5 June 2018 GENITOURINARY SYSTEM + Consists ofthe eproductve ons and unary sem {Pathogens use this as a portal for entry into the body {Healthcare professional ce mang infections in this area 5 bathouens ‘cam trael up the ureters and Teach the edness in small‘ minorty of cases, causing real Csmoge end kidney fale + Uisare named according the place of infection tbls «Inthe prtate (mien) + Majority of infections are eausod by bacteria, though Some ate fngal URINARY INCONTINENCE Usinary incontinence (UD may be defined as ny involuntary or ‘normal urn os UL is charaeeried by lover urinary tract stmptoms (LUTS),Incidence + Prevalence inereases with age (but itis not a part of normal aging) + 25-30% of community dwelling older women (mostly after 80 yrs of age) + 10-15% of community dwelling older men + 80% of urinary incontinence can be cured or improved Cause - Delirium = Infection - trophic vaginitis or urethritis - Pharmaceuticals ~ Psychological disorders - Endocrine disorders - Restricted mobility - Stool impaction 5 June 2018 Medications That May Incontinence + Diureties + Antcholinergcs ~ antihistamines, antipsychotics, antidepressants + Sedatives/hypnaties + Alechal + Narcotics Cause + cradrenergic agonists/antagonists + Calcium channel blockers Risk Factor + Pregnancy = Episiotomy + Menopause + Genitourinary surgery 1 Pehiemisele weakness 5 tnmabilty + High impact exercise + stroke {Age related change in urinary tract 1 Obes Toilet unavailability5 June 2018 Types of urinary incontinence ‘Types of urinary incontinence Stress incontinence + Stress _urinary incontinence (SUI) is > Urge incontinence defined as involuntary urine leakage Mixed incontinence associated with specific activities > Reflex incontinence > E.g, sneezing and coughing Overflow incontinence -Unge urinary ineontinencs (JUD is _-Eyicslonal mcoutinenee defined as involuntary urine leakage associated with urgency = Involuntary detrusor muscle contraction Types of urinary incontinence Types of urinary incontinence + Qverfowinsontinenee (OFD is caused. by a retentions re ee Frpotonic Bice bladder cntlet obttction, ot Sobspes see oe eee other forms of urinary retention. cae cpencaste eaters OF my esl infor rina at sympoms ad in thle fi anmnnicotn santa occurs + Re miogas coe wher the vind pace inne ith benign poste perl 8 Contract and urine les (oem i age amuse) viol a we ‘acces ppt ae pike damage he arth ory wars + Eunetional incontinence occurs if your urinary tract saree ga a is functioning properly but. other illnesses or Sane pee eri arora! antes are preventing you from stasing do ea dias dementa oy mental nee decrease arenes he ned fonds tale+ The term overactive bladder (OAB) is often used todescribe UI + OAB comprises a constellation of symptoms typically characterized by urgency, with or without UT, accompanied by frequency and nocturia Management of UI + Drug treatment is not necessary or inappropriate for all types of incontinence + The three major categories of treatment are © Behavioral = Pharmacologic + Surgical 5 June 2018 Nocturnal enuresis + Common in young children + Inability to control urination at night + Treatment may be considered in children over § years old + Treatment: + Advice on fluid intake, diet += Desmopressin a synthetic derivative of antidiuretic hormone is also used for noctural Behavioural management + They decrease the frequency of UI in most individuals when provided by knowledgeable health care providers *Toileting assistance _routine/scheduled toileting, habit training, and prompted voiding. + Bladder retraining + Pelvic muscle rehabilitation - Pelvic muscle exercises (Kegel exercises) involve strengthening and retraining the detrusor bladder muscle to regain some control of urinary functionPharmacological management + Anticholinergie agents Reduce symptoms of urgency and urge incontinence Inhibit bladder contractions crease blader eaacity Ossbutsnin hydrochloride, avoxate “hSirochlonde. Hompium eMoride ‘The now for continuing antimuscarinic drug therapy Should be reviewed every 4-6 seeks Unt Sem ptOms Sige and then every 8-12 months “ + Tricyclic antidepressants ‘Less used beeauke of their eardic side effets Ee Propantheline bromide Surgical management + Surgery is recommended for stress incontinence in men and women + May be recommended as first-line treatment for selected patients who are unable to comply with ‘other non surgical therapies. + Surgery in the management of urge incontinence is uncommon, + Surgical treatment is considered only in highly symptomatic patients in whom non operative ‘management has failed 5 June 2018 Pharmacological management ... contd + Stress ineontinence Non drug method ~ Kegel exercise + Duloxetine, an inhibitor of serotonin and noradrenaline reuptake can be added and is used for treatment of moderate to severe stress incontinencein women Strategies for managing UI +Increase awareness of the amount and timing of all fluid intake + Reduce amount and timing of fluid intake + Avoid bladder stimulants (caffeine) + Avoiding taking diuretics after 4pm + Reduce physical barriers to toilet + Avoid constipation + Void regularly 5 to 8 times a day + Perform all pelvic floor exercise + Stop smoking5 June 2018 Nursing management Complications + Encourage the patient for voiding urine in proper