geriatic urology problems
TRANSCRIPT
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Urological Diseases
Male
$UT
#ematuria
Incontinence
ED
%emale
Incontinence#ematuria
$UT
DU
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aturia
Pre-renal
Renal
Post-renal
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Hematuria
Blood in the urine -Dangerous symptomology
Types:
Macroscopic Gross hematuria Microscopic hematuria (the presence of ! red "lood cells per
high po#er microscopic field$
%ainless or painful
&nitial ' Terminal ' Total
lots ) &f so type of clots)
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Timing o& #ematuria
Total hematuria
&rom !ladder or uppertract
Terminal hematuria
!ladder neck or prostaticurethra
Initial hematuria
&rom urethra
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Hematuria
auses
Urological (surgical$
*ephrological (medical$
+, Glomerular
, *onglomerular!, Blood dyscrasias.
/, &nterstitial nephritis
0, 1eno2ascular
disease
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#ematuria' Common UroCauses
(. )ladder cancer
*. +idney cancer
,. Ureteral cancer
-. Urethral cancer
. Prostate cancer
/. tones
0. Pyelonephritis
1. Cystitis 2Prostatitis
3. )P#(4.Radiation cystitis
((.Chemical cystitis
(*.Drug induced
(,. Parasiticin&estations
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5ork up
History esp, drug history () 343 ) 531631&*$
78amination
&n2estigation :
3ll patients
Urine culture and cytology
1enal U4
&9U or computed tomography (T$ scan
ystoscopy
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Urine Cytology
screening &or urothelial cancer
%reshly 6oided postam!ulant 7hole6oid specimen
Microscopic e8amination o& Papstained cells o!tained !ycentri&ugation o& an ali9uot o& urine:at least (4 m$;
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)ladder Cancer
Most common urological cancer
Transitional cell carcinoma :TCC;
Risk &actors' smoking Urethral di2erticulum> %ost surgery for ?stress@ incontinence pel2ic masses (e,g,. o2arian masses$
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Acute urinary retention
Initial Management :
Urethral catheterisation
4uprapu"ic catheter ( 4%$
Late Management:
Treating the underlying cause
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hronic urinary retention
;"struction de2elops slo#ly. the "ladder is
distended (stretched$ 2ery gradually o2er
#ee=s'months. so pain is not a feature ,
%resentation:
Urinary dri""ling
;2erflo# incontinence
%alpa"le lo#er suprapu"ic mass
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Etiology
)P#
Dia!etic cystopathy
@eurogenic !ladder Parkinosinism Multiple sclerosis
pinal cord injury patients
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Chronic urinary retention
Usually associated #ith
1educed renal function,
Upper tract dilatation
Treatment is directed to renal support,
Bladder drainage under slo# rate to a2oid
sudden decompressionhematuria,
Treatment of cause
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5hat"s $UTK
LUTS Lower Urinary Tract Symptoms
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$UT
torage :irritati6e or?lling; symptoms
Urgency %re9uency
@octuria
Urge incontinence
oiding :o!structi6e; symptoms
#esitancy
5eak stream training to pass urine
Prolonged micturition
%eeling o& incomplete!ladder emptying
Urinary retention
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)P# > 7hat causes these symptomsK
Prostate gro7s 7ith age :androgendependent;
Pressure on the urethra restricts urine
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Indications &or treatment
!structi6e uropathy to renal
impairment
Bcute retention o& urine
Chronic retention o& urine
Urinary tract in&ection
)ladder stone &ormation
Urinary incontinence
#ematuria
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medication
First line of defense againstot!ersome urinar"s"mptoms
Manage the condition > don"t ?8 it
#$o ma%or t"pes&
(Alp!a''lo*er)> rela8 the
prostate and pro6ide a largerurethral opening :Tamsulosin6aporisation
Transurethral incision
Transurethral laser techni9ue:holmium
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TURP
Gold tandardHo& care &or )P#
Uses an electrical kni&eH to surgicallycut and remo6e e8cess prostate tissue
Eecti6e in relie6ing symptoms and
restoring urine Lo7
:transurethral resection o& the
prostate;
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Urinary Incontinence
Bects'
(F>,4F li6ing at
home
,4F > ,F in acutecare
N4F in RC%:residential care&acilities;
Nygaard I, et al. JAMA 2008, 300:1311.
