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Chapter 27 Urinary Tract Disorders

Lithiasis Stone formation
Incidence and risk factors for patient with a Urinary Tract Tumor - Males over age 60 - White
Incidence and risk factors for patient with a Urinary Tract Tumor - Presence of carcinogens in urine - Chronic inflammation or infection of bladder mucosa
Congenital or acquired risk factors for Bladder Cancer - Chronic UTIs or calculi - Schistosoma haematobium - Infection/dev of squamous cell of the bladder
Behavioral risk factors for Bladder Cancer - Smoking - Occupational exposure to chemicals - Residence in urban areas
Other risk factors for Bladder Cancer - Exposure to toxins, esp chemicals used in hairdressing, rubber, paint, electric cable and textile industries increase the risk of bladder cancer. - Smoking is a major risk factor for bladder cancer
Pathophysiology of patient with a Urinary Tract Tumor – Most common in bladder – Most are papillary lesions (papillomas) polyp-like – Carcinoma in situ (CIS) rarer with poorer prognosis – Grade I tumors (highly differentiated) – Grade III tumors (poorly differentiated) becomes invasive
Manifestations of patient with a Urinary Tract Tumor – Painless hematuria – Signs of UTI – Obstruction of urinary outflow – Colicky pain – Renal failure
Diagnosis test for Urinary Tract Tumor – Urinalysis – Urine cytology – Ultrasound of the bladder, intravenous pyelography – Cystoscopy and ureteroscopy – CT scan or MRI
Diagnostic Assessment for Urinary Tract Tumor - The only significant finding on a routine urinalysis is gross or microscopic hematuria. - Cystoscopy usually performed to evaluate painless hematuria with biopsy of any visible mass of the bladder.
Medications for patient with a Urinary Tract Tumor - Intravesical instillation of immunologic or chemotherapeutic agents (primary tx of multiple early stage lesions) - Bacille Calmette-Guérin - Antituberculin treatment for complications
Surgery for patient with a Urinary Tract Tumor - Transurethral resection of bladder tumor (excision) - Partial cystectomy (remove solitary lesion) - Complete or radical cystectomy (tx for invasive tumors) - Prostate or hysterectomy/bilateral salpingo-oophorectomy - Urinary diversion
Urinary Diverersion Ostomies (Cutaneous uterterostomy ) Ureter opening is brought out onto the skin
Ileal Conduit - Ureters are surgical placed in the ilium and urine is collected in a pouch on the skin around the stoma.
Urinary Retention Incomplete emptying of the bladder
Pathophysiology of Urinary Retention – Mechanical obstruction (e.g., BPH, stricture, calculi) – Fecal impaction – Acute inflammation – Scarring from repeat UTI
Pathophysiology of Urinary Retention – Surgery affecting detrusor muscle function – Long-standing diabetes and drugs – Anticholinergic medications – Voluntary urinary retention
Urinary Retention can lead to - Overdistention of bladder - Weak detrusor muscle - Inability to urinate - Hydroureter or hydronephrosis
Manifestations of Urinary Retention – Firm, distended bladder – Overflow voiding or incontinence – Percussion of the lower abdomen reveals a dull tone
Diagnosis of Urinary Retention – Bladder scan – Insert a urinary catheter and measure the urine output
Treatment of Urinary Retention – Indwelling or intermittent catheterization – Cholinergic medications – Removal of calculi – Resection of prostate if related to BPH
Patient Education for Urinary Retention – Intermittent self-catheterization – Avoidance of OTC medications with anticholinergic effect – Bladder training information – Care of indwelling catheter – Signs of UTI
Neurogenic Bladder - Results from disruption of central or peripheral nervous systems linked to bladder function
Pathophysiology of Neurogenic Bladder - Flaccid bladder dysfunction - Detrusor muscle contraction impaired - Caused by myelomeningocele or spinal injury
Diagnosis of Neurogenic Bladder – Urine culture – Urinalysis – Postvoid bladder scan – Cystometrography
Medications for Neurogenic Bladder – Anticholinergic drugs to treat spastic bladder – Cholinergic drugs to stimulate micturition
Anticholinergic drugs Substance that blocks the neurotransmitter acetylcholine in the central and the peripheral nervous system.
Cholinergic drugs Medications that produce the same effects as the parasympathetic nervous system.
Interprofessional Care for Neurogenic Bladder - Measures to reduce the risk of UTI or calculi - Bladder retraining
Bladder retraining – The Credé's method - For spastic neurogenic bladder
Bladder retraining – Intermittent catheterization - For flaccid neurogenic bladder
Surgery for Neurogenic Bladder – Rhizotomy – Urinary diversion – Artificial sphincter implant
Continuity of care for Neurogenic Bladder – Measures to stimulate reflex voiding and promote bladder emptying – Use of prescribed medication – Manifestations of UTI or urolithiasis, how to reduce risk
Urinary Incontinence - Involuntary urination – Physical problems – Psychosocial consequences
Pathophysiology of Urinary Incontinence - Results when the pressure within urinary bladder exceeds urethral resistance - May be an acute, self-limited disorder or chronic
Causes of incontinence – Congenital – Acquired – Reversible
Types of incontinence – Stress incontinence – Urge incontinence – Overflow incontinence – Functional incontinence – Mixed incontinence – Total incontinence
Diagnosis of Urinary Incontinence – Urinalysis and urine culture – Postvoiding residual (PVR) – Bladder stress testing – Cystometrography – Uroflowmetry – Cystoscopy or ultrasonography
Medications for Stress Urge Incontinence - Teaching - Pelvic muscle exercise - Duloxetine
Medications for UI associated with postmenopausal atrophic vaginitis - Estrogen therapy
Medications for Urge Incontinence - Preparations that increase bladder capacity - Use a barrier cream to prevent skin breakdown
Surgery for Urinary Incontinence – Suspension of the bladder neck – Prostatectomy – Artificial sphincter – Urethral sling – Bladder augmentation
Complementary therapies for Urinary Incontinence – Biofeedback and relaxation techniques
Created by: pdimple