Showing posts with label Urology. Show all posts
Showing posts with label Urology. Show all posts

02 October 2012

Vesicoureteral Reflux



Vesicoureteral reflux (VUR) is an abnormal movement of urine from the bladder into ureters or kidneys. Urine normally travels from the kidneys via the ureters to the bladder. In vesicoureteral reflux the direction of urine flow is reversed.

Endoscopic Correction of Vesicoureteral Reflux in Patients with Myelomeningocele and Low Bladder Compliance using Dextranomer/Hyaluronic Acid Copolymer.
Satyan K. Shah, M.D.
Director of Robotic Surgery
http://medicine.unm.edu

Diagnosis and Management of VUR after first UTI
Ron Keren, MD, MPH
http://www.research.chop.edu

Pediatric GU Dysfunction
http://www.gdn.edu/

Nursing Care of the Child with GU disorders
http://www.austincc.edu

Pathology of renal failure
http://www.mona.uwi.edu

The Child With a Genitourinary Alteration
http://www.kishwaukeecollege.edu

Alterations of Renal and Urinary Tract Function in Children
http://users.ipfw.edu

Genitourinary Dysfunction
http://www2.sunysuffolk.edu

UTI
Lindsay Chase MD
http://www.bcm.edu

Nephrology Board Review
Sidharth Shah, MD.
http://www.med.unc.edu

Human Genetics of Urinary Tract Malformation
Ali Gharavi, MD
http://www.columbia.edu

Pediatric Genitourinary Disorders
http://www.austincc.edu

GU, Endocrine, Integ
Nancy Pares, RN, MSN
http://faculty.mccneb.edu

Urologic Disorders
http://legacy.owensboro.kctcs.edu/

Nursing Management Renal and Urologic Problems
S. Buckley, RN, MS
http://www.napavalley.edu

Urinary Tract Infections in Infants & Toddlers: An Evidence-based Approach
Thomas B. Newman, MD, MPH
http://www.epibiostat.ucsf.edu

Imaging Studies After First Febrile Urinary Tract Infection in Young Children
Ellen Chen, M.D.
http://sfghdean.ucsf.edu

The Child with Genitourinary Alterations
http://course1.winona.edu

231 free full text published articles

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28 September 2012

Priapism



Priapism is a potentially painful medical condition, in which the erect penis or clitoris does not return to its flaccid state.

Sickle Cell Disease
Paolo Aquino, M.D., M.P.H.,
http://www.med.wayne.edu

Medical Emergencies - Urology and Nephrology Topics
http://web.uaccb.edu

Case Study
http://www.meddean.luc.edu

Sickle Cell Disease
http://users.phhp.ufl.edu

Antiestrogens, Antiprogestins, and Androgens Drugs Affecting Fertility and Reproduction
Gerianne R. Bliss, M.D., Chuck Hensley, R.Ph.
http://cmsu2.ucmo.edu

Sickle Cell Disease: Pain & Fever
John Cheng, MD
http://www.pediatrics.emory.edu

Inflammatory Disorders of the Male
Penne Mott
http://intranet2.dpe.edu

Male GU Disorders
http://cstl-hhs.semo.edu

Sickle Cell and Transfusions
Ashley Duckett, MD
http://clinicaldepartments.musc.edu

Sickle Cell Disease
By Brent Durschmidt
http://faculty.chemeketa.edu

One for You and One for Me: Drug Seeking Patients and Professionals
Frank Paloucek PharmD DABAT
http://www.pitt.edu

Sickle Cell Anemia
http://www.rcc.mass.edu

Head and Spine Injuries
http://faculty.sgc.edu

Polycythemia and Hyperviscosity
Kirsten E. Crowley, MD
http://www.ohsu.edu

Sex organs of the male
http://campus.houghton.edu

Pediatric Hematological Disorders
Whaley and Wong
http://ruby.fgcu.edu

Antidepressants
Cesar A. Soutullo, M.D.
http://www.hsc.wvu.edu

Suspected Spinal Injury
http://web.monroecc.edu

Trauma Emergencies
http://web.uaccb.edu 


600 Published articles on Priapism

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27 September 2012

Scrotal Mass



Testis Cancer
Christopher Saigal MD MPH
http://www.endocrinology.med.ucla.edu

Hemoptysis... or  that Large Testicular Mass I’ve Been Ignoring
Christine Williams, MD
https://medicine.med.unc.edu

Testes, Scrotum and Prostate
http://faculty.orangecoastcollege.edu

Case Study
Kommerien Daling
http://www.fpm.emory.edu

Benign and Malignant Diseases of the Testis and Scrotum
Gary J Faerber, MD
http://open.umich.edu

Gender-Based Pathology
Ann Sudoh, M.D.
http://www.d.umn.edu

Private Cancer: Cancers of the Prostate, Testicles and Ovaries
Paolo Aquino
http://www.med.wayne.edu/

What’s Going On Down There, Doc?
Emily A. Boohaker, MD, Analia Castiglioni, MD
http://www.uab.edu

Reproductive Health Problems in Pediatric Males
http://www.imperial.edu/

Abdominal and Genitourinary
K. Burger, MSEd, MSN, RN, CNE
http://www2.sunysuffolk.edu

Testicular Cancer
http://www.stritch.luc.edu

Autologous Stem Cell Transplantation as Initial Treatment of Diffuse Large B-Cell Lymphoma
Amanda F. Cashen, M.D.
http://hematology.wustl.edu

Male Reproductive
By Diana Blum RN MSN
http://faculty.mccneb.edu

Reproductive Function & Disorders
Mandy Vichas RN, BSN, NPS
http://facweb.northseattle.edu

