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TO PEE OR NOT TO PEE THAT IS THE QUESTION TO PEE OR NOT TO PEE THAT IS THE QUESTION Shawn McGlew PA-C, DFAAPA Kennebec County Urology Manchester/Oakland,

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Presentation on theme: "TO PEE OR NOT TO PEE THAT IS THE QUESTION TO PEE OR NOT TO PEE THAT IS THE QUESTION Shawn McGlew PA-C, DFAAPA Kennebec County Urology Manchester/Oakland,"— Presentation transcript:

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3 TO PEE OR NOT TO PEE THAT IS THE QUESTION TO PEE OR NOT TO PEE THAT IS THE QUESTION Shawn McGlew PA-C, DFAAPA Kennebec County Urology Manchester/Oakland, ME Shawn McGlew PA-C, DFAAPA Kennebec County Urology Manchester/Oakland, ME

4 Pre-Test T or F Incontinence 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.

5 I cant pee. I pee to much. It hurts. Im peeing blood.

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7 Prostate Strictures Poor pelvic floor relaxation Other pathology

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9 Incomplete bladder emptying Hesitancy Nocturia Urgency with or without leaking Frequency Pelvic pain

10 Evaluation: U/A PE / DRE PSA PVR Cysto and/or UDS +\-

11 TREATMENT: Conservative – voiding techniques Alpha Blockers 5 Alpha Reductase Inhibitors CIC Foley SP tube

12 Alpha Blockers: Tamsulosin (Flomax) Terazosin (Hytrin) Doxazosin (Cardura) Silodosin (Rapaflo) Alfuzosin (Uroxatral)

13 5 Alpha Reductase Inhibitors: Blocks Testosterone conversion to DHT in the prostate. Not first line Consider PSA (getting it and correction) Side effects - breast tender/enlarge, low vol. ejaculate.

14 Others: Combinations – Jalyn (Dutasteride / Tamsulosin Tadalafil (Cialis) low dose daily CIC Foley, SP Tube Surgery - TURP

15 CIC Clean Intermittent Catheterization Foley Cath SP Tube

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20 History & physical – voiding history, foods, liquids, stress. PVR, U/A Treatment: AUA Guidelines Behavioral changes, Bladder training, Physical Therapy, Trial ACh medication Work-up if not improved – Cysto, UDS, CT +/- Other treatments: Beta 3 agonist, Neuromodulation, Botox

21 Anticholinergics: Oxybutynin (Ditropan) Tolterodine (Detrol) Fesoterodine (Toviaz) Trospium (Sanctura) Solifenacin (Vesicare) Darifenacin (Enablex) Flavoxate (Urispas)

22 Beta 3 Agonist: Mirabegron (Myrbetriq) – Relaxes bladder during filling

23 Side Effects: Dizziness Dry mouth Constipation Urinary retention Contraindicated in narrow angle glaucoma

24 Leaking with cough, sneeze, laughing, getting up.

25 Treatments: Behavior modification – timed voids, diet, fluids Absorbent pads Kegels Periurethral bulking therapy Surgery

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31 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 50 Think about stone with recurrent UTIs due to: Klebsiella, Proteus, Pseudomonas, Enterococcus. Work up: imaging > CT vs KUB vs RUS Treatment: Flomax, ESWL, Ureteroscopy, PNL, Prevention: 24 hour urines, hydration, low Na, low Ox, hydration.

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37 Hydration, Hydration…. Urine SG > 1.010

38 Gross: not disgusting… You can see it. Microscopic: more than 3 RBC /HPF Smokers: bladder cancer risk x5 Etiology: Stones, infection, kidney disease, prostate, neoplasm. Pathology: benign, malignant. Work up: 3 Cs Follow up for negative evaluation: U/A micro, cytology 3 years

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