Treat and Prevent UTIs Without Drugs

UTI-Be-Gone Ebook

UTI Be Gone is a new program that provides people with natural remedies, techniques, tips, and detailed instructions on how to beat their urinary tract infection quickly. In the program, people will discover a lot of healthy foods that support them in the urinary tract infection treatment process. In addition, the program is designed by Sherry Han, who suffered from urinary tract infection for many years. Using antibiotics is not a good way to treat urinary tract infections since bacteria will boost resistance against antibiotics after each use. The only way to treat urinary tract infections permanently is to do that the natural and effective way. With UTI Be Gone, sufferers will know how to alleviate their problems once and for all. The program is designed to be suitable for those who want to eliminate their urinary tract infection without any medication. Buying the program, people will get a lot of instruction books from the author such as the UTI Be Gone-Beat Urinary Tract Infections 100% Naturally book, the Secrets Of Organic Foods book, and theHealth Secrets Of Water book.

Uti be gone Natural Urinary Tract Infection Cure Overview

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Signs And Symptoms Of Urinary Tract Infections

Pain, a primary symptom associated with urinary tract infection, involves the kidneys, the ureter, and the bladder. Kidney pain will be manifested as a dull ache in the flanks extending along the rib margin toward the umbilicus. (The flank is the side of the body between the ribs and the pelvis.) In the ureter, pain radiates from the costovertebral angle down the course of the ureter to the scrotum or vulva to the inner thighs. During urination, the individual experiences bladder pain that radiates to the distal urethra.

Laboratory Procedures For Urinary Tract Infections

Common laboratory procedures for urinary tract infection include the following routine analysis, culture sensitivity, blood tests, cystoscopic examination, and X-ray procedures. b. Specimens. Culture and sensitivity (clean catch) specimens are taken to determine specific agents in infectious diseases of kidneys, ureters, and bladder. Good cleaning techniques are essential, especially in women. In such cases, void and collect midstream urine in a sterile cup. The patient can be catheterized (in and out catheterization), but this is the last resort because of increased incidence of introducing UTIs with catheterization. Specimens must be sent to the laboratory as soon as possible and refrigerated, if needed.

Etiology Of Urinary Tract Infections

The cause of urinary tract infections (UTI) can be traced to the presence of infectious microorganisms located anywhere between the kidneys and the urethral opening. The common pathogens are the gram-negative bacilli, often found in the colon, especially E. coli, klebsiella, and proteus. Microorganisms acquire access to the kidneys by ascension from the lower urinary tract beginning at the urethra. Bacterial infections of the lower urinary tract occur about 10 times more frequently in females than in males. A common cause of urinary tract infection in females is an improper wiping technique. b. Predisposing Factors. Factors which predispose an individual to UTI include sex, stasis of the urine, instrumentation, and neurogenic bladder. (1) Sex of the individual. Urinary tract infections are common in females of all ages because the female urethra is short. Additionally, large numbers of pyogenic bacteria (pus-producing bacteria) inhabit the vaginal...

Cystitis

Definition Signs Symptoms of Cystitis. Inflammation of the bladder, called cystitis, is ten times as frequent in women as in men. Part of the reason may be that the female urethra is very short compared to the urethra of the male. Bacteria (for example, colon bacilli) ascend from the outside through the urethra into the bladder causing cystitis. The most common symptoms of cystitis are pain, urgency (a feeling of needing to void although the bladder is not full), and frequency of urination. b. Interstitial Cystitis. Interstitial cystitis is a type of cystitis in which the tissues below the mucosa are inflamed. Symptoms include pelvic pain with discomfort before and after urination. This disease can be diagnosed only with the use of a cystoscope (a kind of endoscope). c. Etiology of Cystitis. Causes of cystitis can be traced to the following (1) Bladder infection caused by the infecting organism ascending through the urethra. Such infections are more common in females, especially...

General Precautions

Aseptic technique is essential. Each catheterization is a potential source of infection if not carried out properly. Most cases of cystitis that develop after catheterization are caused by improper catheterization technique. Cystitis is difficult to cure and causes increased pain for the patient.

Abnormalities Of Fillingstorage And Emptying Overview

The pathophysiology of failure of the lower urinary tract to fill with or store urine adequately may be secondary to reasons related to the bladder, the outlet, or both. Hyperactivity of the bladder during filling can be expressed as phasic involuntary contractions, as low compliance, or as a combination. Involuntary contractions are most commonly seen in association with neurologic disease or following neurologic injury however, they may also be associated with aging, inflammation or irritation of the bladder wall, bladder outlet obstruction, or they may be idiopathic. Decreased compliance during filling may be secondary to neurologic disease, usually at a sacral or infrasacral level, but may also result from any process that destroys the viscoelastic or elastic properties of the bladder wall. Storage failure may also occur in the absence of hyperactivity secondary to hypersensitivity or pain during filling. Irritation and inflammation can be responsible, as well as neurologic,...

Treatment of Early Localized Prostate Cancer

Probably because of the slow turnover rate of prostate tumors 8 . This suggests that prostate cancers may be particularly sensitive to hypofractionation and that using larger fraction sizes could result in greater cell kill. In addition to the possible radiobiological gains, other benefits to hypofractionation include shorter overall treatment times and a smaller number of hospital visits, which increases patient convenience and reduces resource utilization. The side effects of EBRT can be divided into acute and late reactions. Acute reactions start about halfway through a course of treatment and principally involve the bladder (cystitis) and bowel (proctitis, occasional enteritis). These effects normally settle with conservative management within 4 to 6 weeks of the end of treatment. Rarely, severe acute side effects may necessitate a break in treatment, but it is unusual for acute effects to be dose limiting in practice. It is rare for patients to experience significant skin...

Prostate Brachytherapy

Almost all patients develop urethritis of variable intensity which may last for 3 months. Symptoms may be helped by alpha-blockers and nonsteroidal antiinflammatory drugs. A minority of patients (15 ) develop acute retention either immediately or in the few days following implantation. This is usually due to postimplant edema and requires catheterization. In most patients, micturition resumes within 2 weeks as edema resolves, although recovery may occasionally take longer. Long-term effects include persistent cystitis and prostatitis (3 ), proctitis (2 ), and impotence (25 ). The risk of urinary incontinence is small ( 1 ) unless patients have had a previous TURP.

Prophylactic Antibiotic Administration

Most centres use prophylaxis with a cephalosporin 24 h peri-operatively. Prolonged treatment is saved for cases with known infectious focus or when infections are diagnosed. In addition to skin infections and graft infections, the vascular patient is at risk of pulmonary infection (see below) and urinary infection after urethra catheteriza-tion. For open abdominal aortic surgery, postoperative septicaemia may be one of several possible complications 23 . There is no evidence that prophylactic treatment with antibiotics peri-operatively prevents postoperative septicaemia.

Cisplatin Side Effects

ID CC A 40-year-old male who has been diagnosed with pemphigus vulgaris complains of dysuria and increased urinary frequency. Treatment Maintain good hydration and HCOs loading -amino caproic acid and mesna may prevent hemorrhagic cystitis. Discussion Cyclophosphamide is an alkylating agent that covalently crosslinks DNA at guanine N-7 and requires bioactivation by the liver. It is used for lymphomas and for breast and ovarian carcinomas. Complications of cyclophosphamide use include hemorrhagic cystitis, bladder fibrosis, and bladder carcinoma sterility alopecia and inappropriate ADH secretion. Cyclophosphamide needs to be converted to an active toxic metabolite, acrolein, which is responsible for producing hemorrhagic cystitis.

Clinical Course and Manifestations in Patients Who Receive Antimicrobials

The approximate frequencies of symptoms and signs expected to be found in hospitalized patients in endemic areas of the developing world are summarized in Tables 17-3 and 17-4. Before hospitalization, most of these patients will have been ill for 6 to 12 days, most will have seen a healthcare provider at some point, and most will have received short courses of antibiotics. Fever is universal and, although present daily, is usually higher in the late afternoon and evening. Chills and dull frontal or diffuse headaches are common. The headaches often prevent patients from sleeping comfortably. Most patients are anorectic. They complain of abdominal pain, but cannot localize it well. Both diarrhea and constipation are common normal bowel function is unusual.50,77 Children frequently have diarrhea. Bloody dysentery is occasionally encountered. The incidence of cough and chest discomfort varies considerably. Sore throats are common during the first week of illness, but less common later....