Scrotal Pain and Swelling
Jesse Sturm, MD
http://www.pediatrics.emory.edu

Male Sexual Anatomy and Physiology
http://www.public.iastate.edu

Sex Values and Human Nature
http://philosophy.illinoisstate.edu

Lymphatic Filariasis
B.Ganesh
http://www.pitt.edu


74 Published articles on Scrotal Mass

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12 July 2012

Neurogenic bladder



Urinary Elimination
http://www.stchas.edu

Basic Human Needs Urinary Elimination
http://www.mccc.edu/

Hydronephrosis
Donna C. Queyquep, M.D.
http://www.ttuhsc.edu/

Congenital Midline Anomalies
http://www.austincc.edu

Obstetric Fistula An Overview
Brad R. MacKinnon
http://www.pitt.edu

Neurogenic Bladder Dysfunction
Sean Collins, M.D.
http://www.medschool.lsuhsc.edu/

Catheter Associated UTI
http://www.ucdenver.edu/

Urinary Incontinence and Medical Management
Mani Vijayan
http://nursing.ouhsc.edu

Genital-urinary System
http://www.portervillecollege.edu

Urinary Catheterization
http://faculty.lagcc.cuny.edu/

Toilet Training Children with Moderate-Severe Disability
Lisa Samson-Fang MD
http://www.uvm.edu

Cholinergic-Blocking Drugs
http://www.mccc.edu


103 free access published articles

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23 June 2012

Proteinuria



Applications of ACE Inhibitors in Non-Diabetic Proteinuria
Eric T. Pride, M.D.
ace.ppt

Case Report and Lit Review: Reduction of Proteinuria in Diabetic Nephropathy with Spironolactone
Harry W. Floyd, M.D.
Case Report and Lit Review.ppt

Diseases of the Kidney
Diseases of the Kidney.ppt

Nephrotic Syndrome
Nephrotic Syndrome.ppt

Preeclampsia - Eclampsia
Jack Ludmir, M.D
Preeclampsia-Eclampsia.ppt

Renal Disease: Overview and Acute Renal Failure
Jack DeRuiter, PhD
Renal Disease: Overview and Acute Renal Failure.ppt

Acute Renal Failure
Jayanti Jasti, M.D.
Acute Renal Failure.ppt

Orange Urine on Halloween
Eva Delgado, MD
Glomerulonephritis.ppt

Hypertension Control and Progression of Renal Disease
Hypertension Control and Progression of Renal Disease.ppt

Alport Syndrome
Aditya Mattoo, MD
Alport Syndrome.ppt


Adult Onset Minimal Change Disease
Nephrology Grand Rounds, Aditya Mattoo, MD
Adult Onset Minimal Change Disease.ppt

Association between HIV and renal disease
Saleem Bharmal
HIV-Associated_Nephropathy.ppt

Hematuria
Sarah Swartz, MD
Hematuria.ppt

Laboratory Evaluation of Renal Function
S .POPLI. M.D.,F.A.C.P.
Laboratory Evaluation of Renal Function.ppt

Hypertension in Pregnancy
Peter Bernstein, MD, MPH
Hypertension in Pregnancy.ppt

Proteinuria Is an Independent Risk Factor for Mortality in Type 2 Diabetes
Ahmed M. Awad, D.O.
proteinuria_reduction.ppt

Poststreptococcal Glomerulonephritis
Nirav Dhruva
Glomerulonephritis.ppt

Recurrent And De Novo GN After Renal Transplantation
GN-after-renal-transplantation.ppt

Crescentic IgAN
Aditya Mattoo
Crescentic IgAN.ppt
600 Scholarly Published articles free access

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24 May 2012

Voiding Dysfunction



Voiding Dysfunction is a general term to describe the condition where there is a lack of coordination between the bladder muscle (detrusor) and the urethra. With normal urination, the urethra relaxes and opens when the bladder muscle contracts allowing urine to pass out of the body freely. In those with voiding dysfunction, the urethra does not relax when the bladder muscle contracts making it difficult for urine to pass.

Management of Patients With Upper or Lower Urinary Tract Dysfunction
Mrs.Mahdia Samaha Kony
Renal incontinence.ppt
Part-2 by Miss Iman Shaweesh
Renal incontinece-2.ppt

Pediatric GU Dysfunction
Pediatric GU Dysfunction.ppt

Common Genitourinary Disorders
Common Genitourinary Disorders .ppt

Urinary Incontinence in Older Adults
Tomas L. Griebling, MD, MPH
Urinary Incontinence in Older Adults.ppt

Urinary Tract Infections Diagnosis and Management
Tristan T. Berry,
Fungal_GR.PPT

Neurogenic Bladder Dysfunction
Sean Collins, M.D.
Neurogenic_Bladder_Dysfunction.ppt

Urine & Body Fluid Analysis Renal Disease
Ricki Otten MT(ASCP)SC
Urine & Body Fluid Analysis Renal Disease.ppt

Toileting: The Assessment and Treatment of Enuresis and Encopresis
Emily D. Warnes, Ph.D.
ToiletingEnuresisandEncopresisNoPic.ppt

Neurological and Medical Complication of Stroke
Harvey A. Drapkin, D.O. F.A.C.N.
Neurological and Medical Complication.ppt

Genitourinary dysfunction
Genitourinary dysfunction.ppt

Common Prepubescent Gynecological Issues
D’Juanna White Satcher MD MPH
http://www.bcm.edu/web/pediatrics/documents/nc_archive_64.ppt

Genital-Urinary System
Genital-Urinary System-1.ppt
Genital-Urinary System-2.ppt

Evaluation and Treatment of Urinary Incontinence and Prolapse
Prolapse.ppt

Renal & Urologic Problems
Urologic Problems.ppt

Alterations of GI System
GI System.ppt

Genitourinary
Elisa A. Mancuso RNC-NIC, MS, FNS
Genitourinary.ppt

Genitourinary Disorders
Jan Bazner-Chandler
Genitourinary Disorders.ppt

Incontinence - Urinary and Fecal
Incontinence - Urinary and Fecal.ppt

Drug Treatment Choice in Older Adults with Urinary Incontinence
Catherine E. DuBeau, MD
Urinary Incontinence.ppt

