NUR 6111 WEEK 7
GU Men’s Health
Complete Notes & Study Guide
William Paterson University
Verified Content
What You’ll Get:
Complete Week 7 Lecture Notes
Case Studies with Diagnostic Workups
Pharmacological & Non-Pharmacological Management
Clinical Guidelines (AUA, USPSTF)
High-Yield Exam Prep for GU & Men’s Health
,● Urinary Incontinence
■ Involuntary loss of urine (in an adult patient) from the urethra
■ Major inconvenience for patients
■ Transient or chronic
■
○ Incidence
■ 15-35% of elderly population
■ Approximately 12 million in the U.S.
■ Up to 50% of nursing home residents
■ Females > males
○ Risk Factors
■ Increasing age
■ Declining estrogen levels
■ Multiparity
■ Dementia
■ Diabetes mellitus
■ Spinal cord injury/lesion and other neurologic conditions
■ Prostatic hypertrophy
■ Stroke
■ Medications (i.e., diuretics)
■ Immobility
○ Classic presentation
■ Stress UI: predictable loss of urine with activities that increase
intra-abdominal pressure (e.g., exercising, sneezing, laughing)
■ Urge UI: urgency as well as increased urinary frequency or nocturia.
Patients typically lose urine on the way to the toilet.
■ Mixed UI: has both components of stress and urge UI
■ Overflow UI: urinary retention and subsequent leakage. Patients may
strain to pass urine or have a sensation of incomplete emptying.
■ Functional UI: occurs when there are barriers to toileting, such as
cognitive impairment, physical frailty, or immobility.
○ Assessment Findings
■ Involuntary loss of urine
■ Urinary urgency
■ Perineal irritation
■ Pelvic exam: may detect GU pathology
■ Rectal exam: may demonstrate prostatic pathology, fecal impaction
, ■ Abdomen: may palpate distended bladder
○ Differential Diagnoses
■ Urinary tract infection
■ STD
■ Medications
■ Undiagnosed diabetes
■ Benign prostatic hyperplasia
■ Psychiatric illness
○ Diagnostic studies
■ Urinalysis: should be normal unless the underlying condition is present
● Abnormal: hematuria, pyuria, bacteriuria, glycosuria, proteinuria
● Order urine culture if bacteria is detected
■ Cystometry
● Severe urgency or bladder contractions when <300ml of bladder
volume = urge incontinence
■ BUN, creatinine
● suspected obstruction, noncompliant bladder, urinary retention
■ Fasting Blood Sugar (FBS) and Ca levels
● Polyuria and lack of diuretic drugs
■ Voiding diary 2-3 days indicating when incontinent episodes occur
■ Post-voiding residual volume measurement (200-300ml)
○ Management of Incontinence
■ Urge UI
● Behavioral therapies: same as stress UI with bladder training,
scheduled voiding, bladder irritant minimization, and urge
suppression
● Medical therapies:
○ Anticholinergic/antimuscarinics-
○ Oxybutynin 2.5-5 mg PO BID-TID, extended-release 5-10
mg daily
○ Tolterodine 2 mg BID
■ Caution with bladder outflow obstruction, Caution
in older adults: sedation, confusion, delirium
○ Beta-adrenergic agonists- Mirabegron 25mg PO daily
■ It may increase BP in patients with hypertension
but is not recommended in severe hepatic or renal
impairment
● Surgical therapies: neuro sacral modulation, bladder
augmentation, botulinum toxin injection
■ Stress UI
● Behavioral therapies: timed or double voiding, smoking
cessation, weight loss, pelvic muscle exercises with or without a
physical therapist, pessary, bowel management
● Medical therapies: Not FDA-approved for UI
GU Men’s Health
Complete Notes & Study Guide
William Paterson University
Verified Content
What You’ll Get:
Complete Week 7 Lecture Notes
Case Studies with Diagnostic Workups
Pharmacological & Non-Pharmacological Management
Clinical Guidelines (AUA, USPSTF)
High-Yield Exam Prep for GU & Men’s Health
,● Urinary Incontinence
■ Involuntary loss of urine (in an adult patient) from the urethra
■ Major inconvenience for patients
■ Transient or chronic
■
○ Incidence
■ 15-35% of elderly population
■ Approximately 12 million in the U.S.
■ Up to 50% of nursing home residents
■ Females > males
○ Risk Factors
■ Increasing age
■ Declining estrogen levels
■ Multiparity
■ Dementia
■ Diabetes mellitus
■ Spinal cord injury/lesion and other neurologic conditions
■ Prostatic hypertrophy
■ Stroke
■ Medications (i.e., diuretics)
■ Immobility
○ Classic presentation
■ Stress UI: predictable loss of urine with activities that increase
intra-abdominal pressure (e.g., exercising, sneezing, laughing)
■ Urge UI: urgency as well as increased urinary frequency or nocturia.
Patients typically lose urine on the way to the toilet.
■ Mixed UI: has both components of stress and urge UI
■ Overflow UI: urinary retention and subsequent leakage. Patients may
strain to pass urine or have a sensation of incomplete emptying.
■ Functional UI: occurs when there are barriers to toileting, such as
cognitive impairment, physical frailty, or immobility.
○ Assessment Findings
■ Involuntary loss of urine
■ Urinary urgency
■ Perineal irritation
■ Pelvic exam: may detect GU pathology
■ Rectal exam: may demonstrate prostatic pathology, fecal impaction
, ■ Abdomen: may palpate distended bladder
○ Differential Diagnoses
■ Urinary tract infection
■ STD
■ Medications
■ Undiagnosed diabetes
■ Benign prostatic hyperplasia
■ Psychiatric illness
○ Diagnostic studies
■ Urinalysis: should be normal unless the underlying condition is present
● Abnormal: hematuria, pyuria, bacteriuria, glycosuria, proteinuria
● Order urine culture if bacteria is detected
■ Cystometry
● Severe urgency or bladder contractions when <300ml of bladder
volume = urge incontinence
■ BUN, creatinine
● suspected obstruction, noncompliant bladder, urinary retention
■ Fasting Blood Sugar (FBS) and Ca levels
● Polyuria and lack of diuretic drugs
■ Voiding diary 2-3 days indicating when incontinent episodes occur
■ Post-voiding residual volume measurement (200-300ml)
○ Management of Incontinence
■ Urge UI
● Behavioral therapies: same as stress UI with bladder training,
scheduled voiding, bladder irritant minimization, and urge
suppression
● Medical therapies:
○ Anticholinergic/antimuscarinics-
○ Oxybutynin 2.5-5 mg PO BID-TID, extended-release 5-10
mg daily
○ Tolterodine 2 mg BID
■ Caution with bladder outflow obstruction, Caution
in older adults: sedation, confusion, delirium
○ Beta-adrenergic agonists- Mirabegron 25mg PO daily
■ It may increase BP in patients with hypertension
but is not recommended in severe hepatic or renal
impairment
● Surgical therapies: neuro sacral modulation, bladder
augmentation, botulinum toxin injection
■ Stress UI
● Behavioral therapies: timed or double voiding, smoking
cessation, weight loss, pelvic muscle exercises with or without a
physical therapist, pessary, bowel management
● Medical therapies: Not FDA-approved for UI