B Dengue Fever Dandy Fever Breakbone Fever

A variety of procedures may ensure a successful outcome although specific therapy is not available. The reduction of intracranial pressure (by using mannitol or a urea), con-trolling convulsions, administration of oxygen, maintenance of the airway, and providing adequate nutrition during prolonged coma are measures that have proven to be effective. The conventional IV nutrition may continue for 72 hours, but must be replaced by a nasogastric tub or intestinal feedings. It is important to begin treatment early for prevention of decubiti, urinary tract infection, and pneumonia. If necessary, administer anticonvulsants.

Intravesical Therapy and Dose Scheduling

As well as longer induction courses 67 . Although one review of 14 such trials 68 suggested that response rates were maximized with additional BCG courses and led to a more durable long-term advantage over single-induction regimens, only one randomized study has proven any (statistically significant) advantage for progression. The SWOG 8507 study 69 showed a disease-free improvement from 40 to 61 and a 6 reduction in the rate of surgical intervention in patients receiving 3-week maintenance instillations at 3 and 6 months and every 6 months thereafter over 3 years. However, only 16 of the 243 patients were able to tolerate the complete 3-year regimen due to the local side effects. Overall, only a third to one half of the patients in these studies were able to tolerate regular BCG instillations due to the cumulative BCG-induced cystitis 68,69 . The toxicity of maintenance regimes (consisting of up to 27 instillations over a 3-year period) has also been addressed by the EORTC-GU group....

Overview of Urine Studies

Catheterized specimens are collected if there is concern for specimen contamination or when voiding is difficult as with obstruction and severe urinary tract infection. The straight catheter method is accomplished by inserting a sterile, lubricated catheter into the urinary bladder and collecting the urine. For patients who have an indwelling catheter, commonly called a Foley catheter, the urine specimen must not be collected from the urinary drainage bag. The indwelling catheter is equipped with a specimen collection port that allows urine to be collected with a syringe before it reaches the drainage bag.

Prevention of chronic disease

Cessation of menses Vaginal dryness Bladder infections More frequent yeast infections Urinary frequency Stress incontinence Intestines Although it is a large, well-conducted clinical trial, the WHI does not answer all clinically pertinent questions. Not all WHI participants began EPT or ET during the perimenopausal or early menopausal period, the usual time for women to initiate these drugs. Many study participants began these hormones in their seventh and eighth decades, when they had established (if unrecognized) heart disease. In addition, only one type of estrogen and one type of progestin were studied, and only one regimen (daily fixed oral administration of both estrogen and progestin) was studied. Whether the risks would be the same if different types of hormone, for example estradiol compared with conjugated estrogen, were utilized is not known. Because transdermal estradiol tends not to raise triglyceride levels, not to affect clotting, and not to cause cholelithiasis, as...

Technique and radiation

The main contraindication is the presence of a concurrent UTI. In addition, due to edema and risk of subsequent scarring following instrumentation, contrast studies are best deferred for at least 6 weeks post-surgery. The catheter balloon is distended with 2 mL of water to provide a seal. If the balloon is not utilized, a penile clamp over the penile tip can be employed to provide external occlusion

Vesicoureteral Reflux

A 2-year-old girl presents with urinary tract infection. She has had multiple urinary tract infections since birth but has never had any follow-up studies to evaluate these infections. Physical examination is remarkable for an ill-appearing child who has a temperature of 40 C and is vomiting. Risk Factors Etiology. Vesicoureteral reflux is caused by congenital incompetence of the vesicoureteral junction and may be familial. Urinary tract infections are more common in uncircumcised boys. There is incompetence of the junction from infection and obstruction. This incompetence exposes the kidney to increased pressure during voiding and predisposes the patient to urinary tract infections. Vesicoureteral reflux is a common cause of hypertension in children and may lead to renal scarring. Reflux is seen in 50 of boys with posterior urethral valves. Presentation. Vesicoureteral reflux is usually found during an evaluation for urinary tract infection. Treatment. Vesicoureteral reflux may...

Summary And Conclusions

Finally, the panel believed that establishing a registry of patients undergoing uterine artery embolization could provide non-experimental data on the risks and benefits of UAE, as well as provide data on patient selection, technique, and diffusion of the procedure throughout the country. Such a registry would collect answers to a standard panel of questions about the radiologist performing the procedure, technique, patient demographics, symptoms, and long and short term outcomes (including complications). The utility of a registry could be increased by soliciting data on a comparison group, either women with uterine myomata who do not undergo UAE (i.e., have either standard interventions, or no intervention), or with an unselected population of women in similar demographic strata. This type of registry would be relatively less costly to implement than a randomized trial, and would provide information more rapidly than an RCT, albeit with less reliability and validity due to the use...

Implantation Of Theartificial Sphincter In

The most precise way to diagnose erosion is with urethroscopy. Patients may present urinary tract infection (UT1), perineal pain, irritative voiding symptoms, or pain and induration at the pump. These findings warrant consideration of possible erosion. Almost all cases of erosion should be managed by removal of the entire prosthesis. Occasionally, if identified early and associated with sterile urine, only the cuff may need to be removed. The authors recommend this practice with great caution, as in our experience we have never been able to successfully salvage a sphincter in these circumstances. A repeat sphincter may be implanted after 4-6 mo. It is imperative that patients be instructed to carry medical identification cards and or bracelets as one of the most common causes of erosion is instrumentation of the urethra The use of pubovaginal slings in the management of female stress urinary incontinence (SUI) is well-established. The use of slings in male patients has been previously...

Pathogenicity Of The Genus Escherichia

Escherichia coli is one of the most abundant species of bacteria represented in the normal intestinal tract. In this region, the organism contributes to normal function and nutrition. E. coli and other enteric saprophytes become pathogenic when introduced into tissues outside the intestinal tract, especially the urinary and biliary tracts, peritoneum, or meninges. E. coli more frequently invades the urinary tract and is the most common cause of cystitis. The organism has also been isolated from local infections such as conjunctivitis. E. coli may also be the cause of septicemia. A number of E. coli serotypes have been associated with infant diarrhea, and when E. coli is isolated from pediatric patients, it should always be serotyped.

Pathogenicity Of The Genus Proteus

Of the genus Proteus, four species are recognized--Proteus vulagaris, P. mirabilis, P. morganii, and P. rettgeri. Although these organisms are primarily free-living in water, soil, and sewage, they are frequently isolated from fecal specimens of normal individuals. Proteus morganii has been responsible for diarrhea of infants and children. Proteus species often cause human infections and usually do so when introduced into tissues other than the normal intestinal tract. In this connection, Proteus species rank next to E. coli as the etiological agent of cystitis. These organisms are also encountered frequently in eye and ear infections and occasionally in pleurisy, peritonitis, and suppurative abscesses in many areas of the body. Proteus are commonly associated with other bacteria in purulent wounds and may contribute to the severity of such infections.

Infections of the Genital Tract in

Chlamydial infection of the urethra results in the development of NGU. C. trachomatis is the causative agent in approximately 50 of cases of NGU, while other possible causes include Mycoplasma genitalium and Ureaplasma ure-alyticum. Clinically, chlamydia-positive and chlamydia-negative NGU cannot be differentiated on the basis of signs or symptoms. The incubation period of NGU (including chlamydial urethritis) is longer than that of gonorrhoea, varying from 1 to 3 weeks in the majority of cases, and the onset of symptoms of NGU is more insidious. These symptoms include dysuria, appearance of a clear or white urethral discharge, and occasionally frequency of micturition. Many patients may be asymptomatic or minimally symptomatic, which results in prolonged periods when they may be infectious to their sexual partner. Despite these mild manifestations, it is often difficult to differentiate between gonococcal and chlamydial infections on clinical grounds alone and, indeed, the two...