Tennstedt S, et al. Am J Epidemiol 2008,1!:3"0.Sa# o$n N% et al A in Trends 2001 ' :1)
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Urinary Incontinence
,ontinene re-uires'
Bde9uate mo!ility
Mentation
Moti6ation
Manual de8terity Intact lo7er urinary tract &unction
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Urinary Incontinence
edial,ompliations
as!es Pressure ulers
#1
Falls Fratures
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Urinary Incontinence
Ps"!osoialompliations
Em!arrassment
tigmatisation
Isolation
Depression Institutionalisation
risk
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Urinary Incontinence
BGEI@G )$BDDER C#B@GE )ladder capacity decreases
)ladder compliance decreases
B!ility to postpone 6oiding decreases
Urethral closing pressure decreases in 7omen Prostate enlarges in men
In6oluntary !ladder contractions increase
Post>6oid residual 6olume increases :4>(44ml;
Also: Increased Luid e8cretion at night
Bge associated sleep disorders
Detrusor muscle changes
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Urinary Incontinence
#ransient 1nontinene
,ommon e.g. 302 ommunit" d$ellers
+02 of inpatients
D ' Delirium1 ' 1nfetion
A ' Atrop!i ret!ritis/vaginitis
P ' P!armaeutials
P ' Ps"!ologial (rare) ' essive urine output
' estrited moilit"
S ' Stool impation
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Urinary Incontinence
rinar" trat auses ofinontinene'
Detrusor overativit"
Detrusor underativit"
5enuine stress inontinene
(lo$ uret!ral resistane) 6strution
(!ig! uret!ral resistane)
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Urinary Incontinence E6aluation
GB$'
In6estigate and treat transient andesta!lished causes.
Bssess patient@s en6ironment and
support
To detect uncommon !ut seriousunderlying conditions'
>)rain lesions> pinal cord lesions> Carcinoma !ladder2prostate> )ladder stones> Decreased !ladder compliance
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Urinary Incontinence
Drug #reatment of 6A7
Anti'!olinergi (anti'musarinis)
6"ut"nin
Solifenain
Darifenain
#olterodine
7est as ad%unts toladder drill.
Dose esalation "titration
Ne$er ones ettertolerated
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Pel6ic Loore8ercises
aginal cones
Urethral plugs )io&eed!ack
Dulo8etine
urgery i& all &ails
GI > ID
U l i l t i
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Urological ymptoms inParkinsons
%re9uency
Urgency
Urge incontinence
@octuria
5eak stream2dri!!ling
ensation o& incomplete6oiding2Dou!le 6oiding
ED
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Drug Induced
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UDE Pattern
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Management
PD is slo7ly progressi6e &or 7hichonly symptomatic treatment isa6aila!le.
PD treatment may alter GU &unctionitsel& parado8ically.
Treat PD related symptoms
Treat non PD related symptoms:prostatic enlargement
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Dia!etes = UI
O Detrusor dys&unction uninhi!ited contractions< cystopathy
O #yperglycemia > osmotic diuresis and polyuria
O Medications
O Constipation
O %unctional impairment amputation
O Cogniti6e impairment 6ascular dementia
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Dia!etic cystopathy
(. decreased !ladder sensation
*. decreased !ladder contractility
,. increased !ladder capacity
-. detrusor o6eracti6ity
. urinary incontinence
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5hat is Erectile Dys&unction
ynonym' Impotence
Ina!ility to attain and maintain anerection sucient &or satis&actory
se8ual per&ormance
)enign
igni?cant impact on 9uality o& li&e
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Epidemiology
Incidence and pre6alence is high7orld7ide
Eects up to *F o& men :-4>04yrs;
teep age>related increase.Complete impotence &rom F o& -4yrolds to (F o& 04yr olds
nly (4>*4F solely psychogenic
Ri k & t E d th li l
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Risk &actors Endothelial
Dys&unction
urrogate marker &or ED'
edentary li&estyle
!esity
moking
#ypercholesterolaemia
Meta!olic syndrome Dia!etes mellitus
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Betiology
rganic
#ormonal
Bnatomical
Drugs
Psychogenic
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rganic causes
ascular &actors :CD
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acuum de6ices
Third line treatment Penile
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Third>line treatment > Penile
Prostheses
emi>rigid rods
* piece inLata!le prosthesis
, piece inLata!le prosthesis 7ith a!dominalreser6oir
Risks In&ection
Destroys corpora ca6ernosa
Erosion and e8trusion
Mechanical &ailure
P il P th i
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Penile Prosthesis
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#:AN;