Urinary Elimination
Urinary Elimination.ppt
53 Free full text articles 

  1. Predictors of Voiding Dysfunction after Mid-urethral Sling Surgery for Stress Urinary Incontinence.
  2. Patients with a history of infection and voiding dysfunction are at risk for recurrence after successful endoscopic treatment of vesico ureteral reflux and deserve long-term follow up.
  3. Helping patients with voiding dysfunction: What are our current options?
  4. Clinical, imaging and cystometric findings of voiding dysfunction in children.
  5. Percutaneous intervention of large bladder calculi in neuropathic voiding dysfunction.
  6. Voiding dysfunction after total mesorectal excision in rectal cancer.
  7. Voiding dysfunction after pelvic colorectal surgery.
  8. Role of Purinergic Signaling in Voiding Dysfunction.
  9. Pharmacokinetic study of nicotine and its metabolite cotinine to clarify possible association between smoking and voiding dysfunction in rats using UPLC/ESI-MS.
  10. Rethinking suprapubic cystostomy in voiding dysfunction: new trial with timed drainage.
  11. Predictors of Postoperative Voiding Dysfunction following Transobsturator Sling Procedures in Patients with Stress Urinary Incontinence.
  12. Treatment of urinary voiding dysfunction syndromes with spinal cord stimulation.
  13. The forefront for novel therapeutic agents based on the pathophysiology of lower urinary tract dysfunction: alpha-blockers in the treatment of male voiding dysfunction - how do they work and why do they differ in tolerability?
  14. The forefront for novel therapeutic agents based on the pathophysiology of lower urinary tract dysfunction: pathophysiology of voiding dysfunction and pharmacological therapy.
  15. Voiding dysfunction after brachytherapy in patients with prostate cancer.
  16. Voiding dysfunction in prostate cancer.
  17. Voiding dysfunction in prostate cancer.
  18. Efficacy and safety of tamsulosin for the treatment of non-neurogenic voiding dysfunction in females: a 8-week prospective study.
  19. Role of voiding and storage symptoms for the quality of life before and after treatment in men with voiding dysfunction.
  20. Social stress in mice induces voiding dysfunction and bladder wall remodeling.
  21. Voiding dysfunction due to multiple sclerosis: a large scale retrospective analysis.
  22. Hormone replacement therapy has no routine role in the management of postmenopausal voiding dysfunction.
  23. Should hormone replacement therapy be used in postmenopausal women for voiding dysfunction?
  24. Effect of Goshajinkigan on storage symptoms in prostatic disease--fundamental researches of Chinese herbal medicine for voiding dysfunction and its future aspects.
  25. Early versus late treatment of voiding dysfunction with pelvic neuromodulation.
  26. The potential of hormones and selective oestrogen receptor modulators in preventing voiding dysfunction in rats.
  27. Prevalence and characteristics of late postoperative voiding dysfunction in early-stage cervical cancer patients treated with radical hysterectomy.
  28. Evaluation of purinergic mechanism for the treatment of voiding dysfunction: a study in conscious spinal cord-injured rats.
  29. Effects of thyrotropin-releasing hormone on urethral closure pressure in females with voiding dysfunction.
  30. Urodynamic features of the voiding dysfunction in HTLV-1 infected individuals.
  31. Conservative management of voiding dysfunction.
  32. Effectiveness of tolterodine in nonneurogenic voiding dysfunction.
  33. Is There a Role for alpha-Blockers for the Treatment of Voiding Dysfunction Unrelated to Benign Prostatic Hyperplasia?
  34. Evaluation of voiding dysfunction and measurement of bladder volume.
  35. Sacral nerve stimulation for the management of voiding dysfunction.
  36. Risk factors of voiding dysfunction and patient satisfaction after tension-free vaginal tape procedure.
  37. Combined use of alpha-adrenergic and muscarinic antagonists for the treatment of voiding dysfunction.
  38. Investigation of voiding dysfunction in a population-based sample of children aged 3 to 9 years.
  39. Voiding dysfunction and urodynamic abnormalities in elderly patients.
  40. Neurogenic voiding dysfunction after sacrococcygeal teratoma resection.
  41. Sonographic findings in a case of voiding dysfunction secondary to the tension-free vaginal tape (TVT) procedure.
  42. Ultrasound diagnosis of intra-urethral tension-free vaginal tape (TVT) position as a cause of postoperative voiding dysfunction and retropubic pain.
  43. Voiding dysfunction in women with systemic lupus erythematosus.
  44. Voiding dysfunction in Duchenne muscular dystrophy.
  45. Vesicoureteric reflux and functional voiding dysfunction in children.
  46. Assessment of voiding dysfunction in Parkinson's disease by the international prostate symptom score.
  47. Experimental study of voiding dysfunction induced by cerebral infarction in rats.
  48. Voiding dysfunction in brain disease.
  49. Voiding dysfunction after abdominal radical hysterectomy. Comparison between patients with and without adjuvant irradiation therapy.
  50. Improvement of urethral resistance after the administration of an alpha-adrenoceptor blocking agent, urapidil, for neuropathic voiding dysfunction.
  51. Voiding dysfunction in patients with human T-lymphotropic virus type-1-associated myelopathy (HAM).
  52. Clinical evaluation for voiding dysfunction in patients with cerebral-palsy.
  53. Abnormal electromyographic activity of the urethral sphincter, voiding dysfunction, and polycystic ovaries: a new syndrome?