Infections of the Genital Tract in Women

The endocervix is the most common site of infection with C. trachomatis in women. In many cases, the infection may be completely asymptomatic. However, those with symptoms may complain of vaginal discharge, dysuria, or lower abdominal pain. On examination, the cervix may appear normal or may be severely eroded with follicular hypertrophy and an associated mucopurulent endocervical discharge. Likewise, chlamydial infection of the urethra in women may either be asymptomatic or associated with urethral symptoms such as dysuria and frequency. C. trachomatis has been implicated in over 60 of cases of the so-called acute urethral syndrome in women. The infection is characterized by the presence of urethral symptoms together with a sterile pyuria.27

Pathogenesis of Infection

Techniques in the operating room and contact of the graft with patient's endogenous flora harboured in lymphatics rupturing intraoperatively, sweat glands or mucosas. Additionally, pre-existing bacterial colonization within atherosclerotic plaques, aneurysms or thrombi may act as a source of pathogens. Bacteria find their way to the host, despite careful technique and attempted sterility, and recent studies have shown that a sterile wound is almost impossible to achieve, even under laminar air flow conditions 90 . Less frequently, the implant is inoculated by bacteria through the haematogenous or lymphatic route, during bacteraemia from a remote source of infection (pneumonia, urinary tract infection, infected central catheter, infective endocarditis). In late graft infections from virulent pathogens (e.g. Staphylococcus aureus), transient bacteraemia in combination with decreased immune response of the host may play a significant role 7, 10 .

Classification Of Cystoplasty

Substitution cystoplasty is an operation whereby a significant amount of bladder wall is resected prior to incorporating an intestinal segment with the bladder remnant. This procedure is used commonly in hypersensitive bladder states such as interstitial cystitis. The bladder is usually resected to its trigonal remnant and an isolated intestinal segment is then substituted for the resected bladder.

Indications For Augmentation Cystoplasty

The major indications to perform enterocystoplasty have changed considerably since the early 1950s. Antituberculous drags have significantly decreased the end-stage manifestations of tuberculous cystitis, and, therefore, bladder reconstruction is rarely needed. In contemporary times, cystoplasty is now performed for detrusor hyperactivity resulting from such entities as poor bladder wall compliance, refractory detrusor instability or hyperreflexia, and a structurally reduced bladder capacity owing to inflammatory disease. Regardless of the etiology, these bladders are contracted and bladder capacity reduced, resulting in the symptoms of frequency, urgency, and urge incontinence. As noted earlier, the majority of patients with bladder overactivity and or impaired detrusor compliance respond to anticholinergic agents however, end-stage inflammatory bladders, particularly with thick-walled fibrosis do not, and surgical intervention is often necessary. In addition to the bladder other...

Treatment and Outcome

Due to its rarity, there is little information regarding the optimal treatment of primary bladder lymphoma. Cases of primary MALT lymphoma of the bladder reported in the literature have been variably treated with transurethral or radical surgery, radiotherapy, or chemotherapy, alone or in combination. In keeping with MALT lymphomas at other sites, the outcome has been favorable in almost all cases, with very few lymphoma-related deaths reported 53-57 . Some have recommended radiotherapy as the treatment of choice for localized cases 2,61 . Interestingly, similar to the ability of antibiotic-mediated H. pylori eradication to cure many gastric MALT lymphomas 58 , two primary MALT lymphomas of the bladder have resolved after Helicobacter eradication therapy or antibiotics for chronic cystitis 62,63 . Several case reports and small series have also reported good outcomes for localized DLBCL treated with radiotherapy or chemotherapy with or without surgical intervention 54,55 . In...

Extent of Bladder Resection and Preparation

The extent of bladder resection, if at all, is determined by the pathology of the underlying disease for which cystoplasty is being performed. Patients with an overactive detrusor owing to neurologic or non-neurologic disease may benefit from simple augmentation without bladder resection. In this situation the bladder is incised, either sagittally or longitudinally, and a segment of detubularized bowel is incorporated into the valved bladder. Partial or supratrigonal cystectomy is recommended when the bladder is structurally diseased or symptomatic as in interstitial cystitis, or in those cases in which the bladder diverticulae are present or when the bladder is extremely thick-walled.

Clinical and Radiological Features

The majority of patients present with urinary symptoms, including dysuria and hematuria 87 , and over 50 have metastatic deposits at the time of diagnosis in the lymph nodes, bone liver, or lung 88 . In rare cases, the secretion of neuropeptides by the tumor cells may also lead to paraneoplastic symptoms such as peripheral neuropathy and electrolyte abnormalities including hypercalcemia and hypophos-

Clinical Features

In hollow organs such as the bladder or vagina, the tumor grows in a polypoid fashion into the lumen of the viscus, producing a characteristic appearance resembling a bunch of grapes on endoscopic and ultrasonic examination 117 . Vesical rhabdomyosarcoma commonly presents with urinary symptoms, including hematuria, dysuria, and obstruction to urinary flow.

Radiologic evaluation

For a first or occasional UTI, no radiological evaluation is needed. In a woman with recurrent UTIs or pyelonephritis, further evaluation is essential after the UTI is cleared and the urine is proven sterile. In retrospective studies of women in urology clinics, between 5 and 21 of women with recurrent UTIs had abnormal urinary tracts.45 In one retrospective study of radiological studies in women with pyelonephritis severe enough to require hospitalization, more than 20 had abnormal urinary tracts or previously undiagnosed kidney stones.46

Simple or first infection

Once a UTI is suspected, the treatment is an empiric course of antibiotics. The length of treatment has shortened from ten days to one to five days (Table 21.7). Table 21.8 Single-dose treatment for simple urinary tract infection Table 21.8 Single-dose treatment for simple urinary tract infection One-day treatment has been suggested (Table 21.8), but this is less effective than 10-14-day treatment. Three-day treatment is usually effective in curing simple UTIs. For severe pain, pyridium (100-200 mg three times daily, orally) may be used as an adjuvant for one to two days. Pyridium is a bladder anesthetic and relieves the dysuria immediately. However, it should not be given to patients with renal failure or for more than two days. Patients should be reminded to continue to take the antibiotic, even if the pain is gone. Patients should be advised that pyridium turns urine, and sometimes even sweat, bright orange. Approximately one-quarter of women will have a second UTI within six...

Urinary Schistosomiasis

A 25-year-old sexually active woman presents with burning during micturition ( DYSURIA), increased frequency and urgency of micturition, and low-grade fever. Enterobacteriaceac like E. coli, Klebsiella species, and Proteus and Pseudomonas species are the most common organisms causing UTI. After E. coli, S. saprophytics is the most common cause of primary nonobstructive UTI in sexu ally active young women.

Prevention of recurrent infections

There is a variety of methods with a variety of strength of evidence suggested for the prevention of recurrent UTIs. Clinical Evidence (IV) found no systematic reviews on prevention of recurrent UTIs. Other methods include dietary, hormonal, and mechanical treatments. Ingestion of more water, Lactobacillus juice, and cranberry or other juices has been suggested for the prevention of recurrent UTIs. One RCT of 150 women found that 50 ml of cranberry-ligonberry concentrate reduced recurrences by approximately 50 while ingestion of Lactobacillus GG juice had no effect.30 In menopausal women, supposed urethral and periurethral tissue laxity has been treated with topical and oral estrogens. These hormones are supposed to increase the strength and tone of the urethral tissues, promoting more effective bladder emptying. Estrogen vaginal cream has been used two to three times a week. A small RCT found that women with recurrent UTIs who used the Estring, the vaginal estrogen-embedded ring with...

Indications of upper tract disease and need for hospitalization

Although dysuria, polyuria, and nocturia are primarily symptoms of lower tract disease, they can also occur with upper tract infection or pyelonephritis. CVA or flank tenderness can occur in both, but fever, chills, nausea, and vomiting are more likely to occur in pyelonephritis. In women with pyelonephritis, the white blood cell (WBC) count is likely to be elevated. WBC casts are diagnostic for pyelonephritis but are rarely seen. There is no test that determines or detects upper tract versus lower tract disease. If symptoms of pyelonephritis occur or a woman with a simple UTI does not improve with three- or five-day therapy, then 10-14-day therapy is indicated. 39 Kontiokari, T., Sundquist, K., Nuutinene, M., et al. Randomised trial of cranberry ligonberry juice and Lactobacillus GG drink for the prevention of urinary tract infections in women. Br. Med. J. 2001 322 1571. 40 Hooton, T. M., Scholes, D., Hughes, J. P., et al. A prospective study of risk factor for urinary tract...

