Chapter 27 Urinary Tract Disorders
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| Lithiasis | Stone formation
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| Incidence and risk factors for patient with a Urinary Tract Tumor | - Males over age 60
- White
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| Incidence and risk factors for patient with a Urinary Tract Tumor | - Presence of carcinogens in urine
- Chronic inflammation or infection of bladder mucosa
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| Congenital or acquired risk factors for Bladder Cancer | - Chronic UTIs or calculi
- Schistosoma haematobium - Infection/dev of squamous cell of
the bladder
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| Behavioral risk factors for Bladder Cancer | - Smoking
- Occupational exposure to chemicals
- Residence in urban areas
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| 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
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| 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
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| Manifestations of patient with a Urinary Tract Tumor | – Painless hematuria
– Signs of UTI
– Obstruction of urinary outflow
– Colicky pain
– Renal failure
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| Diagnosis test for Urinary Tract Tumor | – Urinalysis
– Urine cytology
– Ultrasound of the bladder, intravenous pyelography
– Cystoscopy and ureteroscopy
– CT scan or MRI
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| 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.
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| 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
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| 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
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| Urinary Diverersion Ostomies (Cutaneous uterterostomy ) | Ureter opening is brought out onto the skin
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| Ileal Conduit | - Ureters are surgical placed in the ilium and urine is collected in a
pouch on the skin around the stoma.
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| Urinary Retention | Incomplete emptying of the bladder
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| Pathophysiology of Urinary Retention | – Mechanical obstruction (e.g., BPH, stricture, calculi)
– Fecal impaction
– Acute inflammation
– Scarring from repeat UTI
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| Pathophysiology of Urinary Retention | – Surgery affecting detrusor muscle function
– Long-standing diabetes and drugs
– Anticholinergic medications
– Voluntary urinary retention
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| Urinary Retention can lead to | - Overdistention of bladder
- Weak detrusor muscle
- Inability to urinate
- Hydroureter or hydronephrosis
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| Manifestations of Urinary Retention | – Firm, distended bladder
– Overflow voiding or incontinence
– Percussion of the lower abdomen reveals a dull tone
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| Diagnosis of Urinary Retention | – Bladder scan
– Insert a urinary catheter and measure the urine output
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| Treatment of Urinary Retention | – Indwelling or intermittent catheterization
– Cholinergic medications
– Removal of calculi
– Resection of prostate if related to BPH
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| 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
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| Neurogenic Bladder | - Results from disruption of central or peripheral nervous
systems linked to bladder function
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| Pathophysiology of Neurogenic Bladder | - Flaccid bladder dysfunction
- Detrusor muscle contraction impaired
- Caused by myelomeningocele or spinal injury
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| Diagnosis of Neurogenic Bladder | – Urine culture
– Urinalysis
– Postvoid bladder scan
– Cystometrography
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| Medications for Neurogenic Bladder | – Anticholinergic drugs to treat spastic bladder
– Cholinergic drugs to stimulate micturition
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| Anticholinergic drugs | Substance that blocks the neurotransmitter acetylcholine in the central and the peripheral nervous system.
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| Cholinergic drugs | Medications that produce the same effects as the parasympathetic nervous system.
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| Interprofessional Care for Neurogenic Bladder | - Measures to reduce the risk of UTI or calculi
- Bladder retraining
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| Bladder retraining | – The Credé's method
- For spastic neurogenic bladder
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| Bladder retraining | – Intermittent catheterization
- For flaccid neurogenic bladder
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| Surgery for Neurogenic Bladder | – Rhizotomy
– Urinary diversion
– Artificial sphincter implant
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| 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
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| Urinary Incontinence | - Involuntary urination
– Physical problems
– Psychosocial consequences
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| Pathophysiology of Urinary Incontinence | - Results when the pressure within urinary bladder exceeds
urethral resistance
- May be an acute, self-limited disorder or chronic
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| Causes of incontinence | – Congenital
– Acquired
– Reversible
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| Types of incontinence | – Stress incontinence
– Urge incontinence
– Overflow incontinence
– Functional incontinence
– Mixed incontinence
– Total incontinence
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| Diagnosis of Urinary Incontinence | – Urinalysis and urine culture
– Postvoiding residual (PVR)
– Bladder stress testing
– Cystometrography
– Uroflowmetry
– Cystoscopy or ultrasonography
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| Medications for Stress Urge Incontinence | - Teaching
- Pelvic muscle exercise
- Duloxetine
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| Medications for UI associated with postmenopausal atrophic vaginitis | - Estrogen therapy
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| Medications for Urge Incontinence | - Preparations that increase bladder capacity
- Use a barrier cream to prevent skin breakdown
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| Surgery for Urinary Incontinence | – Suspension of the bladder neck
– Prostatectomy
– Artificial sphincter
– Urethral sling
– Bladder augmentation
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| Complementary therapies for Urinary Incontinence | – Biofeedback and relaxation techniques
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