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29 April 2012

Urethral Dilation



Development of the Urinary System
Development of the Urinary System.ppt

The Urinary System
urinarysystem.ppt

Diseases of the Urinary & Reproductive Systems
Diseases of the Urinary & Reproductive Systems.ppt

Renal Stones: A Guide for the Non-Urologist
F. A. Fried, MD
Renal Stones: A Guide for the Non-Urologist.ppt

Urinary System
Urinary.ppt

Urinary Tract Infections Diagnosis and Management
Tristan T. Berry
Fungal_GR.PPT

Invasive Fetal Therapy
Jessica M. DeMay, MD
Invasive Fetal Therapy.ppt

Infective Endocarditis
Endocarditis.ppt

Infectious and Inflammatory Disorders of the Urinary System
Infectious and Inflammatory Disorders.ppt

Major Functions of the Kidneys and the Urinary System
Urinary system.ppt

Genetal Urinary System
Genetal Urinary System.ppt

The Urinary System
The Urinary System.ppt

Urinary tract infection in children
Professor Abdelaziz Elamin
Urinary tract infection in children.ppt

Kidney and Upper Urinary Tract
J. Stuart Wolf, Jr., M.D.
KidneyUpperUT.ppt

Genitourinary System Kidneys
Genitourinary_System.ppt

Neonatal Surgical Issues
Sue Ann Smith, MD
Neonatal-Surgical-Issues.ppt

Nephron Anatomy Filtration Renal Tubules Urine
quiz_show_game.ppt

Male Reproductive System
Male Reproductive System.ppt

Nephrolithiasis
Adnan Alsaka M.D.
Nephrolithiasis.ppt

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24 March 2012

Interstitial cystitis



Interstitial cystitis is a long-term (chronic) inflammation of the bladder wall

Urinary Tract Infections
Lourdes Lozano Vargas
Urinary Tract Infections .ppt

Chronic Pelvic Pain in Women
Eddie Needham, MD, FAAFP
Chronic Pelvic Pain in Women.ppt

Infectious and Inflammatory Disorders of the Urinary System
S. Buckley, RN, MS
Infectious and Inflammatory Disorders.ppt

Pelvic Pain – Dysmenorrhea and Endometriosis
PelvicPainDysmenorrheaandEndometriosis.ppt

Urinary Incontinence
Tova Ablove, Alev Wilk
Urinary Incontinence.ppt

Chronic Pelvic Pain (CPP)
Cherrell Triplett, MD
ChronicPelvicPain2010.ppt

Urology
Gerianne R. Bliss, M.D., Chuck Hensley, R.Ph.
Urology.ppt

Altered Renal Function
Altered Renal Function.ppt

Urologic Disorders
UTI.ppt

Chronic Fatigue Syndrome
Manasa Manapragada
Chronic Fatigue Syndrome.ppt

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28 February 2012

Urological Examination



Male GU Examination
Jong  M. Choe, MD
Male GU Examination.ppt

Hematuria
Hematuria.ppt

Infertility
By Joan Meade
Infertility.ppt

Overactive Bladder
Raji  Gill, D.O., M.Sc.
Overactive_Bladder.ppt

Acute Abdominal  Pain
Medical Student  Lecture Series
Acute Abdominal Pain lecture.ppt

Urinary  Incontinence in Older  Adults
Tomas  L. Griebling, MD, MPH
Urinary Incontinence Module.ppt

Nephrolithiasis
B.  Wayne Blount, M.D. MPH
Nephrolithiasis

Abnormal Urine Color or clarity
Jill McClure, DVM,MS
AbnormalUrine.ppt

Urinary Incontinence  In The Aging Patient
Deb Mostek
Urinary_incdidacticslide_dm.ppt

Urinary Tract  Infection 
Michele Ritter, M.D.
UTI.ppt

Testis  Cancer
Christopher  Saigal MD MPH
http://www.endocrinology.med.ucla.edu/Saigal%20slides.ppt

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17 February 2012

Urethral stricture Ppt Lecture Notes Publications




Neonatal urinary Obstruction
by Donna C. Queyquep, M.D.
Hydronephrosisdrqueyquep.ppt

Obstructive  Renal Disorders
Obstructive%20Disorders.ppt

Urinary Disorders
lecture%20notes/Urinary%20Disorders%20web.ppt

Alterations  of Renal and Urinary Tract Function
Renal%20disfunction.ppt

Genital-urinary  System
Genital%20Urinary/Renal%202%20web.ppt

Hepatobillary  & Genitourinary
Hepatobillary%20&%20Genitourinary.ppt

UTI prevention  in Older Patients with Foley Catheters
uti-prevention.ppt

Uroepithelial Tumors
Terrence C. Demos, MD
Uroepithelial_tumors/UROEPITHELIAL%20NEOPLASMS.ppt

Urinary  Incontinence in Older  Adults
by Tomas  L. Griebling, MD, MPH
Urinary%20Incontinence%20Module.ppt

Prostatic  neoplasms / cancer
Genital%20Urinary/Male%20GU%201c.ppt

Assessment  of the Male Genitourinary System
MaleGenitourinarySystem.ppt

Acute Renal Failure
by John K. Amory MD
AmoryRenalFailurelecture.ppt

Publications free access:

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31 January 2012

Uterine prolapse Ppts and latest 20 publications



Uterine prolapse is falling or sliding of the womb (uterus) from its normal position into the vaginal area.

Causes, incidence, and risk factors: Muscles, ligaments, and other structures hold the uterus in the pelvis. If these muscles and structures are weak, the uterus drops into the vaginal canal . This is called prolapse. This condition is more common in women who have had one or more vaginal births.