You Should Have Completed Approximately 25 Questions and Have 30 Minutes Remaining

A 19-year-old woman presents with severe right-sided flank pain accompanied by fever, shaking chills, dysuria, and frequency. She is sexually active with one partner and always uses condoms. Her last menstrual period was 5 days ago. On physical examination, her temperature is 103.8 F and her heart rate is 120 beats min. Blood pressure and respirations are normal. Abdominal examination reveals suprapubic tenderness with palpation. The patient complains of pain when percussion is performed with the ulnar surface of the fist over the right costovertebral angle (CVA). Pelvic examination is normal. Which of the following is the most likely diagnosis b. Acute cystitis

Followup Prevention Of Complications

Urinary-tract infections are the most common urologic complication in patients with spinal-cord injuries (77). All urinary infections in these patients are considered complicated because an uncomplicated infection is defined as community acquired without structural or neurologic abnormalities. UTIs are responsible for many uroseptic episodes in the SCI population. Many risks exist including instrumentation, intermittent catheterization, stones, urethral strictures, benign prostatic hyperplasia, and detrusor external sphincter dyssynergia. Other causes include bladder overdistention, vesicoureteral reflux, large postvoid residuals, and high voiding pressures. The aim in management is to prevent, not to treat. This is best done by ensuring the well-being of the patient, providing adequate urinary drainage, and preserving healthy bacterial commenseral environment. Antibiotics should only be used during episodes of clinical infection, not asymptomatic bacteriuria. Asymptomatic bacteriuria...

Two Stage Meshgraft Urethroplasty

Mesh Graft

The classical two-stage methods developed in the 1950s, represented here by the Bengt-Johanson procedure, were based on marsupilization of the restricted urethra, followed by a second operative stage after the first stage had healed. All these methods used scrotal or peri-neal skin for reconstructing the urethra. Bengt-Johanson's great achievement was the development of a reconstructive-surgery urethral treatment that is suitable for all types of strictures. However, the drawback of this method was that hair growth occurred because scrotal and perineal skin was used, which could lead to chronic urinary tract infection, abscesses, calculi, and fistulas. Scrotal skin, which is extremely elastic, often resulted in the formation of diverticula and sacculations in the neourethra.

Endoscopic Urethroplasty

Metal Sounds For Urethral Dilatation

Complications included hemorrhage requiring transfusion in one patient and persistent (6 and 8 weeks) urinary tract infection in two patients. The mean hospital stay for realignment was 6 days (range, 3-18 days). The median follow-up is now 81 months (40-194 months). Potency was good in seven of ten (70 ) patients and moderately impaired in one. Continence was preserved in all patients.

Parasitic Infections Trichomonas

The primary symptom of Trichomonas vaginitis is severe pruritus, irritation, and, often, vulvar dysuria, accompanied by a grossly and microscopically purulent vaginal discharge. Sometimes, pelvic pain is present. The severity of disease varies widely, with some patients exhibiting fairly mild symptoms and signs. The infected male partner is usually asymptomatic. A physical examination reveals deep redness of the introitus, vagina, and cervix, classically but nonspecifically and unpredictably producing a strawberry cervix.'' This finding is characterized by a red cervix covered with monomorphous, discrete, bright-red, tiny papules. Vaginal secretions are most often described as yellow and frothy. Microscopically, vaginal secretions show small (about the size of white blood cells), rapidly moving, teardrop-shaped, flagellate organisms that quickly lose motility and distinctive shape as they cool. In addition, very large numbers of neutrophils are present and lactobacilli are absent,...

Longterm Urologic Management

The use of a chronic indwelling catheter is never desirable because of its complications including epididymitis, urethrocutaneous fistula, traumatic hypospadias, and squamous cell carcinoma. Yet, chronic catheterization remains the most common form of management in patients who are tetraplegic and bedridden. Many female patients, unable to use an external collecting device, are managed with catheter drainage because they fail pharmacologic therapy and or have limited hand function. McGuire followed 35 women managed with either an indwelling catheter or CIC for 2-12 yr following spinal-cord injury and found a significant reduction in the incidence of autonomic dysreflexia, febrile UTIs, pyelonephritic scarring by I VP, and bladder stones in patients managed with intermittent catheterization. This same study showed 92 of women with long-term indwelling catheters eventually had incontinence around the catheter and 54 had urethral erosion, whereas none on CIC had these complications (51)....

Positively Worded Questions The Most Common Question Type

An 85-year-old man has had urinary frequency, difficulty initiating stream and dysuria for the last two months. A rectal exam reveals an enlarged prostate. Prostate-specific antigen (PSA) is riot elevated. Which part of the prostate is most likely affected in this patient's condition

Microscopic Analysis of Urine

Urine Micro Cope Cells

Increased numbers of transitional epithelial cells are seen in bladder infections. Clusters or sheets of these cells indicate a urinary tract lesion. Variations from Normal. Increased numbers of red blood cells can be seen in urinary tract and kidney diseases. Urinary tract infections or specimen contamination demonstrate an increase in white blood cells. stitial inflammation or infection and can distinguish an upper urinary tract infection from a lower urinary tract infection.

Inflammatory Dermatoses Eczema

Desquamative Inflammatory Vaginitis

Vulvo-vaginal-gingival LP principally affects the inner aspects of the labia minora, vestibule, and vagina the lesions are painful and itchy. Patients will complain of dyspareunia, dysuria and, if there is vaginal involvement, an increased vaginal discharge, and postcoital bleeding. Clinically, the vulvar lesions are eroded and have a distinctive fine white lacy border. The anal margin may also

Acute Tubular Necrosis

He also describes slow-onset dull pain in his left flank and blood in his urine. He was recently treated for recurrent UTIs, which were attributed to an enlarged prostate gland. His father died of chronic renal failure, and his paternal grandfather died of cerebral hemorrhage.

Obstetrics and Gynecology

The answer is b. (Fauci, 14 e, p 2102.) The patient is presenting with symptoms of normal menopause, which may include hot flashes, urinary frequency, dysuria, urinary incontinence, vaginal dryness, vaginal itchiness, and dyspareunia. Patients also have amenorrhea. Patients may become anxious or depressed during this time, but there is no evidence that personality or mood changes are due to menopause.

Microbiology Immunology

A 20-year-old woman presents with a 2-day history of dysuria and increased urinary frequency. She states that she was recentiy married and was not sexually active prior to the marriage. Physical examination reveals a temperature of 100.7 F with normal vital signs. Gynecologic examination reveals no evidence of discharge, vaginitis, or cervicitis. Urinalysis reveals 14 white blood cells per high-powered field with many gram-negative rods. Which of the following is the most appropriate pharmacotherapy

Pregnancy After Bladder Reconstruction

Pregnancy following enterocystoplasty is becoming more common as women who undergo bladder reconstruction for congenital problems enter their childbearing years. These women during their pregnancy could potentially have significant morbidity including febrile urinary infections, premature labor, urinary tract obstruction, and compromised renal function. Renal function should be monitored vigilantly in these women with monthly serum creatinines and, when indicated, renal ultrasonography. Hill and Kramer (38) recommend that those women

Homoeopathy Medicine For Bladder Infiltration Of Rectosigmoid Tumor

Testicles Undescended Adult

The wall (77) and lumen (38) of the urinary bladder can only be adequately evaluated when the bladder is full. An indwelling catheter (76) usually results in an empty bladder (Fig. 55.1), precluding any reliable evaluation. The catheter therefore should be clamped for an extended period to achieve filling of the bladder (38). When the edema of the bladder wall (77) is rather advanced, cystitis (Fig. 55.2) can also be recognized with the bladder empty.

Gastrointestinal Radiography

Cystography, a radiographic examination of the urinary bladder, is the best tool for examining primary bladder diseases and conditions. The bladder is filled with a radiopaque contrast medium, which allows for visualization of the bladder as it fills and empties. Fluoroscopy can be used to observe bladder function. Suspected primary bladder disorders indicate the need for cystography, while contraindications are urethral or bladder infection or injury.

