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Elderly Urinary Issu

Urinary Problems in the Elderly

Urinary Problems in the Elderly ? * BPH, Atrophic Vaginitis, UTI/Cystitis, and Prostitis
Incontinence and aging ? * NOT a normal part of aging
Types of Incontinence ? * Urge -- Stress -- Overflowing -- Functional -- Mixed
Urge Incontinence ? * Got to go, got to go right now.... * most common over 75 y/o..... * usu due to an idiopathic cause (atrophic, stones, infections, etc.)..... * or from irritants = caffeine, alcohol, chocolate
Stress Incontinence ? * Most common cause in women.... * Loss of urine with increased intra-abdominal pressure...... * Basically, you cough and then pee ...... * can be from child birth or surgery
Overflow Incontinence ? * Over distension of the bladder causing frequent urination and dribbling...... * Most Common in MEN ...... * can be cause by obstruction like fecal impaction or from lumbar stenosis
Overflow incontinence special thing ? * Must be worked-up --> Chronic over distension of the bladder can lead to hydronephrosis, which can lead to renal failure.
Functional Incontinence ? * Not a problem of the lower urinary tract ...* Causes = cognition and physical impairment
Mixed Incontinence ? * Overlap of 2 or more types of incontinence
Transient incontinence ? * DIAPERS : Delirium Infection (UTI symptomatic) -- Atrophic urethritis/vaginitis -- Pharmaceutical -- Psychological -- Excessive urine output -- Restricted mobility -- Stool impaction
Established Incontinence ? * Detrusor over activity - Urge ..... * Detrusor under activity - Neurogenic ..... * Urethral obstruction - Overflow ...... * Urethral incontinence - Stress
Drugs affecting Urinary Function ? * Sedatives/hypnotics -- Alcohol -- Anticholinergics -- Antipsychotics -- Tricyclic antidepressants -- Antiparkinsons- except L-dopa -- Narcotics -- Alpha blockers -- Diuretics
Work-up to get on them ? * HISTORY .... * Do a good physical .... * Labs: UA on every eldery that comes to ER and electrolytes/BUN/Cr
Post Void Measurements ? * Do within 5 mins of voiding ..... * Then do a bladder scan or cath.... * < 100 cc adequate if over 65 ..... *100-200 cc borderline .... * > 200 cc abnormal needs further evaluation
Urge Incontinence-Treatment ? * 1st = Behavioral .... * 2nd = Drugs /anticholinergic (Oxybutynin and Tolerodine)
Side Effects of Anticholinergics ? * ANTI- DUMBELLS ..... * Dizziness - Sleepiness -Confusion -Dry eyes -Dry mouth -Tachycardia -Palpitation -Dyspepsia -Constipation -Urinary retention
Stress Incontinence Treatment ? * Behavioral (kegals) .... * Drugs (estrogen creams) .... * Surgery (high suc. rate, but fails).... * Pessary
Overflow Incontinence Treatment ? * Treat Obstruction (Surgery or Drugs- alpha blockers) ...... * Catheter
Tmt of Functional ? * Treat the underlying problem with pt. History
Indications for a Temporary Catheter ? * Long surgical procedure -- Monitoring urine during severe illness -- Decompress bladder following prolonged retention. -- Obtain urine specimen -- Protect surgical wound during initial post-op period.
Indications for a Premanent Catheter ? * Neurogenic bladder -- Skin protection for debililated, immobile patient -- Comfort measure during terminal illness -- Non repairable bladder outlet obstruction.
Predisposing factors in UTIs in the Elderly ? * structure issues, post void urine left of over 100cc, BPH, stones, UBx use and Catheters.... * Basically anything that would leave urine trapped in the bladder, which causes bacteria growth
Elderly UTI presentation ? * Fever, dysuria, frequency, and pt comes in of family saying they are acting "Out of the normal"
UTI Bacteriology cause ? * E.Coli = top cause
UTI-Emperic Treatment ? * Independent/Community = Oral quinalone -- Trimethoprim Sulf -- Amoxicillin/Clavulanate -- Cephalexin ....... * LTC = same ..... *Hospital (very sick) = IV Quinalone -- IV Ceftazidime
Asymptomatic Bacteruria and Pyuria A Special Problem of the Elderly ? * Treating does not reduce incidence of symptomatic infection. .... * Treating does increase antibiotic resistance, costs, drug toxicity.
Atrophic Vaginitis/ Pro UTI ? * from decrease estrogen postmenopause..... * Tmt= estrogen cream
Elderly and renal function ? * After 50y/o, GRF goes down 1%... Normal is 60 or above
Cr Clearance formula ? * Creatinine Clearance (ml/min)= .... (140 – age) x lean body wt. kg. (x .85 for women) /// Serum Creatinine x 72
BPH CxSx ? * Can be asymptomatic...... * Decreased force of stream , Dribbling -- Hesitancy -- Urgency -- Nocturia -- Can also see Confusion
Treatment of BPH/LUTS ? * Observation and behavior modification ..... * herbals.... * alpha blockers ... * 5-alpha reductase inhibitors.... * Surgery
The prostate and bacteria ? * The prostate serves as a reservoir for bacteria
BPH Lab/Tests ? * Digital rectal exam, UA and culture usu. Positive for E.Coli (for Chronic Bacterial Prostatitis)
Treatment = ? * Antibiotics- 4 weeks to 4 months of FQs (have to longer bc prostate is hard to reach with ABx ) ..... * Low dose supressing drugs and even surgery
Created by: thamrick800