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Concise summary of the Genito-Urinary System
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Summary of the Genito-Urinary System
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7 – Genito-Urinary SystemURINARY RETENTION
Chapter 7 – Genito-
Define – inability to voluntarily urinate.
Urinary System
Causes = urethral blockage, post-op, post-
partum drug Tx (antimuscarinics, TCAs, ADs,
URINARY FREQUENCY, ENURESIS AND sympathomimetics), conditions that reduce
INCONTINENCE detrusor contractions or interfere with the
relaxation of the urethra
If caused by detrusor instability – combine
drugs with conservative methods like pelvic Acute UR – medical emergency characterised
floor exercises and bladder training by abrupt development of inability to pass urine
Antimuscarinics – reduce symptoms of Chronic UR – gradual (over months/years)
urgency/urge incontinence and increase development of the inability to empty bladder
bladder capacity. Review every 4-6 weeks completely, characterised by a residual volume
until stable, then every 6-12 months greater than 1L or associated with presence of a
o Duloxetine – for mod-to-severe stress distended or palpable bladder
incontinence in women
Common cause of UR in men = BPH. Men with
o Oxybutynin – direct relaxant effect on
enlarged prostate can have lower UT symptoms
urinary smooth muscle. M/R form reduces
associated with obstruction like urinary
SEs and also available as transdermal patch
retention, frequency, urgency or nocturia
o Flavoxate – fewer SEs but less effective
o Propantheline – rarely used due to SEs o Catheterisation – used to relieve acute
o Mirabegron – selective beta-3 agonist used painful UR or when no cause can be found
with symptoms associated with overactive
Acute UR Tx
bladder syndrome
o Immediate catheterisation (due to pain)
NOCTURNAL ENURESIS IN CHILDREN o Before catheter is removed, use alpha-
adrenoceptor blocker (alfuzosin, doxazosin,
Define – involuntary discharge of urine tamsulosin, prazosin, terazosin) for at least
during sleep, common in young children 2 days to manage UR
Non-Drug Tx Chronic UR Tx
Consider fluid intake, diet, toileting o Consider intermittent catheterisation
behaviour and use of reward systems
before using an indwelling catheter
Consider enuresis alarm for motivated kids.
o Consider alpha-blocker for mod-to-severe
Alarms have a lower relapse rate than drug
UR
Tx when discontinued
o Bethanechol – increases detrusor muscle
o Desmopressin – +/- alarm
contraction. Superseded by catheterisation
Drug Tx
UR due to BPH
o Desmopressin (oral or sublingual) – advised
o If symptoms are NOT troublesome and
in >5 year olds when alarm use is
complications (renal impairment, UR,
inappropriate or when rapid or short-term
recurrent infection) have not developed –
results are priority (e.g. away from home).
consider “watchful waiting”
Repeated courses may be used but must be
o 1st line = alpha blocker
withdrawn gradually at regular intervals
o Imipramine – consider if desmopressin fails
, 7 – Genito-Urinary System
o If enlarged prostate, a raised prostate Maintain normal daily calcium intake of
specific antigen concentration and 700-1200mg and salt intake of <6g
considered to be a high risk of progression =
If recurrent calcium stones – avoid excess
5-alpha-reductase inhibitor (like finasteride
intake of oxalate-rich products like rhubarb,
or dutasteride)
spinach, cocoa, tea, nuts, soy, strawberries,
o If severe symptoms plus drugs fail = surgery
wheat bran
RENAL AND URETERIC STONES If recurrent uric acid stones – avoid excess
Define – crystalline calculi in the upper UT intake of urate rich products like liver, kidney,
May be asymptomatic but can cause pain calf thymus, poultry, herring, sardines and
when they move or with flow of urine anchovies
Usually composed of calcium salts like Pain Management
calcium oxalate, calcium phosphate or both
o 1st line = NSAIDs
Causes – decrease in urine volume and/or an o 2nd line = IV paracetamol
excess of stone forming substances in urine
o 3rd line = opioids
RFs – dehydration, calcium or vitamin D
Medical Expulsive Therapy – consider alpha
supplements, protease inhibitors, diuretics,
blockers if distal stones are <10mm
change in urine pH, males aged 40-60yrs,
positive family history, obesity, urinary Prophylaxis = potassium citrate, thiazides
anatomical abnormalities and excessive dietary
intake of oxalate, urate, sodium and animal
UROLOGICAL PAIN
protein Tx = lidocaine gel
Symptoms = abrupt onset of severe, unilateral Urine alkalinisation – potassium citrate or
abdominal pain radiating to groin (renal colic), sodium bicarbonate
N/V, haematuria, increased urinary frequency,
dysuria, fever BLADDER INSTILLATIONS AND
UROLOGICAL SURGERY
Stones may pass spontaneously. This
depends on size of stone (>6mm = low Aqueous chlorhexidine – used for common
chance of passing easily), location (distal bladder infections but ineffective against most
ureteral stones more likely to pass) and Pseudomonas spp. Solutions of 1 in 5000 may
degree of obstruction cause burning, haematuria and irritate mucosa.
Hence, sterile sodium chloride solution 0.9% is
Aims of Tx = improve detection, clearance and
preferred as a mechanical irrigant
prevention or renal and ureteric stones
Sterile sodium chloride solution 0.9% - used to
Non-drug Tx
treat clot retention (helps dissolve clots)
If asymptomatic and <5mm = “watchful
wait” Doxorubicin and mitomycin – used for recurrent
Surgery = shockwave lithotripsy, superficial bladder tumours
percutaneous nephrolithotomy,
BCG live attenuated strain – for primary or
ureteroscopy
recurrent bladder carcinoma in-situ
Stone analysis and measure serum calcium
Drink 2.5-3L of water and avoid fizzy drinks Glycine below irrigation solution 1.5% - for
transurethral resection of prostate gland
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