Urinary and Male Reproductive Disorders

24-Hour Urine Specimen Start Protocol

Have patient void, discard first specimen, then collect all subsequent urine for 24 hours.

24-Hour Urine Specimen Missed Sample Action

Restart the entire 24-hour collection process from the beginning.

Ideal Time for Urinalysis Collection

Early morning, as it provides a more concentrated urine sample.

Significance of Glucose, Ketones, and Protein in Urine

Abnormal findings indicating potential diabetes mellitus, fat metabolism, infection, or cancer.

Key Nursing Action Prior to CT Scan with IV Contrast

Ask for iodine/shellfish allergies, establish IV access, and check for Metformin use.

Hydration Recommendation After Contrast Media Radiography

Increase fluid intake to flush contrast and prevent contrast-induced kidney injury.

Essential Pre-MRI Assessment

Screen the patient for metal implants, pacemakers, or any metallic objects.

Cystography vs. Voiding Cystourethrogram (VCUG)

Cystography detects bladder injury; VCUG uses x-rays during urination to detect ureteral reflux.

Nephrotoxicity Risk of Cystography Contrast

Not nephrotoxic, as contrast is instilled directly into bladder and doesn't enter bloodstream.

Post-Cystourethrogram Monitoring Window

Monitor for urinary tract infection signs for 72 hours after the procedure.

Pre-Procedure Positioning for Kidney Biopsy

Prone position with a pillow placed under the patient's abdomen.

Post-Kidney Biopsy Laboratory Monitoring

Monitor hemoglobin and hematocrit levels to detect internal bleeding.

Nurse Action for Decreased Urine Output Post-Cystoscopy

Irrigate the urinary catheter if blood clots are present or output is absent.

Target Symptoms to Report 72 Hours Post-Cystoscopy

Urinary retention, gross hematuria, severe abdominal pain, fever, chills, or dysuria.

Retrograde Pyelogram Purpose

Identifies obstruction or structural disorders of ureters and the renal pelvis.

Cystogram vs. Urethrogram Diagnostic Focus

Cystogram identifies bladder fistulas/diverticula/tumors; urethrogram identifies urethral structural details.

Renal Scan Function

Assesses renal blood flow and estimates glomerular filtration rate (GFR) via radioisotopes.

Captopril Risk During Renal Scan

Increases risk of orthostatic hypotension; monitor vitals and encourage fluids post-scan.

Excretory Urography Metformin Protocol

Withhold Metformin 24 hours before and 48 hours after contrast administration.

Expected vs. Reportable Urine Post-Excretory Urography

Pink-tinged urine is expected; frank hematuria or blood clots must be reported.

Definition of CAUTI

Urinary tract infection developed 2 or more days after catheter insertion.

Lower vs. Upper UTI Classifications

Lower includes cystitis, prostatitis, urethritis; Upper includes pyelonephritis and renal abscess.

Urethrovesical Reflux Mechanism

Backflow of urine from the urethra into the bladder.

Ureterovesical Reflux Mechanism

Backflow of urine from the bladder into one or both ureters.

Three Routes of Bacterial Invasion in UTIs

Transurethral (ascending), bloodstream (hematogenous), and direct extension via intestinal fistula.

Primary Clinical Presentation of Geriatric Urosepsis

Hypotension, tachycardia, tachypnea, fever, and acute delirium or confusion.

Uncomplicated vs. Complicated UTI

Uncomplicated is simple localized burning/frequency; complicated coexists with systemic illness or anatomical issues.

Key Urinalysis Markers for Active UTI

Positive leukocyte esterase, positive nitrites, sediment, and elevated WBCs/RBCs.

Transrectal Ultrasonography (TRUS) Indication

Evaluates prostate and bladder conditions specifically in male patients.

Dietary Irritants to Avoid in Active UTI

Coffee, tea, citrus, spices, cola, and alcohol.

Perineal Hygiene Education for Females

Wipe the perineal area strictly from front to back after elimination.

Clothing Modifications to Prevent UTIs

Avoid pantyhose with slacks, tight clothing, and synthetic underwear.

