depression, suggesting anorexia nervosa. Slowing or retardation of growth may be the first clinical indication of illness in children. Occasionally, the initial presentation is indistinguishable from an acute appendicitis.
Labial adhesions may be seen in young girls and may be partial or complete (fusion) and asymptomatic. However, labial adhesions can be associated with difficult or abnormal urination and may contribute to the development of UTIs. It is important to perform an external genital examination in the female with her first UTI (Fig. 40-10). Retrospective data and case series support topical estrogen cream to the affected areas, with gentle traction until the adhesions have separated (Bacon, 2002). In a recent study, however, labial separation occurred more quickly and with less recurrence in patients treated with betamethasone than in those treated with estrogen cream (Mayoglou et al., 2009).