Physical Analysis of Urine

The urine of an uncontrolled diabetic may have a fruity odor because of the presence of ketones. Infants with phenylketonuria (PKU), a metabolic disorder involving the amino acid phenylalanine, have a mousy or musty odor to their urine. Maple syrup urine disease, a metabolic disorder that can be diagnosed in infants, is characterized by urine that smells like maple syrup. Urine containing bacteria may present an ammonia odor, particularly if the urine is left unrefrigerated. A fresh urine specimen that has a foul order usually indicates a urinary tract infection.

Chemical Analysis of Urine

Blood in the urine is a nonspecific abnormal finding that may indicate infection or trauma of the urinary tract, or bleeding in the kidneys. Red blood cells in the urine can be an indication of bleeding somewhere along the urinary tract, which may be caused by urinary tract infection, trauma, neoplasms, or other urinary system abnormalities. Variations from Normal. The presence of white blood cells in the urine indicates urinary tract infection or inflammatory disorder. The nitrite urine test is a screening test that may indicate a urinary tract infection (UTI). This test may not be included in the routine urinalysis in all laboratories. Nitrites are found in the urine when nitrate, a substance normally present in urine, is converted to nitrites by the action of enzymes produced by gram-negative bacteria. Nitrites produce a chemical reaction in the reagent strip. A positive reagent test result should be verified by microscopic examination, or urine culture and...

Standard External Beam Radiotherapy EBRT

Scan Bladder Cancer

There is evidence that the a p ratio for prostate cancer may be as low as 1.5, comparable to late-responding normal tissues, probably because of the slow turnover rate of prostate tumors 8 . This suggests that prostate cancers may be particularly sensitive to hypofractiona-tion and that using larger fraction sizes could result in greater cell kill. In addition to the possible radiobiological gains, other benefits to hypofractionation include shorter overall treatment times and a smaller number of hospital visits, which increases patient convenience and reduces resource utilization. The side effects of EBRT can be divided into acute and late reactions. Acute reactions start about halfway through a course of treatment and principally involve the bladder (cystitis) and bowel (proctitis, occasional enteritis). These effects normally settle with conservative management within 4 to 6 weeks of the end of treatment. Rarely, severe acute side effects may necessitate a break in treatment, but...

Collecting and processing urine specimens

Urine Processing

Urine cultures (figure 1-8) are of value in diagnosing primary infections of the anterior urinary tract (urethritis), bladder (cystitis), and kidneys (nephritis). Urine cultures are also important in diagnosing certain systemic infections, for the etiological agents are often excreted via the urinary tract. Staphylococcus species, a Streptococcus species, and Neisseria gonorrhea are among the primary etiological agents of urethritis while Escherichia, Proteus, and occasionally Pseudomonas species are among the chief causative agents of cystitis. Any one or more of these organisms may be the cause of a bacterial nephritis. Yet, many of the above mentioned organisms may be a common urine contaminant. A medical officer usually does not make a diagnosis on the basis of one urine culture. Rather, repeated isolation of large numbers of a particular organism from a series of urine specimens is evidence for pathogenicity of the organism concerned.

Items 519 through 520

A 74-year-old man presents with the abrupt onset of pain in the left lower abdomen. The pain has been progressively worsening over the last 2 days. The patient states that the pain is unremitting. He has some diarrhea but no nausea or vomiting. He has no dysuria or hematuria. His temperature is 102 F. Bowel sounds are decreased. The patient exhibits involuntary guarding. There is tenderness and rebound tenderness when the left lower quadrant is palpated. The referred rebound test is positive. A fixed sausagelike mass is palpable in the area of tenderness. There is no CVA tenderness. Rectal examination reveals brown stool, which is FOBT positive. Bloodwork demonstrates a leukocytosis. Which of the following is the most likely diagnosis

Other possible applications of intravesical TRPV1 agonists

Trpv1 The Spinal Cord

Intravesical administration of capsaicin 6 or RTX 7 can prevent pain induced by acute bladder inflammation in the rat, as shown by the suppression of c-fos gene expression in the spinal cord. An eventual analgesic effect of intravesical vanilloids in pain generated by chronic inflammatory bladder conditions would, therefore, be extremely relevant in a clinical setting. Chronic inflammatory pain is frequently disproportional to the intensity of the stimulus and is more resistant to common analgesics than acute pain. To investigate the effect of intravesical vanilloids in chronic inflammatory pain at the experimental level, a rat model of chronic cystitis induced by cyclophosphamide was used 46 . Instillation of a 100 nM RTX solution in cyclophosphamide-inflamed bladders prevented spinal c-fos overexpression induced by physiologic bladder contractions (Fig. 4) 46 . In addition, increased micturition frequency accompanying bladder inflammation was analogously suppressed. The potential...

Overflow Incontinence After Lefort Surgery

The answer is d. (Scott, 8 e, pp 767-768.) As patients age, the incidence of vesicle instability or unstable bladder increases dramatically. Although estrogen has been reported to decrease urgency, frequency, and nocturia in menopausal women, its effect on correction of stress urinary incontinence or vesicle instability is unclear. In the elderly population there are also many transient causes of incontinence that the physician should consider. These include dementia, medications (especially a-adrenergic blockers), decreased patient mobility, endocrine abnormalities (hypercalcemia, hypothyroidism), stool impaction, and urinary tract infections. 394. The answer is a. (Scott, 8le, p 753. Rock, 8le, pp 1088-1089.) When patients present with urinary incontinence, a urinalysis and culture should be performed. In patients diagnosed with a urinary tract infection, treatment should be initiated and then the patient should be reevaluated. It is not uncommon for symptoms of urinary leakage...

Atrophic Vaginitis And Serosanguineous Discharge

The answer is b. (DiSaia, 5 e, pp 619-622.) Different tissues tolerate different doses of radiation, but the ovaries are by far the most radiosensitive. They tolerate up to 2,500 rads, while the other tissues listed tolerate between 5,000 and 20,000 rads. Acute evidence of excessive radiation exposure includes tissue necrosis and inflammation, resulting in enteritis, cystitis, vulvitis, proctosigmoiditis, and possible bone marrow suppression. Chronic effects of excessive radiation exposure are manifest months to years after therapy, and include vasculitis, fibrosis, and deficient cellular regrowth these can result in proctitis, cystitis, fistulas, scarring, and stenosis. (Hoskins, 2 e, pp 385-386, 393-394, 628-630.) Cyclophosphamide is an alkylating agent that cross-links DNA and also inhibits DNA synthesis. Hemorrhagic cystitis and alopecia are common side effects. Cisplatin causes renal damage and neural toxicity. Patients must be well hydrated. Its mode of action does not fit...

Clinical Manifestations

In men, gonococcal urethritis is the most common manifestation of infection. Following inoculation of the anterior male urethra, N. gonorrhoeae attaches to and infects columnar epithelial cells. The incubation period may range from 24 hours to 14 days, but 75 of men develop symptoms (dysuria and discharge) within 4 days of infection.20,21 Dysuria usually precedes the development of purulent discharge by approximately 24 hours. Although 90 of newly acquired infections are symptomatic, about 50 of all infections in the community have few to no symptoms.22 If left untreated, gonococcal urethritis usually resolves over the course of several weeks, with the majority of cases becoming asymptomatic within 6 months.23 The incubation period for gonorrhea is longer in women than in men but is usually less than 10 days. The clinical presentation is highly variable and includes vaginal discharge secondary to mucopurulent cervicitis (MPC), abnormal menstrual bleeding, and anorectal...

Hypertrophic Pyloric Stenosis

PE Abdominal exam shows no rebound tenderness (vs. peritonitis or appendicitis) guarding is present painful and difficult urination (dysuria) blood in urine (hematuria) patient is restless and keeps switching position (vs. peritonitis, in which patient lies still because of pain).

