Genitourinary

GENITOURINARY

URINARY-FREQUENCY/INCONTINENCE: (urge incontinence) # >7 during daytime, > 2-3 times/night # increases : with age, Diuretics & Hypercalcemia (large volume, urine), Infection (cystitis, prostatitis), Diabetes, tumor, debility, Diabetes, Bladder spasm / cancer, Fecal impaction, Retention with overflow, ** Anxiety, Detrusor weakness, coffee *Rx: ** Ditropan (oxybutynin); Detrol (tolterodine) ** Elavil (amitriptyline)** Catheter ** Bladder Training ** Flomax • Dysuria ** Phenazopyridine (Pyridium): for dysuria ** Septra DS bid if not allergic ** antispamodics: levsin SL, Scopolamine ** TCA: Elavil, Tofranil

*** HESITANCY/RETENTION: # Frequent small volume, large postvoid, overflow incontinence, Urinary Retention *Rx: bedpan, schedule urination ** Minipres ** Hytrin ** Urecholine (bethanecol), ** Flomax, ** Cardura A stop anticholinergics A catheter ** suprapubic catheter

*** BLADDER SPASM: # Infection, tumor, radiation, fecal impaction *Rx: ** Ditropan

** Urispas ** Probanthine ** Tofranil ** Flomax ** Benzodiazepines ** levsin SL ** Scopolamine ** Aropine ** Naprosyn ** TCA: Elavil, Tofranil ** Belladonna

*** URINARY TRACT INFECTIONS: # Dysuria, fever n treat if symptomatic, not near death, don’t treat if asymtomatic bacteriuria ** Pyridium (pink urine) ** Septra ** Floxin ** Cipro

*** MESTASTIC PROSTRATE CANCER • Bone pain, anorexia, weakness, malaise, anemia, hematuria, obstructive uropathy ** Lupron (leuprolide) / month (Less side effects than estrogens) ** Antiandrogens – Eulexin (flutamide) (Prevents testosterone receptor binding, less side effects ** Orchiectomy instead of Lupron (less expensive) ** Corticosteroids: for painful bony mets ** Radiation ** Didronel ** Calcitonin

*** HEMATURIA: Bloody urine # tumor, infection, chemotherapy, radiation, coagulopathy • *RX: ** Antibiotics ** Continuous irrigation with 1% Alum solution at 5cc/min ** Radiation ** Amicar 5gm po followed by 1 gm po q1-4h as needed ** Transfusion (benefits lasts 2 days)

*** URETHAL CATHETER: • Cause: clot, sediment, tumor, infection and Irrigation ** Larger catheter ** Larger balloon ** Emmett catheter – multiple holes

*** CATHETER: Catheter better than pads or diapers, drained to gravity, if ambulatory use leg bag