Female  Genitourinary System
http://www.mccc.edu/~martinl/documents/FemaleGenitourinarySystemSession9.ppt

Post-Reproductive  Gynecology
http://www.uphs.upenn.edu/obgyn/education/documents/PostreproductiveObGynHonebrink.ppt

Reproductive System - Review of Structure and Function
http://bioweb.wku.edu/faculty/Crawford/aging22.ppt

Gynecologic  Assessment of Women
by Eileen Hawkins, MSN, ARNP
http://www.nursing.twsu.edu/advhealth/lesson/11/pelvic.ppt

Hysterectomy
by Eric Cui
http://ed.hs.uci.edu/trap/resources%5CHysterectomy.ppt

Maternal & New-born Health  with  Reference to   India & Rajasthan
by Dr.  Kanupriya Chaturvedi
http://www.pitt.edu/~super4/39011-40001/39771.ppt

Urinary  Incontinence in Older  Adults
by Tomas  L. Griebling, MD, MPH, University of Kansas
http://www2.kumc.edu/coa/Education/FacDevPowerPoint/Urinary%20Incontinence%20Module.ppt

Post-Partum Complications
http://www2.sunysuffolk.edu/kiralyc/nur248/Post_Partum_Complications%209%20student%20version.ppt

Assessment  of the Female Genitourinary System
http://www.mccc.edu/~martinl/documents/NRS102Week12FemaleGenitourinarySystem.ppt

Disorders of  Female Reproductive System
by Eva Talastas
http://webenhanced.lbcc.edu/vnjm/vn255jm/coursedocs/female.ppt

UTI prevention  in Older Patients with Foley Catheters
from Virginia  Mason Medical Center
http://www.plu.edu/~clabotsc/doc/uti-prevention.ppt

Urogynecology Cytocele &  rectocele urinary ioncontenence
by Mrs. Raheegeh Awni
http://elearning.najah.edu/OldData/pdfs/5407Cytocele%20&%20rectocele%20GYN%20LECT%204.ppt

Latest 20 Published articles

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25 March 2010

Urinary Tract Infections



Urinary Tract Infections
By:Lourdes Lozano Vargas

Urinary Tract Infections
* Leading cause of morbidity and health care expenditures in persons of all ages.
* An estimated 50 % of women report having had a UTI at some point in their lives.
* 8.3 million office visits and more than 1 million hospitalizations, for an overall annual cost > $1 billion.

Acute Uncomplicated Cystitis
* Sexually active young women.
* Causes: anatomy and certain behavioral factors, including delays in micturition, sexual activity, and the use of diaphragms and spermicides tract.
* Aggressive diagnostic work-ups are unwarranted in young women presenting with an uncomplicated episode of cystitis.

Acute Uncomplicated Cystitis
* The microbiology is limited to a few pathogens.
* 70%- 85% are caused by Escherichia coli
* 5-20%are caused by coagulase-negative Staphylococcus saprophyticus
* 5-12% are caused by other Enterobacteriaceae such as Klebsiella and Proteus.

Acute Uncomplicated Cystitis
* Clinical Features: dysuria, frequency, urgency, suprapubic pain, hematuria.
o Fever >38C, flank pain, costovertebral angle tenderness, and nausea or vomiting suggest upper tract infection.

Acute Uncomplicated Cystitis
* Diagnosis: direct history and PE
* PE: Temperature, abdominal exam, assessment of CVA tenderness, pelvic exam.
o H/o STD’s, new sexual partner, partner with urethral symptoms, gradual onset.

Acute Uncomplicated Cystitis
* Guidelines for tx of acute cystitis recommend empiric antibiotic tx.
* Unnecessary antibiotic use??
* Clinical criteria for Dx:

Dysuria, presence of > trace urine leukocytes, and presence of nitrites or...
Dysuria and frequency in the absence of vaginal discharge.
Acute Uncomplicated Cystitis
* UA: Evaluation of midstream urine for pyuria.
o White blood cell casts in the urine are Dx of upper tract infection.
* Urine Culture: Not necessary
o Warranted in: Suspected complicated infection, persistent symptoms following tx, symptoms recur < 1 mo after tx. Acute Uncomplicated Cystitis * Urine dipsticks: o Leukocyte esterase (pyuria), sensitivity 75-90%, specificity 95% o Nitrite (Enterobacteriacea), sensitivity 35-85%, specificity 95%, false positive with phenazopyridine, beets. o Microscopic evaluation for pyuria or a culture is indicated in pt with negative leukocyte esterase that have urinary symptoms. Acute Uncomplicated Cystitis * Susceptibility: o E.coli o S.saprophyticus Acute Uncomplicated Cystitis * Treatment: o Short course vs. prolonged tx + Short course preferred except with beta-lactam agents o TMP-SMX (160/800mg BID x 3) first-line tx if: no allergy to the drug, no antibiotics in the past 3 mo, no recent hospitalization. o Nitrofurantoin (100mg BID x 5 days) o Analgesia: Phenazopyridine 200mg TIDx2 Acute Urethral Syndrome * Acute symptomatic women with dysuria and frequency with a midstream culture containing < 10(5) CFU/mL. * > 10(2) CFU/mL in women with acute symptomatic pyuria = UTI
* Tx as an uncomplicated UTI
* Mycoplasma genitalium, Ureaplasma urealyticum

Acute Complicated Cystitis
* UTI when/with structural, functional or metabolic abnormalities (polycystic, solitary, transplant kidney;DM, CRF, indwelling cath, neurogenic bladder) or elderly, male, child, pregnant or h/o recurrent UTI)
* E.coli accounts for fewer than one third of complicated cases.
* Clinically, the spectrum of complicated UTIs may range from cystitis to urosepsis with septic shock.

Acute Complicated Cystitis
* Urine culture and susceptibility are necessary.
* These infections are usually associated with high-count bacteriuria (> 10(5) CFU/mL).
* MO: Proteus, Klebsiella, Pseudomonas, Serratia, and Providencia, enterococci, staphylococci and fungi AND E.coli

Acute Complicated Cystitis
* Empiric therapy for these patients should include an agent with a broad spectrum of activity against the expected uropathogens: fluoroquinolone, ceftazidime, cefepime, aztreonam, imipenem-cilastatin. (Obtain Ucx prior to Tx)
* Tx x 7-14 days
* Follow-up urine culture should be performed within 14 days after treatment???

