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Problems with Urination

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

  2. Cystitis • Pain, burning, frequency, tender bladder • Treat on the basis of symptoms • Confirm cure with culture • Bactrim, Gantrisin, Keflex, Macrodantin • Pyridium 200 mg PO TID x 2 days Video

  3. Gonorrheal Urethritis • Burning, frequency, tender urethra • Purulent discharge from urethra/Skene's • GC culture • Cephtriaxone 250 mg IM, plusDoxycycline 100 mg PO BID x 7 days • Treat partner

  4. Non-Gonorrheal Urethritis • Burning, frequency, tender urethra, bladder • They don't improve on antibiotics • Negative urine culture • Treat on basis of suspicion • Doxycycline 100 mg BID x 7 days, orClindamycin 150 mg TID x 7-10 days • Treat sexual partner

  5. Herpes Vulvitis • Severe pain when urine passes over the vulva • Multiple tiny blisters/ulcers • Zovirax 200 mg PO Q4 hours while awake x 10 days • May need Foley cather • Try urinating into bathtub • Will resolve within 5-10 days

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

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

  8. Blood in the urine • Usually due to cystitis • If it persists or returns, thenUrology consultation necessary to r/o: -Renal stones -Bladder tumors -Endometriosis • Microscopic hematuria most commonlydue to exercise in this age group

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

  10. Can't Urinate • Put in Foley catheter • Drain about 500 cc, then wait 5-10 minutes before draining another 500 cc...and then another 500 cc • Leave Foley in place for 1-2 days to allow the bladder to regain its' tone • Rule out: -pregnancy -pelvic mass -pelvic trauma -herpes Video

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

  12. Stress Urinary Incontinence • Anatomic problem -Loss of urethrovessicle angle -UV junction exteriorized • Loss of urine with cough, sneeze, exercise • Mild, Mod & Severe • Surgery • Kegel Exercises • Double-voiding • Caffeine, tobacco, alcohol, antibiotics

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

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

  15. Unpredictable Urine Loss • If not associated with urgency or activity, suggests neurologic cause such as: -multiple sclerosis -spinal cord tumors -spinal disc compression • If single episode, reassure patient • If recurring problem or worsening, evaluate for neurologic disease or injury

  16. Pyelonephritis • Severe flank pain and tender kidney(s) • Fever (typically quite high) • May or may not have urinary symptoms • Treat with IV antibiotics • This patient is very ill and may need MEDEVAC

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