UTI, Bladder/Kidney cancer

Urinary Tract Infections

Most common infection, second most common bacterial disease in women

UTI Cause

• Common pathogen: Escherichia coli (E. coli)
• Second-Candida albicans; indwelling catheters, symptomatic colonization
• Fungal/parasitic-uncommon

Classification of UTI

• Upper-renal parenchyma, pelvis, ureters (pyelonephritis)
• Lower-bladder (cystitis) and urethra (urethritis)
• Systemic spread-urosepsis, LT
• Uncomplicated-bladder only
• Complicated-occur with structural/functional problem in tract

Lower urinary tract symptoms (LUTS)

• Emptying symptoms
—Hesitancy, intermittency, post void dribbling, retention, incomplete emptying, dysuria
• Storage symptoms
—Frequency, urgency, incontinence, nocturia, nocturnal enuresis
• Hematuria and/or cloudy appearance

Other Manifestations UTI

Fatigue, anorexia, asymptomatic

• Asymptomatic bacteriuria
—Bacteria in bladder; screen and treat with pregnancy

Older adults: classic symptoms absent UTI

• Nonlocalized abdominal discomfort, cognitive impairment, or generalized deterioration; often afebrile

Labs & Diagnostics UTI

• Initial: dipstick for nitrates, WBCs, leukocyte esterase
• Urine culture/sensitivity

Imaging - Ultrasound/CT scan

Management (Uncomplicated) UTI

• Patient teaching, adequate fluids
• Drug therapy: phenazopyridine and antibiotics (empiric) for 3 days

Recurrent UTI Care

• As above plus: susceptibility testing, suppressive/prophylactic antibiotics
• Antibiotics 7 -14 days

Drug Therapy UTI

• Uncomplicated or initial UTIs
• Trimethoprim/Sulfamethoxazole (TMP-SMX) Bactrim
• Nitrofurantoin, Cephalexin
• Fosfomycin

UTI Care

• Complicated: fluoroquinolones
• Fungal: Fluconazole
• Urinary Analgesic: Phenazopyridine (azo dye-stains urine reddish orange)

Health promotion UTI

• Recognize at-risk patients
• Patient teaching
• Empty bladder regularly and completely
• Evacuate bowel regularly
• Wipe front to back
• Adequate fluid intake

Prevention of CAUTI

• Avoid unnecessary catheterizations
• Early removal of indwelling catheters
• Aseptic technique
• Hand hygiene
• Gloves for catheter care

Hospitalized patients - thorough perineal hygiene

Acute care UTI

• Adequate fluid-dilute urine, reduces irritation
• Avoid irritating fluids/foods (caffeine, alcohol, citrus juices, chocolate, spicy)
• Heating pad; warm shower/bath

Patient teaching Acute care UTI

—Drugs and side effects-complete entire prescription
—What to look for (improvement) and what to report HCP

Ambulatory care UTI

• Patient and caregiver teaching
• Antimicrobials as ordered (prevent recurrence/resistance)
• Adequate fluid
• Void: regularly and before/after intercourse
• Stop using diaphragm (temporarily)

Renal cell carcinoma (adenocarcinoma)—

Most common
• Males more than females; average age 64 years old
• Risk factors: smoking, ACKD, obesity, HTN, asbestos, cadmium, gasoline
• First-degree relatives

Early stage Kidney Cancer

Asymptomatic; often incidental finding for unrelated condition
• 25% metastasis when diagnosed
• Renal vein, vena cava, lungs, liver, long bones

Manifestations and Diagnostics (KD)

Common manifestations: hematuria, flank pain, palpable mass (flank/abdomen)
• Other: weight loss, fever, HTN, anemia

Diagnostic Studies:

CT scan, US, angiography, biopsy, MRI; radionuclide isotope scan

Bladder cancer

• Most common urinary system cancer
• Older adults more than 55 = 90% cases
• Men more than women; WHITES more than blacks or Hispanics
• Transitional cell cancer—most frequent
—Most papillomatous growths

Bladder Cancer Risks

Cigarette smoking
• Other: Industrial dyes; cervical cancer with radiation/chemotherapy; indwelling catheters, chronic, recurrent UT stones, chronic UTIs

Bladder cancer Manifestations

Microscopic or gross, painless hematuria
• Other: dysuria, frequency, urgency

Bladder cancer Diagnostics

• Urine specimens for cancer/atypical cells, bladder tumor antigens
• CT scan, US, MRI
• Cystoscopy, Biopsy—confirm cancer

Urine blocked from:

• Bladder cancer, neurogenic bladder, congenital anomalies, strictures, trauma, chronic inflammation
• Surgical procedures for urinary diversion

Ileal conduit most common (Bladder Cancer)

• Meticulous skin care
• Avoid: alkaline encrustations with dermatitis/yeast infections, product allergies, shearing effect excoriations
• Changing appliances: Continent diversion
• Patient teaching: how/when to catheterize/irrigate
Body image
—Share concerns about all aspects of life

Discharge teaching—ileal conduit

• Symptoms of obstruction/infection
• Ostomy care; stoma may shrink as heals
• Appliances: faceplate with adhesive, collecting pouch, drainage opening; proper fit important
• Where to buy supplies, emergency contacts, location of ostomy clubs
• Follow-up visits with WOCN and HC