interval + Provide support + Teach regarding bladder function + Teach patient use daily diary to record timing of. Kegel exercise + Explain the action and side effect of drugs + Follow up treatment + Social stigma - leads to restricted activities and depression + Medical complications - skin breakdown, increased urinary tract infections + Institutionalization - Ul is the second leading cause of nursing home placement Urinary Retention URINARY RETENTION + Urinary retention is the inability to empty the bladder + It'may occur in_conjunetion with or independent of urinary incontinence + Urinary retention ean be acute or chronic + Acute urinary retention is a medical emergency + Urinary retention is a side effect of the bladder not ‘emptying properly This is also known as having residual urine (Urine that remains inthe bladder after voiding)5 June 2018 Incidence Pathophysiology Postop de to refx paso sphincie + Most common in men in thelr 50s and 60s Babes because of prostate enlargement Prostatic enlargement Blade stones, . Thtetion tht cause sweligo itation Women uy experience urionry retention Crete patho rat ‘uma Peanut ero dsorers (Interfere between bain and Neo Ntekatons eg tree antidepressants Weak bladder mule Constpaion Symptoms Goals and outcomes ‘Ate urinary retention ‘Garni urinary retention + Patient empties bladder completely: ~ Seve disor and pal > Mildad pines + Patient voids in sufficient quantity with no pocree eee henna Palpble binder distension ++ Bloated lower belly ‘stream or emptying your + Urine volume greater than or equal to 300 mL pete with each voiding and residual volume less than ere roomManagement + Acute urinary retention should be managed by immediate and complete decompression of the bladder through catheterization + Benign prostatic hyperplasia (BPH) is treated either surgically or medically with alpha~ blockers, 5 June 2018 Complications Urinary tract infections Bladder damage Chronic kidney disease Urinary retention isa disorder that needs to be ‘managed immediately and correctly to prevent complications. Pharmacological approach + Alpha 1 selective blockers Relax smooth muscle in benign prostatic hyperplasia producing an increase in urinary flow rate + Improve obstructive symptoms + Egtamsulosin, prazosin,alfuzosin + Tamsulosin has an advantage of once daily dose as compared to prazosin and alfuzosin Pharmacological approach...contd «+ Dutasteride and Finasteride » sa-reductase inhibitors * Metabolise testosterone into the more potent androgen, diydrotestosterone + Alternatives toalpha-bloekers, particularly in men ‘witha significantly enlarged prostate.5 June 2018 Nursing Interventions ALKANISING DRUGS ae ae ALKANISING DRUGS ‘+ Measures are sometimes taken to increase the acidity ofthe urine + Thereby making it hostile to bacteria but making CAURETKS pireruciegl nas Facicie wieavattalinleiagtageste -Drogrsich neat on of oi i ater in rine uring an attack of sits helps to relieve the ‘Mast idl pressed dr iscomfort + Bg potassium citrate, sodium citrate + For maximum effect, all drugs treatments prescribed for urinary tract infections need to be accompanied by increased fuid intake ‘Used nthe management of ypemtenson and oedemaClassification of diuretics 1. Loop diureties (High ceiling) + Eg Furosemide 2. Thiazides <" Eg Chlorthiazide, chlorthalidone bydrochlorthiazide, 3. Potassium sparing diureties Eg pironolactne 5 June 2018 Classification of diuretics ... contd 4. Osmotic diuretic Eg Mannitol 5. Carbonic anhydrase inhibitors + Bg Acetazolamide 1. LOOP DIURETICS + Rapidly acting highly efficacious diuretic + Maximum natriureti effect than that of other clases + Upto 101 of urine may be produced in a day + Quick onset of action + Short duration (9-6 hrs) + Can be administered im, iv or oral + Used in pulmonary oedema due to left ventricular failure + Ly administration produces relief of breathlessness and reduces left ventricular filling pressure 1. Loop diuretics ... contd + CAUTION: = Can exacerbate diabetes and gout = Urinary retention may occur in prostatic hyperplasia + SIDE EFFECTS: * Electrolyte imbalance Deafness with high doses and rapid iw administration + Eg. Furosemide (1 loop diuretic to be introduced), Bumetanide 102. THIAZIDES + Moderately potent diureties + Only administered orally + Action tars within hour an ean last wp to 2- + Usually administered early in the day so that diuresis does not interfere with the sleep + Uses: + Ocdema * Hypertension * Chronic hear failure 3. POTASSIUM SPARING DIURETICS + Weak diuretic on its own + They cause retention of potassium «Therefore given in combination with a thiazide or loop diuretic as a more effective alternative to potassium supplements + Eg spironolactone, amiloride 5 June 2018 2. Thiazides ... contd + Eg Hydrochlorthiazide (Esidrex®) + Dose: 25mg ~ 100mg once or twice dally + Chlorthalidone = Dose: up to some dally 4. OSMOTIC DIURETICS + Can be used to treat cerebral oedema + Also to treat raised intra-ocular pressure + Eg mannitol 20% + Caution: Mannitol 20% has the property of crystallisation. Also ensure to dissolve the cexystals properly before use 15. CARBONIC ANHYDRASE INHIBITOR + Weak diuretic + Little used for its diuretic effect ‘+ Mostly used for lowering the intraocular pressure + Eg acetazolamide 5 June 2018 12