1. Problems with Urination
CAPT Mike Hughey, MC, USNR

2. Cystitis Pain, burning, frequency, tender bladder
Treat on the basis of symptoms
Confirm cure with culture
Bactrim, Gantrisin, Keflex, Macrodantin
Pyridium 200 mg PO TID x 2 days
Video

3. Gonorrheal Urethritis
Burning, frequency, tender urethra
Purulent discharge from urethra/Skene's
GC culture
Cephtriaxone 250 mg IM, plus Doxycycline 100 mg PO BID x 7 days
Treat partner

4. Non-Gonorrheal Urethritis
Burning, frequency, tender urethra, bladder
They don't improve on antibiotics
Negative urine culture
Treat on basis of suspicion
Doxycycline 100 mg BID x 7 days, or Clindamycin 150 mg TID x days
Treat sexual partner

5. Herpes Vulvitis Severe pain when urine passes over the vulva
Multiple tiny blisters/ulcers
Zovirax 200 mg PO Q4 hours while awake x 10 days
May need Foley cather
Try urinating into bathtub
Will resolve within 5-10 days

6. Causes of Urinary Frequency
Bladder infection (with dysuria)
Excessive fluid intake (particularly at night)
Increased stress
Pelvic mass
Pregnancy
Naval Hospital Camp LeJeune

7. Evaluation of Urinary Frequency
Palpate for bladder tenderness (inf)
Palpate for pelvic mass
Urine culture (dipstick OK)
Pregnancy test

8. Blood in the urine Usually due to cystitis
If it persists or returns, then Urology consultation necessary to r/o: -Renal stones -Bladder tumors -Endometriosis
Microscopic hematuria most commonly due to exercise in this age group

9. Bad odor to the urine Either cystitis or vaginitis
Look for: -Lost and forgotten tampon -Yeast -Trichomonas -Bacterial vaginosis -Asparagus eating -Ampicillin intake

10. Can't Urinate Put in Foley catheter
Drain about 500 cc, then wait minutes before draining another 500 cc...and then another 500 cc
Leave Foley in place for 1-2 days to allow the bladder to regain its' tone
Rule out: -pregnancy -pelvic mass -pelvic trauma -herpes
Video

11. Forms of Urinary Incontinence
Stress incontinence
Irritable bladder
Loss of urine at unpredictable times

12. Stress Urinary Incontinence
Anatomic problem -Loss of urethrovessicle angle -UV junction exteriorized
Loss of urine with cough, sneeze, exercise
Mild, Mod & Severe
Surgery
Kegel Exercises
Double-voiding
Caffeine, tobacco, alcohol, antibiotics

13. Irritable Bladder Local problem Sudden urge to urinate
Eliminate caffeine, tobacco and alcohol
Double voiding
Antibiotics
Will need consultation

14. Urethral Diverticulum
Local problem
Unexpected loss of urine on rising
Will need consultation
Surgery is curative
Nothing else helps

15. Unpredictable Urine Loss
If not associated with urgency or activity, suggests neurologic cause such as: -multiple sclerosis -spinal cord tumors -spinal disc compression
If single episode, reassure patient
If recurring problem or worsening, evaluate for neurologic disease or injury

16. Pyelonephritis Severe flank pain and tender kidney(s)
Fever (typically quite high)
May or may not have urinary symptoms
Treat with IV antibiotics
This patient is very ill and may need MEDEVAC