TO PEE OR NOT TO PEE THAT IS THE

QUESTION

Shawn McGlew PA-C, DFAAPAKennebec County UrologyManchester/Oakland, ME

Shawn McGlew PA-C, DFAAPAKennebec County UrologyManchester/Oakland, ME

Pre-Test T or F

Incontinence is natural part of aging for women not men.

Renal ultrasound is the best imaging study for stones.

A high sodium diet is the number one reason for stones.

Finasteride is a first line treatment for BPH.If CT sees a stone no further imaging is needed.Renal U/S is the most cost effective for hematuria.

• I can’t pee.• I pee to much. • It hurts.• I’m peeing blood.

• Prostate• Strictures• Poor pelvic floor relaxation• Other pathology

• Incomplete bladder emptying• Hesitancy• Nocturia• Urgency with or without leaking• Frequency• Pelvic pain

Evaluation:•U/A•PE / DRE•PSA•PVR•Cysto and/or UDS +\-

TREATMENT:•Conservative – voiding techniques•Alpha Blockers•5 Alpha Reductase Inhibitors•CIC•Foley•SP tube

Alpha Blockers:•Tamsulosin (Flomax)•Terazosin (Hytrin)•Doxazosin (Cardura)•Silodosin (Rapaflo)•Alfuzosin (Uroxatral)

5 Alpha Reductase Inhibitors:•Blocks Testosterone conversion to DHT in the prostate.•Not first line•Consider PSA (getting it and correction)•Side effects - breast tender/enlarge, low vol. ejaculate.

Others:•Combinations – Jalyn (Dutasteride / Tamsulosin•Tadalafil (Cialis) low dose daily•CIC•Foley, SP Tube•Surgery - TURP

CICClean Intermittent Catheterization

Foley Cath

SP Tube

History & physical – voiding history, foods, liquids, stress.PVR, U/A

Treatment: AUA Guidelines

Behavioral changes, Bladder training, Physical Therapy, Trial ACh medication

Work-up if not improved – Cysto, UDS, CT +/-

Other treatments: Beta 3 agonist, Neuromodulation, Botox

Anticholinergics:•Oxybutynin (Ditropan)•Tolterodine (Detrol)•Fesoterodine (Toviaz)•Trospium (Sanctura) •Solifenacin (Vesicare)•Darifenacin (Enablex)•Flavoxate (Urispas)

Beta 3 Agonist: •Mirabegron (Myrbetriq) –

Relaxes bladder during filling

Side Effects:•Dizziness•Dry mouth•Constipation•Urinary retention

•Contraindicated in narrow angle glaucoma

Leaking with cough, sneeze, laughing, getting up.

Treatments:•Behavior modification – timed voids, diet, fluids•Absorbent pads•Kegels•Periurethral bulking therapy•Surgery

Presentation: Classic, not so classicComposition: Ca, Ox, Phosphate, uric acid,

struvite (magnesium ammonium phosphate) Prevalence: 1 in 8 will develop stone by age 70 and usually before 50Think about stone with recurrent UTIs due to:

Klebsiella, Proteus, Pseudomonas, Enterococcus.

Work up: imaging > CT vs KUB vs RUSTreatment: Flomax, ESWL, Ureteroscopy, PNL, Prevention: 24 hour urines, hydration, low Na, low Ox, hydration.

Hydration, Hydration, Hydration….

Urine SG > 1.010

Gross: not disgusting… You can see it. Microscopic: more than 3 RBC /HPFSmokers: bladder cancer risk x5Etiology: Stones, infection, kidney disease, prostate, neoplasm.Pathology: benign, malignant.Work up: 3 C’s Follow up for negative evaluation: U/A micro, cytology 3 years