Is Livergen Suitable For Three Months Pregnancies

The answer is b. (Carr, 1 e, p 408.) Empiric treatment of simple UTI in pregnancy should consider the following coverage of probable organisms (usually Escherichia coli), possibility of complicating factors such as pyelonephritis or nephrolithiasis, stage of pregnancy, and relative contraindication to the antibiotic. The antibiotics listed all would cover suspected organisms in simple UTI of pregnancy. However, all but one of the antibiotics is contraindicated in pregnancy. Ciprofloxacin is pregnancy category D because of concern about cartilage formation in animal studies. Trimethoprim-sulfa is not the best choice in later stages of pregnancy because trimethoprim is a folate antagonist and is teratogenic in rats and sulfa drugs have increased risk of kernicterus in premature neonates. Tetracycline is avoided because of possibility of discoloration of teeth and

How does diabetes affect your kidneys

One of the substances that appear in the urine when the filters are damaged is protein and a particular protein called albumin appears in the urine at a very early stage of diabetic kidney damage. Albumin in the urine is also called albuminuria and a current test can detect the presence of very small amounts (microalbuminuria). The availability ofthese tests is one reason why you will be asked to provide a urine sample at each of your diabetic clinic visits, even if you are normally performing blood tests for glucose. Sometimes you may get a positive result from the albumin test, which may in fact be caused by a urinary infection. Your clinic will check your urine sample to exclude this.

Primary prevention and risk factors

The history often leads to the definition of type of UI (see below). The amount, frequency, and situations under which incontinence occurs should be discussed. Any inciting factors should be noted, such as exercise, sneezing, coughing, or sex. A gynecological and surgical history is important. Recent symptoms or changes, such as increased frequency, dysuria, hematuria, or nocturia, should be questioned. Medications and concomitant diseases, including diabetes, should be considered as causative factors. Recent changes in urinary symptoms tend to suggest medication effects or urinary-tract infections as the cause. A physical examination is necessary, but it rarely provides additional clues to diagnosis and treatment. A general and pelvic examination is sufficient. Pelvic examination may show prolapse or atrophic vaginal mucosa. Fever and suprapubic or costovertebral angle tenderness might be consistent with a urinary tract infection. Pelvic masses from tumors or cysts and uterine...

Medications for Inflammatory Conditions of the Bladder Causing Storage Failure

Interstitial cystitis (IC) is a syndrome whose pathogenesis and etiology remain a mystery. Even the diagnosis of this entity is difficult and considered one of exclusion. There are four currently proposed etiologies for this syndrome inflammation, vascular insufficiency, epithelial leak, and deficiency of proteoglycans (i.e., glycosaminoglycans-GAG-). Dimethysulfoxide (DMSO), after being approved for use in 1977, has been shown to induce remission in 35-40 of the patients (128) and is a mainstay of treatment (129). However, no controlled clinical studies have been performed. DMSO is a derivative of lignin, which is a product of the wood-pulp industry. Its therapeutic properties include anti-inflammatory properties, analgesic properties, collagen dissolution, muscle relaxation, and mast-cell histamine release. The usual dose is a 50 solution instilled for 5-10 min. This therapy can be used as a one time dose, repeated weekly for 6-8 wk, or continued weekly for 4-6 mo. Some even...

Complications and Unusual Manifestations

Typhi in the urine at some point during their illness.86,87 Transient proteinuria is the most common urinary abnormality and in some cases is due to an immune complex-mediated glomerulonephritis. On occasion the glomerulonephritis may present as renal failure or nephrotic syndrome, and in these cases the prognosis is poor. In severely ill patients, acute tubular necrosis may develop, and in patients with severe intravascular hemolysis, which may or may not be associated with glucose-6-phosphate dehydrogenase (G6PD) deficiency, renal failure can occur. Both pyelonephritis and cystitis also occur in typhoid patients.

Preoperative Evaluation

The preoperative laboratory evaluation is necessary to assess renal function and acid-base status. Serum creatinine, a blood urea nitrogen (BUN), and 24-h creatinine clearance are helpful measures to assess renal status, particularly in those individuals who may have renal insufficiency or chronic renal failure. Urinalysis and culture should be performed to identify urinary infection, which should be eradicated prior to reconstruction. Urinary cytology may be helpful in those patients with sensory urgency in order to exclude carcinoma in situ.

Immunomodulation

Cyclophosphamide is the preferred initial mode of treatment for patients with severe inflammation. It has proven to be highly successful in treating active OCP 12 . Patients are initially started on 2 mg kg day (all taken in the morning). An increase in dosage is based on a combination of factors, including presence of any side-effects, and bone marrow tolerance. Patients are monitored with a complete blood count every 4 weeks leukopenia is an expected side-effect when therapeutic levels have been reached. The dosage is adjusted to keep the peripheral white cell count at 4,500 cells mm3, with at least 1,500 neutrophils mm3 and 70,000 platelets mm3. While the likelihood of potential side-effects is low, the physician must promptly address thrombocytopenia, gastrointestinal symptoms, infection, and hemorrhagic cystitis. Urinalysis and renal function tests are routinely done every month to detect early manifestations of renal toxicity.

Late Presentation

The symptoms of bladder dysfunction after established CVA include frequency, urgency, and urge incontinence (11,30). These symptoms are generally a result of detrusor hyperreflexia (14,28,29,30). Tsuchida et al. (30) evaluated 39 patients urodynamically after a CVA. The mean time from CVA to urodynamic evaluation was 19 mo (range 11 da to 13 yr). They found that 66 of the patients complained of frequency or urge incontinence and the remaining 33 had either dysuria or urinary retention. Tsuchida determined that the symptoms of urgency or frequency are related to detrusor hyperreflexia, and this may also contribute to urge incontinence.

History

To rule out reversible causes of incontinence such as infection, stool impaction, medications, and so forth. Targeted questions related to symptoms are helpful in relation to symptoms such as urinary frequency. It is prudent to ask if the frequency is associated with high or low volume, whether it is day or night, and if it is associated with any symptoms of dysuria. Selective nocturia in the elderly can be caused by increased urinary output during the night due to loss of circadian rhythm, and or peripheral pooling of fluid, which is mobilized with recumbency. More importantly, nocturia can be owing simply to a poor sleep pattern. A patient's prescription and often-overlooked over-the-counter medications may have urological implications. In the physical examination, specific attention should be detailed to the mobility, visual acuity, hand coordination, and mental status of the patient in addition to the focused urological exam, including a digital rectal exam pelvic floor assessment...

Treatment Overview

Although the ultimate goal of therapy is the restoration of normal voiding, this is usually not possible unless the neurologic abnormalities remit, or if the symptoms are caused by a coincidental urologic condition such as urinary tract infection or benign prostatic hypertrophy. The social and emotional consequences of urinary bladder symptoms, particularly incontinence, must always be weighed against the risks to the patients' general health imposed by the proposed therapy. For example, a woman with mild, yet uncontrollable incontinence resulting from refractory detrusor hyperreflexia may be better managed with incontinence pads (which pose no threat to her health) than with an indwelling vesical catheter (which predisposes her to urinary infection).

Conduct Disorder

Discussion Enuresis is defined as urinary incontinence that is not due to a medical condition. It may be voluntary or involuntary and can occur during the day or, more commonly, at night. Differential diagnosis should include neurogenic bladder, medical conditions that cause polyuria or urgency (e.g., juvenile diabetes, spina bifida, seizure disorder), and acute UTI. Most children with the disorder become continent by adolescence.

Holism

I had a bladder infection and I knew that there was more to it. I realised that there was a lot more to it in terms of the whole psychology. I could understand that my body was responding to my own thinking and I was responding to my environment with my thinking. I came from a family of alcoholics, so I was also looking for my healing, so I got involved with the Wellness Centre.

Schistosomiasis

A 12-year-old immigrant from the Middle East presents with terminal hematuria, dysuria, and increased frequency of micturition. Discussion Three major species exist. Schistosoma mansoni, S. japonicum, and S. haematobium infect humans. S. mansoni is found in Africa, the Arabian Peninsula, South America, and parts of the Caribbean S. japonicum is found in Japan, China, and the Philippines and S. haematobium is found in Africa and the Middle East. Transmission of schistosomiasis cannot occur in the United States because of the absence of the specific freshwater snail that is an intermediary host. In S. haematobium infection, the principal symptoms are terminal hematuria, dysuria, and frequent urination hydronephrosis, pyelonephritis, and squamous cell carcinoma of the urinary bladder may develop as complications. In S. mansoni and S. japonicum infection, manifestations may include fever, malaise, abdominal pain, diarrhea, or hepatosplenomegaly. Presinusoidal hepatic trapping of eggs and...