Recurrent Cystitis
* Up to 27% of young women with acute cystitis develop recurrent UTIs.
* The causative organism should be identified by urine culture.
* Relapse: infection with the same organism (multiple relapses = complicated UTIs).
* Recurrence: infection with different organisms.

Recurrent Cystitis
* >3 UTI recurrences documented by urine Cx within one year can be managed using one of three preventive strategies:
* Acute self-treatment with a three-day course of standard therapy.
* Postcoital prophylaxis with one-half of a TMP-SMX double-strength tablet (80/400 mg).
* Continuous daily prophylaxis TMP-SMX one-half tablet per day (40/200 mg); nitrofurantoin 50 to 100 mg per day; norfloxacin 200 mg per day.

Uncomplicated Pyelonephritis
* Suspect if:
o Cystitis-like illness and accompanying flank pain
o Severe illness with fever, chills, nausea, vomiting, abdominal pain
o Gram-negative bacteremia.

Uncomplicated Pyelonephritis
* DX: Clinical, confirm with:
o UA: pyuria and/or WBC casts
o UCx with > 10 (5) CFU/mL (80%)
* Tx: 14 days total
o Oral: TMP/SMX, fluoroquinolones
o IV: 3rd gen cephalosporin, aztreonam, quinolones, aminoglycoside

Uncomplicated Pyelonephritis
* Pt with symptoms after 3 days of appropriate antimicrobial tx should be evaluated by renal US or CT for obstruction or abscess.

UTI in Men

* At risk: Older men with prostatic disease, UT instrumentation, anal sex, or partner colonized with uropathogens.
* UCx: 10 (3) CFU/mL sensitivity and specificity 97%.
* Additional studies?
o Not necessary in young healthy men who have a single episode.

UTI in Men
* Tx:
o Uncomplicated cystitis:
+ TMP/SMX or fluoroquinolones x 7 days
o Complicated cystitis:
+ Fluoroquinolones x 7-14 days
o Bacterial prostatitis:
+ Fluoroquinolone x 6-12 weeks

Catheter-Associated UTI
* Risk of bacteriuria is ~ 5%/day (long term catheter bacteriuria is inevitable).
* 40% of nosocomial infections
* Most common source of gram-negative bacteremia.
* Dx: Ucx 10 (2) CFU/mL
o MO: E.coli, Proteus, Enterococcus, Pseudomona, Enterobacter, Serratia, Candida

Catheter-Associated UTI
* Mild to mod: oral quinolones10-14days
* Severe infection: IV/oral 14-21days
* Asymptomatic bacteriuria in pt with an indwelling Foley should not be Tx unless they are immunosuppressed, have risk of bacterial endocarditis or pt who are about to undergo urinary tract instrumentation.

Asymptomatic Bacteriuria
* UCx: > 10(5)CFU/mL with no symptoms
* Three groups of pt with asymptomatic bacteruria have been shown to benefit from tx:
o Pregnant
o Renal transplant
o Pt who are about to undergo urinary tract procedures.

Pregnant patients

* Asymptomatic bacteriuria: two consecutive voided urine specimens with isolation of the same bacterial strain >10(5) or a single cath urine specimen.
o Nitrofurantoin 100mg BID x 5-7 days
o Amoxi/Clav 500mg BID or 250 TID x 7days
o Fosfomycin 3g PO x 1

Interstitial Cystitis
* Frequency, urgency, urge incontinence with periurethral and suprapubic pain on bladder filling that is improved by voiding. Terminal hematuria may be present.
* Etiology. Unclear (autoimmune, altered glycosaminoglycal layer, allergic)

Interstitial Cystitis
* TX
o Refer to urology for cystoscopy.
o Dietary modifications
o Behavioral modifications
o Rx:
+ Pyridium
+ Pentosan polysulfate 100mg TID x 6mo to 2 years.
+ Amitriptyline 10-75mg QHS

Interstitial Cystitis
* Intravesical therapies
o Dimethyl Sulfoxide instillations q1-2 wks
o BCG instilled q1wk x 6-8 wks
o Hyaluronic acid instilled q1wk x 4-6wk.

References

Urinary Tract Infections.ppt

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29 December 2009

Urinalysis



METHODS OF URINE COLLECTION

1. Random collection taken at any time of day with no precautions regarding contamination. The sample may be dilute, isotonic, or hypertonic and may contain white cells, bacteria, and squamous epithelium as contaminants. In females, the specimen may cont contain vaginal contaminants such as trichomonads, yeast, and during menses, red cells.
2. Early morning collection of the sample before ingestion of any fluid. This is usually hypertonic and reflects the ability of the kidney to concentrate urine during dehydration which occurs overnight. If all fluid ingestion has been avoided since 6 p.m. the previous day, the specific gravity usually exceeds 1.022 in healthy individuals.
3. Clean-catch, midstream urine specimen collected after cleansing the external urethral meatus. A cotton sponge soaked with benzalkonium hydrochloride is useful and non-irritating for this purpose. A midstream urine is one in which the first half of the bladder urine is discarded and the collection vessel is introduced into the urinary stream to catch the last half. The first half of the stream serves to flush contaminating cells and microbes from the outer urethra prior to collection. This sounds easy, but it isn't (try it yourself before criticizing the patient).
4. Catherization of the bladder through the urethra for urine collection is carried out only in special circumstances, i.e., in a comatose or confused patient. This procedure risks introducing infection and traumatizing the urethra and bladder, thus producing iatrogenic infection or hematuria.
5. Suprapubic transabdominal needle aspiration of the bladder. When done under ideal conditions, this provides the purest sampling of bladder urine. This is a good method for infants and small children.

