2TO PEE OR NOT TO PEE THAT IS THE QUESTION URINE TROUBLETO PEE OR NOT TO PEETHAT IS THE QUESTIONShawn McGlew PA-C, DFAAPAKennebec County UrologyManchester/Oakland, ME
3Pre-Test T or FIncontinence is natural part of aging for women not men.Renal ultrasound is the best imaging study for stones.A high sodium diet is the number one reason for stones.Finasteride is a first line treatment for BPH.If CT sees a stone no further imaging is needed.Renal U/S is the most cost effective for hematuria.
4I can’t pee. I pee to much. It hurts. I’m peeing blood. Urology Made EasyI can’t pee.I pee to much.It hurts.I’m peeing blood.
12Bladder Outlet Obstruction 5 Alpha Reductase Inhibitors:Blocks Testosterone conversion to DHT in the prostate.Not first lineConsider PSA (getting it and correction)Side effects - breast tender/enlarge, low vol. ejaculate.
30Kidney stones Presentation: Classic, not so classic Composition: Ca, Ox, Phosphate, uric acid,struvite (magnesium ammonium phosphate)Prevalence: 1 in 8 will develop stone by age 70 and usually before 50Think about stone with recurrent UTIs due to:Klebsiella, Proteus, Pseudomonas, Enterococcus.Work up: imaging > CT vs KUB vs RUSTreatment: Flomax, ESWL, Ureteroscopy, PNL,Prevention: 24 hour urines, hydration, low Na, low Ox, hydration.
37Hematuria Gross: not disgusting… You can see it. Microscopic: more than 3 RBC /HPFSmokers: bladder cancer risk x5Etiology: Stones, infection, kidney disease, prostate, neoplasm.Pathology: benign, malignant.Work up: 3 C’sFollow up for negative evaluation: U/A micro, cytology 3 years