Long-Term Complications of Unresolved UTIs

Gram-negative urosepsis, acute kidney injury, and chronic kidney disease.

Pathophysiology of Acute Pyelonephritis

Active bacterial infection causing interstitial inflammation, tubular necrosis, and temporary renal impairment.

Pathophysiology of Chronic Pyelonephritis

Repeated infections causing progressive inflammation, post-inflammatory fibrosis, and permanent renal scarring.

Classic Clinical Signs of Pyelonephritis

Chills, fever, flank pain, and costovertebral angle (CVA) tenderness.

Serum Lab Elevations in Pyelonephritis

Elevated serum creatinine, BUN, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR).

Recommended Fluid Intake for Pyelonephritis

Increase oral fluid intake to 3 to 4 liters per day unless contraindicated.

Pyelolithotomy Definition

Surgical removal of a large kidney stone blocking urine flow from the pelvis.

Ureteroplasty Purpose

Repair or revision of the ureter, often involving reimplantation to preserve function.

Chronic Kidney Disease Sign in Pyelonephritis

Hypertension combined with persistently elevated BUN, creatinine, and electrolyte imbalances.

Primary Trigger for Glomerulonephritis

An immunologic reaction following an infection, particularly skin or upper respiratory streptococcal infections.

Glomerulonephritis Urine Characteristics

Reddish-brown, smoky, or cola-colored urine due to hematuria.

Fluid Volume Excess Signs in Glomerulonephritis

Edema (hands/face/eyes), crackles in lungs, S3 heart sound, dyspnea, and weight gain.

Gold Standard Diagnostic for Glomerulonephritis

Kidney biopsy to confirm diagnosis, determine prognosis, and guide treatment.

Electrolyte Imbalances in Glomerulonephritis

Hyperkalemia, hyperphosphatemia, and hypocalcemia.

Stress Management in Glomerulonephritis

Teach relaxation exercises to decrease systemic stress and help lower blood pressure.

Stress Urinary Incontinence Cause

Intact urethra but pelvic floor weakness; triggered by coughing, sneezing, or laughing.

Urge Urinary Incontinence Mechanism

Strong, unstoppable urge to void caused by neurologic dysfunction inhibiting bladder contraction.

Functional Urinary Incontinence Definition

Involuntary urine loss due to physical or cognitive impairments preventing timely toileting.

Iatrogenic Urinary Incontinence Cause

Extrinsic medical factors, such as medications like alpha-adrenergics for hypertension.

Overflow Urinary Incontinence Mechanism

Continual leakage of urine from an overdistended, poorly contracting bladder.

Bladder Irritants to Avoid for Incontinence

Alcohol, carbonation, caffeine, and artificial sweeteners.

Pharmacologic Management for Urge Incontinence

Anticholinergics and amitriptyline to inhibit bladder contractions.

Vaginal Cone Therapy Protocol

Insert twice daily; contract pelvic muscles to retain cone for 15 minutes.

Normal Aging Postvoid Residual (PVR)

Adults 60 and older may normally have 50 to 100 mL remaining.

Anesthetic Effect on Bladder Retention

Suppresses urge to void and reduces bladder muscle innervation postoperatively.

Maximum Normal PVR in Middle-Aged Adults

No more than 50 mL of residual urine.

Non-Invasive Nursing Measures to Promote Urination

Running water, warm perineal compresses, hot drinks, or stroking inner thighs.

Suprapubic Catheter Indications

Urethral route impassable due to injuries, strictures, prostatic obstruction, or pelvic fractures.

Permanent Suprapubic Catheter Use Case

Spinal cord injury causing neurogenic bladder or bladder areflexia.

Urolithiasis vs. Nephrolithiasis

Urolithiasis is stones in the urinary tract; nephrolithiasis is stones in the kidney.

Renal Colic Pain Pathway

Intense flank pain radiating to the lower abdomen, scrotum, testes, or vulva.

Stone in Renal Pelvis Manifestations

Hematuria, pyuria, and an intense deep ache in the costovertebral area.

Stone in Ureter Manifestations

Acute, excruciating, colicky, wave-like pain radiating to the thigh and pelvic area.