Full details here

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27 May 2009

Urinary Incontinence



Urinary Incontinence
By:Stephen J. Titus MD

Objectives
* Define the main causes of urinary incontinence.
* Formulate an approach to their diagnosis.
* Identify the treatment strategies for each.
* Remind each of us to not eat Yellow Snow

Impact
* Direct cost of treatment in 1995 was $26.3 billion
* More common in women then men
* >1/3 women >65 have some degree of incontinence
* Fewer than 50% will raise complaint to physician

Types of Urinary Incontinence
* Urge Incontinence
* Stress Incontinence
* Mixed Incontinence
* Overflow Incontinence
* Functional Incontinence
* Incontinence due to secondary causes
o Medications
o Urinary Tract Infections
o Stool Impaction
o Hyperglycemia
o Heart Failure
o Interstitial Cystitis
o Bladder Malignancies

Medications
* Diuretics
* Caffeine
* Alcohol
* Anticholinergics
* Alpha agonists
* Beta agonists
* Sedatives/Antidepressants/Antipsychotics
* Narcotics
* Alpha blockers
* ACE inhibitors(cough)
* Mixed
* Stress

Notre Dame
Evaluation
* History
* Physical
* Post Void Residual
* Laboratory
o Urinalysis (with culture if infection suspected)
o Renal function
o Fasting Glucose
* Urodynamic Testing

Venus de Milo
Treatment
* Urge Incontinence
* Stress Incontinence
* Mixed Incontinence
* Overflow Incontinence
* Functional Incontinence

Napolean’s Tomb
Cases
Summary
* Most cases of urinary incontinence can be diagnosed and initially treated with an H&P and routine labwork
* First line treatment for Urge, Stress and Mixed incontinence is behavioral and centered around Kegels
* Overflow: Think prostate in men, scar tissue /previous surgery in women.

Resources
Urinary Incontinence.ppt

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Pediatric Urinary Tract Infections



Pediatric Urinary Tract Infections
By: Joshua A. Hodge, Maj, USAF, MC
Staff Family Physician
Andrews AFB, MD

Overview
* Background
* Diagnosis
* Treatment
* Follow up
* Prevention
* Imaging
* Vesiculoureteral reflux (VUR)
* Summary

Diagnosis
* Single organism identified on culture
* Urinalysis
* Blood cultures not useful

Treatment
* Initiate immediately after culture drawn
* Oral route preferred
* 7-14 day course is standard

Follow Up
* AAP Recommendation: 48 hours
Prevention

* Rates of recurrence
* Prophylactic antibiotics
* Circumcision

Imaging
* Who to image?
o AAP
* Renal ultrasound
o GU tract anatomy
o Evaluate renal scarring
* DMSA (renal cortical scan)
o Differentiates pyelonephritis from cystitis
o Assesses renal scarring
* Cystogram- identify and grade vesicoureteral reflux (VUR)
o Voiding cystourethrogram (VCUG)
o Radionuclide cystogram (RNC)

Vesicoureteral Reflux (VUR)
* Concern for pyelonephritis & renal scarring
* Prevalence in females
* Standard treatment options
* Unclear if clinical benefits to treating VUR

Summary
* Urine culture necessary for diagnosis
* Short courses of antibiotics may be as effective as longer courses
* Prophylactic antibiotics are an option but may not provide much clinical benefit
* Routine imaging does not appear to affect outcomes
* Diagnosing VUR does not appear to affect outcomes

References
Pediatric Urinary Tract Infections.ppt

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27 April 2009

Male Genital Problems



Male Genital Problems
PResentation by: Eric Quimbo

Anatomy
* Penis
o 3 cylindrical bodies
+ Corpus Cavernosum (2)
+ Corpus Spongiosum (1)
o Tunica albuginea
o Buck’s Fascia
* Testes
o Tunica albuginea
o Epididymis
o Tunica vaginalis
+ Torsion risk
# Lack of posterior fixation
+ Parietal portion
# Hydrocele

Physical Examination

* Well-lit, warm room
* Visual inspection
* Penis
* Scrotum
o Mass?
+ If present, carcinoma until proven otherwise
o Lie of the testes?
* Inguinal canal
* Prostate

Scrotum

* Scrotal Edema
* Scrotal Abscess
o Must differentiate if phlegmon in scrotal wall vs. intrascrotal organs
* Fournier Gangrene
o Polymicrobial, necrotizing infection of the perineal subcutaneous fascia.
o Painful, erythematous/edematous scrotum
o DM is risk factor
o Tx – aggressive fluid resus, broad spectrum antibiotic coverage, HBO
o Mortality 20 %

Penis

* Balanoposthitis
o Inflammation of glans and foreskin
o Recurrence – can be sole presenting sign of DM
o Treat type of infection, good hygeine, topical antifungals
* Phimosis
o Inability to retract foreskin
o Emergent if inability to void
o Tx - Definitive – circumcision, Consider topical steroids at tip QD x 4-6 weeks
* Paraphimosis
o Inability to reduce proximal edematous foreskin back to position
o True urologic emergency
o Tx – compress glans several mins, tight wrapping of glans with 2 inch bandage x 5 mins, small needle punctures, or dorsal incision of the band.
* Entrapment Injuries
o String, metal rings, wire
o Human hair
+ 2 – 5 y/o
+ Check with retrograde urethrogram (urethral integrity) and doppler (blood supply)
+ Not a sign of child abuse
* Fracture
o Tear/rupture of corpus caverosa/tunica albuginea
o Hx trauma during sexual activity
o “snapping sound”
o Check retrograde urethrogram
o Surgical indication
o Check XR….
Priaprism

* Urologic emergency
* Complications – urinary retention, impotence 35%
* Causes – anti-impotence meds (papaverine, PGE), anti-hypertensives (hydralazine, prazosin, CCB), psych (chlorpromazine, trazodone, thioridazine), sickle cell in children
* 2 types
o High flow (rare)– nonischemic, nonpainful, traumatic fistula between cavernosal artery & corpus cavernosum, dx with doppler, and treated with embolization
o Low flow – more common, more painful, dx by aspiration dark acidic intracavernosal blood
* Treatment
o Pain control
o Terbutaline 0.25 – 0.5 mg SC q20-30 mins as needed
o Pseudoephedrine 60 – 120 mg PO if within 4 hours
o If sickle cell – exchange transfusion
o Corporal aspiration

Testes and Epididymis
Prostate

* Acute prostatitis
Urethra

* Urethritis
* Urethral Structure
Urinary Retention
* H&P important
* Voiding history
o Problems with holding/initiating?
o Manner of the stream, complete or interrupted?
o Feeling of bladder emptiness afterwards?