Urine Culture

Urine is an excellent culture and growth medium for most organisms that infect the urinary tract. Urinary tract infections that do not respond quickly to medication are high indicators for urine culture. Assessment and monitoring of the response to treatment for urinary tract infection is another indication for this culture. For pregnant women, antibiotic therapy for UTI is often instituted only after urine culture and sensitivity tests identify the specific causative organism and the antibiotic to which the organism is most susceptible.

Vomiting

Vomiting is one of the signs of many different problems, some minor and some quite serious, so it is important to examine the person carefully. Vomiting often comes from a problem in the stomach or guts, such as an infection (see diarrhea, p. 153), poisoning from spoiled food (p. 135), or 'acute abdomen' (for example, appendicitis or something blocking the gut, p. 94). Also, almost any sickness with high fever or severe pain may cause vomiting, especially malaria (p. 186), hepatitis (p. 172), tonsillitis (p. 309), earache (p. 309), meningitis (p. 185), urinary infection (p. 234), gallbladder pain (p. 329) or migraine headache (p. 162)

Block

A woman brings in her 4-year-old son after his second urinary tract infection that was treated with ampicillin I week ago by an emergency department physician who recommended follow-up. You have never seen the child before. According to the mother, all immunizations are up to date, and the boy has no other health problems. The woman just moved to the area and agrees to have old records forwarded to your office. The child seems to have normal cognitive development for his age. He is quite active, and height and weight are at the 50th percentile for age. Physical examination is unremarkable. Urinalysis reveals the following

Pathegenicity

Typical gonorrhea of males is a urethritis characterized by the exudation of greenish-yellow pus and painful urination. In later stages of infection, the prostate and epididymis may become involved. Following regression of urethral discharge, the formation of fibrotic tissue sometimes leads to urethral stricture.

Review Questions

A 44-year-old Algerian man living in the United States and receiving antibiotic therapy for a urinary tract infection has a self-limiting episode of hemolysis, back pain, and jaundice. The peripheral blood smear reveals a n on spherocytic, normo cytic anemia, and Heinz bodies are seen in some of his erythrocytes.

Etiology

Recent initiation of symptoms may allow the examiner to determine a transient etiology such as endocrine dysfunction, urinary tract infection, immobility, bowel dysfunction (including fecal impaction), or psychogenic cause. Any of these etiologies, alone or in combination, can produce acute loss of bladder contractile capabilities. Medication dose adjustments or addition of new medications to a therapeutic regimen is a particularly important cause of voiding dysfunction in patients with chronic neurologic conditions such as Parkinson's disease, treatment of which is dependent on several classes of drugs with significant anticholinergic side effects (13).

Acute Abdominal Pain

A good history and physical is important in establishing the diagnosis. In children less than 2 years of age, trauma, intussusception, incarcerated hernia, volvulus, and urinary tract infection are causes of acute abdominal pain. In the 2- to 5-year-old age group, sickle cell anemia, lower lobe pneumonia, and urinary tract infection should be considered. Meckel diverticulum is a possibility in infants and children. Any older child or adolescent with appendicitis can present with acute abdominal pain. Adolescent girls may have mittelschmerz, ectopic pregnancy, or pelvic inflammatory disease. Other causes include pancreatitis, Henoch-Schonlein purpura, mesenteric adenitis, lead poisoning, diabetic ketoacidosis, renal stones, and cholecystitis.

Items 415420

An 18-year-old G0 comes to see you complaining of a 3-day history of urinary frequency, urgency, and dysuria. She panicked this morning when she noticed the presence of bright red blood in her urine. She also reports some midline lower abdominal discomfort. She had intercourse for the first time 5 days ago and reports that she used condoms. On physical exam, there is no discharge from the cervix or in the vagina and the cervix appears normal. Bimanual exam is normal except for mild suprapubic tenderness. There is no flank tenderness, and the patient's temperature is normal. c. Cystitis

Urodynatnic Studies

Uroflowmetry measures the volume of urine that is expelled from the bladder during urination. This test is a noninvasive procedure that simply requires the patient to urinate into a flowmeter, which measures the flow. The purpose of uroflowmetry is to evaluate incontinence, urinary tract obstruction, abnormalities of the urethral sphincter, and chronic bladder infection. A cystourethrogram is an evaluation of the bladder and urethra that utilizes x-ray and a contrast medium. The bladder is filled with medium using a catheter, and x-rays are taken of the full bladder. The catheter is removed, and x-rays are taken as the patient voids the medium. Cystourethrograms are used to evaluate female stress incontinence and abnormalities of the bladder and urethra.

Cyclophosphamide

These metabolites crosslink DNA, RNA and cellular proteins, thus ultimately leading to cytotoxicity. Although primarily secreted unaltered through the kidney, the metabolite acrolein is considered to be involved in the development of bladder toxicity 10 . Therefore mesna (sodium 2-mercap-toethane sulphonate) should be given to reduce the risk of haemorrhagic cystitis 9 . Cyclophosphamide inhibits T- and B-cell functions, resulting in reduced delayed type hypersensi-tivity (DTH) reaction as well as reduced antibody responses 72 .

Joseph M Khoury

Augmentation cystoplasty can provide significant relief of refractory storage symptoms such as frequency, urgency, and urge incontinence in those patients who have failed conservative measures such as pharmacotherapy, behavioral techniques, and minimally invasive procedures such as neuromodulation. The concept of augmenting bladder capacity is not a new one. Von Mikulicz in 1899 was the first to use ileum to restore normal bladder capacity in humans (J). Other investigators at the turn of the century used different segments of bowel however, enthusiasm waned until the early 1950s, when pioneers such as Kuss (2), Couvelaire (3), and Gil-Vernet (4) restored the impetus to pursue bladder reconstruction. The primary indication for augmentation entero-cystoplasty at that time was tuberculous cystitis, which caused a structurally contracted bladder. Unfortunately, the postoperative mortality and morbidity was exceedingly high and other supravesical diversions such as the ileal conduit...

Pathology

Microscopically, MALT lymphoma consists of a proliferation of neoplastic small to medium-sized marginal zone cells between and around reactive lymphoid follicles, frequently infiltrating into the muscularis 3,53,55-57 (Fig. 26.2). These cells show variable cytology, often including plasma cell differentiation. In many cases the neoplastic cells infiltrate the epithelium of cystitis glandularis, or sometimes surface transitional epithelium, in small clusters forming characteristic lymphoepithelial lesions. Often a reactive lymphoid infiltrate suggestive of chronic cystitis is seen in the background. The neoplastic cells have an immunophenotype similar to that of normal marginal zone cells (positive for CD20, immunoglobulins Igs M and A negative for CD10, Bcl-6, IgD). The histo-logical features of DLBCLs in the bladder are similar to those in other organs 3 .

Biology and Genetics

Result of chronic inflammation of a mucosa normally devoid of lymphoid tissue 3,58 . Examples include Helicobacter pylori-associated gastritis and Hashimoto thyroiditis. There is evidence to suggest that, at least early in its course, MALT lymphoma may be partially dependent on antigen and T-cell-mediated stimulation occurring in such a microenvironment 58 . Although no studies have specifically investigated the biology of MALT lymphoma arising in the bladder, the lack of convincing native lymphoid tissue in the bladder, the clinical or histological evidence of antecedent chronic cystitis in many patients, and the higher incidence in women than in men of both MALT lymphoma of the bladder and chronic cystitis suggests a similar pathogenesis at this site, in which chronic cystitis is a nonobligate precursor for MALT lymphoma 53,55-57 .