Stone in Bladder Neck Complication

Acute urinary retention and severe localized irritation.

Key Nursing Action for Passed Calculi

Strain all urine, retrieve the stone, and send it to the lab.

Target Urine Output for Stone Prevention

Exceed 2 liters of urine output per day.

Nutritional Therapy for Calcium Stones

Restrict dietary calcium; utilize thiazide diuretics if hyperparathyroidism is present.

Low-Purine Diet Avoidance List

Shellfish, anchovies, asparagus, mushrooms, and organ meats.

Nutritional Therapy for Cystine Stones

Implement a low-protein diet.

Dietary Restrictions for Oxalate Stones

Avoid spinach, Swiss chard, chocolate, peanuts, and pecans.

Chemolysis Definition

Chemical instillation used to directly dissolve urinary calculi.

Extracorporeal Shock Wave Lithotripsy (ESWL)

Non-invasive shock waves break stones into sand-like particles for passage.

Hydronephrosis Complication of Stones

Calculus completely blocks the urinary tract, causing backflow and kidney distention.

Classic Triad of Urethral Trauma

Blood visible at the meatus, inability to void, and a distended bladder.

Leading Risk Factor for Bladder Cancer

Tobacco smoking significantly increases risk.

Primary Clinical Manifestation of Bladder Cancer

Visible, painless hematuria.

Intravesical BCG Therapy Protocol

Instilled for 1 year; uses Mycobacterium bovis to produce a local immune response.

Radical Cystectomy Scope in Men

Removal of the bladder, prostate gland, and seminal vesicles.

Radical Cystectomy Scope in Women

Removal of bladder, lower ureters, uterus, fallopian tubes, ovaries, and anterior vagina.

Cutaneous vs. Continent Urinary Diversion

Cutaneous drains continuously; continent uses an internal reservoir accessed via catheter.

Immediate Postoperative Urinary Diversion Monitoring

Monitor and document urine volume hourly.

Top Three Postoperative Complications of Stomas

Stoma ischemia/necrosis, stoma retraction/separation, and peritonitis.

Digital Rectal Exam (DRE) Screening Guidelines

Annually for men over 50; over 45 for high-risk (African American, family history).

Normal Prostate-Specific Antigen (PSA) Level

Safe range is 0 to 2.5 ng/mL.

Highly Suspicious PSA Level for Cancer

10 ng/mL and above indicates a 50% chance of prostate cancer.

Early Prostate Cancer Antigen (EPCA-2) Significance

Value of 30 ng/mL or greater is highly suggestive of prostate cancer.

Transrectal Ultrasound (TRUS) Pre-Procedure Requirement

Administration of an enema prior to the procedure.

Sildenafil (Viagra) Absolute Contraindication

Concurrent use of organic nitrates (nitroglycerin) due to severe hypotension risk.

Priapism Definition and Risk

Persistent, painful, abnormal erection lasting over 4 hours; medical emergency.

Acute vs. Chronic Bacterial Prostatitis Symptoms

Acute has sudden fever, dysuria, and perineal pain; chronic is typically asymptomatic.

Alpha-Adrenergic Blockers for BPH Action

Relax smooth muscle of the bladder neck and prostate to improve urine flow.

5-Alpha-Reductase Inhibitors for BPH Action

Prevent conversion of testosterone, gradually shrinking the prostate gland tissue.

Transurethral Resection of the Prostate (TURP)

Surgical removal of prostate tissue using a resectoscope inserted through the urethra.

Transurethral Resection (TUR) Syndrome Signs

Hyponatremia and hypervolemia due to absorption of bladder irrigation solution.

CBI True Urine Output Calculation Formula

Total fluid output minus total sterile irrigant infused equals true urine output.

CBI Calculation Example (3L hung, 2L left, 1.6L output)

1600 mL (total output) - 1000 mL (infused) = 600 mL true urine.

Post-Prostatectomy Activity Restrictions

Avoid straining, heavy lifting, and long car trips for 6 to 8 weeks.

Testicular Torsion Definition

Rotation of the testicle twisting the spermatic cord, rapidly reducing blood flow.