Quiz Answers
Male Genital Problems.ppt

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26 April 2009

The Kidney & Urinary Tract



The Kidney & Urinary Tract

Renal Function

* Excretion of metabolic waste
* Regulation of salt & water balance
* Acid-Base balance
* Hormone secretion

Morphological Components

* Glomeruli
* Tubules
* Interstitium
* Blood vessels

Renal Tubular Structure & Function – single nephron
Clinical Manifestations of Renal Disease
Renal Syndromes
Congenital Disease
Glomerular Disease
Normal Glomerulus
Ultrastructure of Glomerular Capillary
Classification of Glomerular Dx
Nomenclature of glomerular injury
Clinical Presentations
Asymptomatic Proteinuria
Acute Nephritis (Nephritic syndrome
Nephrotic Syndrome
Chronic Renal Failure
Pathogenesis of Glomerular Injury
Immune Mechanisms of Glomerulonephritis
Immune Complex Nephritis-in-situ
Anti-glomerular basement membrane disease
Heyman Nephritis (autologous immune complex nephritis)
Circulating Immune Complex Nephritis
(type III hypersensitivity reactions)
Cell Mediated Immune Glomerulonephritis
Mediators of Inflammatory Damage
Other Mediators of Glomerular Injury
Primary Glomerular Disease
Secondary Glomerular Disease
Immune Complex Mediated Conditions
Systemic Lupus Erythematosus
Tubulo-Interstitial Disorders
Acute Tubular Necrosis
Interstitial Nephritis
Acute Interstitial Nephritis
Chronic Interstitial Nephritis
Drug Induced Interstitial Necrosis
Analgesic Nephropathy
Hypokalaemic nephropathy
Urate (Gouty) nephropathy
Hypercalcaemic nephropathy
Oxalate nephropathy
Acute Pyelonephritis
Haematogenous Spread
Chronic Pyelonephritis
Urinary Outflow Obstruction
Renal Calculi
calculus formation
Cystic Disease of the Kidney
Cystic Disease
Simple Cysts
Autosomal Dominant (Adult) Polycystic Kidney Disease
Autosomal Recessive (Childhood) Polycystic Kidney Disease
Disease Involving the Blood Vessels
Benign Nephrosclerosis
Malignant Nephrosclerosis
Thrombotic Microangiopathies
Tumours of the Kidney
Benign Renal Tumours
Malignant Renal Tumours
Bladder
Cystitis

The Kidney & Urinary Tract.ppt

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24 April 2009

The Urinary System



The Urinary System
Presentation by: Jennifer Brewster RN, MSN


Kidney Blood Flow
Kidneys
Regulatory functions
Regulatory
Hormonal
Ureters
Urinary bladder
Urethra
Renal changes in older adult
Patient history
Physical assessment
Lab tests

* Serum creatinine
* Blood urea nitrogen
* Urine culture and sensitivity
* 24 hr urine
* Urine- Creatinine clearance

UA Strip
Urinalysis

* Color, odor, turbidity
* Specific gravity
* pH
* Glucose
* Ketones
* Protein
* Leukoesterase
* Nitrites
* Sediment

Radiology

* Kidney, Ureter, Bladder x-rays
* Intravenous urography (IVP)
* CT, US
* VCUG
* Renal scan
* Cystoscopy

Renal biopsy
Cystitis
Factors for UTI
Nursing diagnosis
Treatment
Patient education
Incontinence
Nursing diagnosis
Additional diagnosis
Management
Urolithiasis
Kidney Stones
Physical assessment
Lithotripsy
Acute and chronic renal failure
Renal failure and electrolytes
Body changes
Patient education for prevention
Hemo vs peritoneal
HD system
Care of HD patient
Peritoneal dialysis
Care of PD patient
Kidney Transplant
Post operative


The Urinary System.ppt

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20 April 2009

Diagnosis of Kidney & Genito-Urinary System



Diagnosis of Kidney & Genito-Urinary System

This 107 slides presentation is covered the following topics

Kidney Functions
Urine Analysis
Renal Function
Manifestations of Kidney & Urinary Tract Disease
Polyuria
Oliguria
Anuria
Dysuria, fequency & urgency
Urinary Incontinence - an uncontrollable loss of urine
Haematuria
Proteinuria
Uraemia
Oedema
Hypertension
Renal Failure
Acute Renal Failure and Causes
Chronic Renal Failureand Causes
Investigations & Diagnosis
Glomerular Disease
Glomerulonephritis
Nephritic Syndrome
IgA nephropathy (Berger’s Disease)
Nephrotic Syndrome
Urinary Tract Infection
Bacterial Infection
Urinary Tract Pathogens
Abacterial Cystitis/Urethral Syndrome
Pyelonephritis - bacterial infection of kidney parenchyma
Acute & Chronic Pyelonephritis
Nephrocalcinosis & Nephrolithiasis
Abnormal Renal Transport Syndromes
Renal Tubular Acidosis
Nephrogenic Diabetes Insipidus
Inherited & Congenital Renal Disorders
Polycystic Kidney Disease
Prostatic Disease
Benign Prostatic Hyperplasia (BPH)
Prostate Carcinoma
Disorders of Penis & Scrotum

Kidney & Genito-Urinary System.ppt

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