Acute urological disorders

Urethritis

Inflammation of the urethra from bacterial or viral infection; usually sexually transmitted (urinate after sex)

Urethritis: treatment

Depends on the cause and obtaining symptomatic relief

Why is urethritis difficult to diagnose?

May have no symptoms, or symptoms overlap with UTI, cystitis, or overactive bladder

Pyelonephritis: manifestations

Fever, chills, vomiting; pain is not sudden in onset (per class notes)

Interstitial cystitis (IC)

Chronic inflammatory disease of the bladder; associated with allergic or autoimmune response; more prominent in women (shorter urethra)

Two primary clinical manifestations of interstitial cystitis

Pain and lower urinary tract symptoms

How is interstitial cystitis diagnosed?

By exclusion: UTI-like symptoms without bacteriuria, pyuria, or a positive urine culture; careful history and physical exam required; etiology is unknown so there is no single treatment

Nursing management of interstitial cystitis

Dietary/lifestyle changes: eat low-acid foods; avoid coffee, tea, carbonated and alcoholic drinks. OTC calcium glycerophosphate can relieve irritating effects of certain foods

IC assessment and data collection

Focus on characteristics of the pain; keep a 3-day voiding diary to determine voiding frequency and patterns of nocturia

Urinary tract calculi: other names and definition

Kidney stones, nephrolithiasis, urolithiasis; hard deposits of minerals and salts that form inside the kidney; affect younger population; higher incidence with family history

Symptoms of urinary calculi

Flank pain, nausea, abdominal pain, blood in urine; more dramatic pain = more obstructive; with infection: vomiting, fever, chills

Etiology of calculi: concentrated urine

Urine becomes concentrated, letting minerals stick together and crystallize; supersaturated crystals can become a stone anywhere in the urinary tract; keeping urine dilute and free-flowing reduces recurrence

Etiology of calculi: infection

Obstruction with urinary stasis and bacterial infection; bacteria make urine alkaline, which promotes stone formation; infected stones may enlarge into a staghorn configuration

Collaborative care of urinary calculi

Pain management; identify the bacteria causing infection; restrict sodium; dietary changes; medications to prevent stone formation (per notes: minimize urine formation of stones)

Acetohydroxamic acid (Acetohydroxide in notes)

Inhibits bacterial urease, which inhibits growth of stone-causing bacteria

What size stone can pass into the urine?

4 mm or less

Why is the UPJ relevant in kidney stones?

The ureteropelvic junction is the most common site of complete obstruction

Urinary diversion: indications

Bladder cancer, neurogenic bladder, congenital anomalies, strictures, bladder trauma, chronic infections with deteriorating renal function

Two types of urinary diversion

Incontinent (ileal conduit/ileal loop) and continent

Incontinent urinary diversion (ileal conduit)

Ureters are anastomosed into one end of the conduit; the other end of the bowel is brought through the abdominal wall as a stoma; client wears a bag

Continent urinary diversion

Reservoir constructed from ileum, ileocecal segment, or colon; self-catheterize every 4-6 hours; no external attachments

Neobladder

Bladder constructed from small intestine and connected to the urethra; allows urination through the urethra; reservoir mimics normal bladder storage; sits inside the pelvis

Post-op care of urinary diversion

Good skin care (alkaline urine breaks down skin); stoma products cut about 0.2 cm from the stoma; normal for stoma to shrink after surgery; NPO with NG for first 3-5 days; prevent stoma injury; maintain urine output

Most common pathogen in urine

E. coli

Bacterial count that indicates UTI

10^5 CFU/mL or greater

UTI classification: upper vs. lower

Upper: renal parenchyma and renal pelvis. Lower: bladder and urethra