Problems with Urination CAPT Mike Hughey MC USNR

Problems with Urination CAPT Mike Hughey, MC, USNR Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide

Cystitis Video • 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 Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 2

Gonorrheal Urethritis • Burning, frequency, tender urethra • Purulent discharge from urethra/Skene's • GC culture • Cephtriaxone 250 mg IM, plus Doxycycline 100 mg PO BID x 7 days • Treat partner Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 3

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, or Clindamycin 150 mg TID x 7 -10 days • Treat sexual partner Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 4

Herpes Vulvitis • Severe pain when urine passes over the vulva • Multiple tiny blisters/ulcers • Zovirax 200 mg PO Q 4 hours while awake x 10 days • May need Foley cather • Try urinating into bathtub • Will resolve within 5 -10 days Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 5

Causes of Urinary Frequency • Bladder infection (with dysuria) • Excessive fluid intake (particularly at night) • Increased stress • Pelvic mass • Pregnancy Naval Hospital Camp Le. Jeune Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 6

Evaluation of Urinary Frequency • Palpate for bladder tenderness (inf) • Palpate for pelvic mass • Urine culture (dipstick OK) • Pregnancy test Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 7

Blood in the urine • Usually due to cystitis • If it persists or returns, then Urology consultation necessary to r/o: -Renal stones -Bladder tumors -Endometriosis • Microscopic hematuria most commonly due to exercise in this age group Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 8

Bad odor to the urine • Either cystitis or vaginitis • Look for: -Lost and forgotten tampon -Yeast -Trichomonas -Bacterial vaginosis -Asparagus eating -Ampicillin intake Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 9

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 Video • Rule out: -pregnancy -pelvic mass -pelvic trauma -herpes Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 10

Forms of Urinary Incontinence • Stress incontinence • Irritable bladder • Loss of urine at unpredictable times Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 11

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 Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 12

Irritable Bladder • Local problem • Sudden urge to urinate • Eliminate caffeine, tobacco and alcohol • Double voiding • Antibiotics • Will need consultation Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 13

Urethral Diverticulum • Local problem • Unexpected loss of urine on rising • Will need consultation • Surgery is curative • Nothing else helps Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 14

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 Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 15

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 Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 16

Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 17