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Problems with Urination. CAPT Mike Hughey, MC, USNR. Cystitis. Pain, burning, frequency, tender bladder Treat on the basis of symptoms Confirm cure with culture Bactrim, Gantrisin, Keflex, Macrodantin Pyridium 200 mg PO TID x 2 days. Video. Gonorrheal Urethritis.

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problems with urination

Problems with Urination

CAPT Mike Hughey, MC, USNR

  • Pain, burning, frequency, tender bladder
  • Treat on the basis of symptoms
  • Confirm cure with culture
  • Bactrim, Gantrisin, Keflex, Macrodantin
  • Pyridium 200 mg PO TID x 2 days


gonorrheal urethritis
Gonorrheal Urethritis
  • Burning, frequency, tender urethra
  • Purulent discharge from urethra/Skene's
  • GC culture
  • Cephtriaxone 250 mg IM, plusDoxycycline 100 mg PO BID x 7 days
  • Treat partner
non gonorrheal urethritis
Non-Gonorrheal Urethritis
  • Burning, frequency, tender urethra, bladder
  • They don't improve on antibiotics
  • Negative urine culture
  • Treat on basis of suspicion
  • Doxycycline 100 mg BID x 7 days, orClindamycin 150 mg TID x 7-10 days
  • Treat sexual partner
herpes vulvitis
Herpes Vulvitis
  • Severe pain when urine passes over the vulva
  • Multiple tiny blisters/ulcers
  • Zovirax 200 mg PO Q4 hours while awake x 10 days
  • May need Foley cather
  • Try urinating into bathtub
  • Will resolve within 5-10 days
causes of urinary frequency
Causes of Urinary Frequency
  • Bladder infection (with dysuria)
  • Excessive fluid intake (particularly at night)
  • Increased stress
  • Pelvic mass
  • Pregnancy

Naval Hospital Camp LeJeune

evaluation of urinary frequency
Evaluation of Urinary Frequency
  • Palpate for bladder tenderness (inf)
  • Palpate for pelvic mass
  • Urine culture (dipstick OK)
  • Pregnancy test
blood in the urine
Blood in the urine
  • Usually due to cystitis
  • If it persists or returns, thenUrology consultation necessary to r/o: -Renal stones -Bladder tumors -Endometriosis
  • Microscopic hematuria most commonlydue to exercise in this age group
bad odor to the urine
Bad odor to the urine
  • Either cystitis or vaginitis
  • Look for: -Lost and forgotten tampon -Yeast -Trichomonas -Bacterial vaginosis -Asparagus eating -Ampicillin intake
can t urinate
Can't Urinate
  • Put in Foley catheter
  • Drain about 500 cc, then wait 5-10 minutes before draining another 500 cc...and then another 500 cc
  • Leave Foley in place for 1-2 days to allow the bladder to regain its' tone
  • Rule out: -pregnancy -pelvic mass -pelvic trauma -herpes


forms of urinary incontinence
Forms of Urinary Incontinence
  • Stress incontinence
  • Irritable bladder
  • Loss of urine at unpredictable times
stress urinary incontinence
Stress Urinary Incontinence
  • Anatomic problem -Loss of urethrovessicle angle -UV junction exteriorized
  • Loss of urine with cough, sneeze, exercise
  • Mild, Mod & Severe
  • Surgery
  • Kegel Exercises
  • Double-voiding
  • Caffeine, tobacco, alcohol, antibiotics
irritable bladder
Irritable Bladder
  • Local problem
  • Sudden urge to urinate
  • Eliminate caffeine, tobacco and alcohol
  • Double voiding
  • Antibiotics
  • Will need consultation
urethral diverticulum
Urethral Diverticulum
  • Local problem
  • Unexpected loss of urine on rising
  • Will need consultation
  • Surgery is curative
  • Nothing else helps
unpredictable urine loss
Unpredictable Urine Loss
  • If not associated with urgency or activity, suggests neurologic cause such as: -multiple sclerosis -spinal cord tumors -spinal disc compression
  • If single episode, reassure patient
  • If recurring problem or worsening, evaluate for neurologic disease or injury
  • Severe flank pain and tender kidney(s)
  • Fever (typically quite high)
  • May or may not have urinary symptoms
  • Treat with IV antibiotics
  • This patient is very ill and may need MEDEVAC