Symptoms

The symptoms of UTI are well known, distinctive, and often diagnostic -polyuria, nocturia, dysuria, and frequency in urination. This may have occurred for hours to days before the woman approaches the physician. There maybe costovertebral angle (CVA), flank, and or suprapubic pain and tenderness. The urine may be dark, cloudy, or bloody. The symptoms are so distinctive that women who have had a previous UTI are very accurate in diagnosing a second or recurrent UTI in themselves.42 Severe back and flank pain, fever, chills, nausea, and vomiting may accompany an episode of pyelonephritis and would suggest a systemic infection that needs more aggressive treatment. Although microscopic hematuria often accompanies a UTI, painless or painful macroscopic hematuria, especially if there are clots, may signal a bladder lesion, polyp, or cancer, and cystoscopy is needed soon.

Clinical Picture

Vaginitis is caused mainly by C. albicans, but C. tropicalis and C. glabrata (T. glabrata ) are also cultured. On the penis (balanitis or balanopostitis), the skin is macerated, has white plaques, and erosions. Sometimes vesicles and pustules appear dysuria and polyuria may be present. In onychomycosis, the ungual lamina is engorged, mainly in the base, and has transverse striae. There is depigmentation, or the nail acquires a yellow, green, or black

Anatomic Obstructive

Gynecologic causes of voiding dysfunction arise from angulation or distortion of the proximal urethral and bladder neck caused by periurethral or perivesical gynecologic lesions. The most common gynecologic cause of outlet obstruction is that resulting from large cystocele formation. Cystocele formation results in acute kinking or angulation of the proximal urethra and bladder neck in relationship to the bladder base. The patient will often complain of positional voiding dysfunction (leaning forward, backward, or having to stand to completely evacuate). She may also report digital manipulation and or manual reduction of the cystocele in order to void. These patients may also have co-existing recurrent urinary-tract infection and stress incontinence. Irritative symptoms (frequency, urgency, and nocturia) often predominate early, but may subsequently progress to a high postvoid residual and occasional retention in these patients. Urinary tract infections may also complicate this disease...

Dissatisfaction

I had a really bad experience with one doctor . I had a really bad infection and what he found out was that I was retaining about five hundred CCs of urine. He said that I was probably going to end up living on antibiotics for the rest of my life because every time I turned around I'd get a bladder infection. That made me decide.

Infectious Diseases

A 25-year-old heterosexual man develops a urethral discharge and dysuria 5 days after having unprotected sexual intercourse with a new partner. Physical examination reveals meatal erythema. There are no penile lesions and no inguinal lymphadenopathy. A purulent ure-thral discharge is evident. Gram stain of the discharge reveals neu-trophils and intracellular gramnegative diplococci and the patient is treated for Neisseria gonorrhoeae. Two weeks after antibiotic therapy (ceftriaxone intramuscular injection), the patient returns with a clear urethral discharge and dys-uria. Gram stain reveals many neu-trophils but no organisms. Which of the following is the most likely diagnosis

Pneumothorax

The most common cause of postoperative fever in the first 48 hours alveolar collapse is produced by occlusion due to viscid secretions favored by recumbency, hypoventilation, and oversedation. Other causes of postoperative fever, usually seen later in the postoperative period, include UTI, IV catheter infection, deep venous thrombosis, wound infection, and drug reactions.

Items 7882

Fetal Tracing Spontaneous Declarations

While you are on call at the hospital covering labor and delivery, a 32-year-old G3P2002 who is 35 weeks calls you complaining of lower back pain. The patient informs you that she had been lifting some heavy boxes while fixing up the baby's nursery The patient's pregnancy has been complicated by diet-controlled gestational diabetes. The patient denies any regular uterine contractions, rupture of membranes, vaginal bleeding, or dysuria. She denies any fever, chills, nausea, or emesis. She reports that the baby has been moving normally On physical exam, you note that the patient is obese her cervix is long and closed. Her abdomen is soft and nontender with no palpable uterine contractions. No flank pain can be elicited. She is afebrile. The external monitor indicates a reactive fetal heart rate strip there are rare irregular uterine contractions demonstrated on toco. The patient's urinalysis comes back with trace glucose and protein, and is otherwise...

Treatment

The urinary blood fluke, Schistosoma hematobium, is a parasite which occurs in Egypt, Africa, and in parts of the Middle East. The general process of development in the first stages is the same for all blood flukes. The adult urinary blood fluke enters the body of the final host, a human, and matures in the venous plexuses of the bladder, prostate, and uterus. Eggs are passed in the urine or retained in the tissues, particularly the bladder wall and the female genital organs. Among the problems caused by this parasite are fibrosis, ulceration, and granuloma and papilloma formation, bladder wall calcification, chronic cystitis, pyelitis, and pyelonephritis. In Egypt, bladder cancer is common in advanced cases.

Items 495497

A 21-year-old female presents with complaints of dysuria for the past 48 h. She denies elevated temperature, chills, or nausea vomiting. She states she is having some difficulty sleeping at night. She is 28 weeks pregnant with her first child. You note she is wearing long sleeves in warm weather and she has bruising on her forearms and left lateral thoracic area. An appropriate way to explore your concerns with the patient would be to ask which of the following questions

Enuresis

A 7-year-old boy has problems with bedwetting. The mother says that during the day he has no problems but is usually wet 6 of 7 mornings. He does not report dysuria or frequency, and has not had increased thirst. The mother also says that he is a deep sleeper. Presentation. Enuresis can be divided into two major types primary enuresis (90 ), in which the patient has never achieved dryness for any significant period of time, and secondary enuresis, in which a previously continent child becomes incontinent. Secondary enuresis is usually secondary to emotional difficulties (e.g.,, birth of a sibling, significant loss, family discord). It is usually transient and has a better prognosis. Primary enuresis can be further divided into nocturnal only, diurnal only, and nocturnal diurnal. Nocturnal diuresis is associated with maturational developmental delay of the bladder and may be a disorder of sleep and arousal. Diurnal enuresis is associated with waiting too long to void, urinary tract...

Viral Methods

Bypassing the CAR receptor has been attempted by engineering viruses that can enter the cell via other adhesion sites. In one study both the epidermal growth factor receptor (EGFR) and epithelial cell adhesion molecule (Ep-CAM) have been targeted 10 . The EGFR seemed most promising, increasing transgene expression by up to 12.5 times. As EGFR is overexpressed in many bladder cancers, this form of targeting may increase the specificity of gene therapy for tumor cells compared to normal urothelium. Chimeric viruses that utilize parts of other viruses that do not enter bladder cells via CAR have also been recently described 11 . Pox viruses are used extensively in gene therapy, but there are only a few reports of use in the bladder. A phase I trial to assess the feasibility of using vaccinia for intravesical gene transfer showed some promise 18 . In this study patients scheduled to undergo cystectomy for muscle-invasive bladder cancer received intravesical vaccinia three times in the 2...

Cystoscopy

Bladder Exam With Scope

Cystoscopy is indicated when the patient is experiencing chronic urinary tract infection or other urinary tract disturbances such as frequency, urgency, incontinence, retention, and hematuria. Contraindications are bleeding disorders and acute urethritis or cystitis. The presence of infection before or during the procedure is of concern because the instrumentation of the urinary tract can allow bacteria to enter the blood, causing septicemia. Antibiotics may be given before and after the procedure to prevent infections. Urinary retention, hematuria, and perforation of the urinary bladder are potential complications of cystoscopy. Variations from Normal. Cystoscopy is utilized to diagnose cancer of the bladder, tumors, polyps and stones, prostatic hypertrophy and prostatitis, stricture of the urethra, inflammation, and congenital abnormalities.

Orchitis

Gross Pathology Infection ascends the urinaxy tract (urethritis, cystitis, pyelonephritis) mucosal hyperemia and edema. Discussion Eighty percent of UTIs are caused by E. coir, Staphylococcus saprophytics is the second most common cause. Other causes, in order of frequency, arc Proteus, Klebsiella, Enterobacter, Serratia, Pseudomonas, and Enterococcus Chlamydia and Neisseria are also causes of urethritis. Risk factors includefemale gender, sexual activity, pregnancy, obstruction, bladder dysfunction, vesicoureteral reflux, and catheterization. JJU J p. 191

Items 402407

Approximately 2 weeks after her surgery, the patient comes to your office complaining of a constant loss of urine throughout the day. She denies any urgency or dysuria. What is the most likely explanation for this complaint b. Urinary tract infection