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Problems with Urination

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

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  1. Problems with Urination CAPT Mike Hughey, MC, USNR

  2. 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

  3. 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

  4. 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

  5. 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

  6. Causes of Urinary Frequency • Bladder infection (with dysuria) • Excessive fluid intake (particularly at night) • Increased stress • Pelvic mass • Pregnancy Naval Hospital Camp LeJeune

  7. Evaluation of Urinary Frequency • Palpate for bladder tenderness (inf) • Palpate for pelvic mass • Urine culture (dipstick OK) • Pregnancy test

  8. 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

  9. Bad odor to the urine • Either cystitis or vaginitis • Look for: -Lost and forgotten tampon -Yeast -Trichomonas -Bacterial vaginosis -Asparagus eating -Ampicillin intake

  10. 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 Video

  11. Forms of Urinary Incontinence • Stress incontinence • Irritable bladder • Loss of urine at unpredictable times

  12. 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

  13. Irritable Bladder • Local problem • Sudden urge to urinate • Eliminate caffeine, tobacco and alcohol • Double voiding • Antibiotics • Will need consultation

  14. Urethral Diverticulum • Local problem • Unexpected loss of urine on rising • Will need consultation • Surgery is curative • Nothing else helps

  15. 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

  16. Pyelonephritis • 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

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