Dysuria Female

Front 1

Lower UTI etiology

Back 1

colonization of bladder epithelium by uropathogens (mostly E. coli 85%; S.saphrophyticus 10-15%)

Front 2

lower UTI risks

Back 2

"female>males, spermicide, sex, previous UTI, first degree female with UTI hx,
in elderly: decreased estrogen, decreased bladder tone, impaired bladder emptying, incontinence, catheters, neurogenic bladder"

Front 3

Lower UTI symptoms

Back 3

"dysuria, internal burning, hematuria, nocturia, urgency, frequency, stress/urge incontinence, malodorous cloudy urine, poor sensation of emptying
in elderly: FTT, agitation, altered mental status, incontinence"

Front 4

Lower UTI signs

Back 4

"urine microscopy: >3-5 WBC, +/- RBCs, + bact
urine dipstick: +/- RBCs, + nitrites (gram - present), + leukocyte esterase"

Front 5

Lower UTI diagnostics

Back 5

C/S gold standard: If recurrent UTI without culture in last year
Symptoms persist or recur within three months following prior antimicrobial therapy
Diabetes
Resistant pattern on previous sensitivities
Suspect pyelonephritis
Equivocal data
Pregnancy
Confused, agitated older adults with no identified source of behavior change


Urine microscopy: spun clean catch urine sediment, >5 WBC/ HPF, maybe RBC, bacteria

Dipstick not sensitive in small colony, looking for maybe RBC, nitrites, leukocyte esterase/ WBC

Consider pelvic exam, foreign body, STI, discharge, mass, lesions

Front 6

Lower UTI Tx

Back 6

TMP/SMX-1ds tablet po BID x 3 days OR nitrofurantoin (macrobid) 100mg BID x 5 days OR fosfomycin (monurol) 3 gm powder x 1 dose

If resistance or allergy: Ciprofloxacin (Cipro®) 250 po BID for 3 days
Levofloxacin (Levaquin®) 250 or 500 mg po BID for 3 days

sx relief: phenazopydridine (pyridium) 200 mg TID prn

If relapse (within 1-2 weeks): Cipro and culture

Front 7

Lower UTI Tx in resistant or allergy to first line treatment

Back 7

in resistant or allergy to 1st line: cipro 250mg BID x 3 days OR levofloxacin 250 or 500mg BID x 3 days

Front 8

Lower uti Tx in elderly

Back 8

in elderly: if crcl <30 decrease fluoroquinolone dose by half; no macrobid if crcl<40;

Front 9

Lower UTI tx pregnancy

Back 9

in preg: amox, nitrofurantoin, cephalosporin
need 10-14 day course
in males, DM, structural abnormality, obstruction, stones, immunosupp, preg, indwelling caths
in relapse: if sx return in 1-2 weeks treat wih fluoroquinolone (get culture)

Front 10

Recurrent lower UTI tx

Back 10

Two or more UTIs in 6 months (> 3 in a year)

use prophy (half dose, q HS x 3-6mo), post-coital (take 30 min before or after),

Front 11

Lower UTI Edu

Back 11

"impt to complete trmt, avoid spermicide, prevent constipation/diarrhea, hypoestrogen
no evidence to support increased fluid, improved perineal hygiene, regular toileting, no bubble baths, urinate after sex, cranberry juice"

Front 12

Upper UTI risk

Back 12

"- Pregnancy
- Bacterial capacity for ascent, compromise in host defenses, ability of bacteria to migrate ureter without washout
- Inflammatory changes in the bladder may induce alteration in competence of ureterovesical junction
- Elderly have increased incidence of upper, assess renal fx"

Front 13

Upper UTI symptoms

Back 13

"- CVA tenderness
- Fever
- Malaise
- Abdominal pain
- N/V
- Chills"

Front 14

Upper UTI signs

Back 14

"- Temp >38.3
- +/- septic shock
- + casts"
high blood pressure and pulse

Front 15

Upper UTI Dx

Back 15

Urine microscopy: spun clean catch urine sediment, >5 WBC/ HPF, maybe RBC, bacteria, white casts


CBC, assess renal fx

Front 16

Upper UTI Tx

Back 16

"- Fluoroquinolones (only medication recommended for outpatient)
-Cipro 500 mg po BID x 7 days
Ciprofloxacin good choice for uncomplicated upper tract if resistance pattern less than 10%
- Levofloxacin, 750 mg qd x 5 days
OR
- TMP- SMX 1 DS tab BID, 14 day course if culture sensitive
- Nitrofurantoin and Fosfomycin NOT useful for upper

AND

Ceftriaxone 1g IV x 1"

Front 17

Intercystitis and bladder pain syndrome symptoms

Back 17

Urinary frequency, urgency, dysuria, small voids, suprapubic pain/pressure relieved by voiding, pelvic/perineal/anterior vaginal wall pain, lower abd or back pain. Periods of exacerbation/remission

Front 18

IC/BPS risks

Back 18

Median age at Dx: 42-46; FEMALE; Concomittent pain syndromes, depression, emotional/physical abuse

Front 19

IC/BPS etiology

Back 19

?Inflammatory, allergic, neurogenic, epithelial dysfunction. Injury/dysfuntion of cytoprotective GAG layer of bladder

Front 20

IC/BPS Signs

Back 20

Suprapubic tenderness, anterior vaginal/perineal discomfort

Front 21

IC/BPS DX

Back 21

Urinalysis, STI screen, cytoscopy, post void residual

R/o UTI's, pelvic/bladder CA, cystitis, renal calculi, overactive bladder, endometriosis, STI, vaginitis; REFER

Front 22

IC/BPS Tx

Back 22

1) local heat or cold, avoid activities and food associated, voiding diary, bladder training 2) pelvic PT,
Systemic pharma: Hydroxyzine, Amitriptyline, anticholinergics, antispasmodics 3) cytoscopy or hydrodistension Tx 4) sacral neuromodulation 5) cyclosporine or botulinum toxin 6. urinary divrsion

Front 23

IC/BPS edu

Back 23

Dietary modifications: low acid, low arylalkylamines, increase fluids; bladder retraining, exercise, psycho/social support, stress reduction