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OTHER
A.
In CKD stage 3, the person will develop CKD compli-
12: GENITOURINARY GUIDELINES
SIGNS AND SYMPTOMS
cations but will usually still not have identiable signs/
symptoms:
1.
HTN.
2.
Decreased dietary calcium absorption.
3.
Reduced renal phosphate excretion.
4.
Elevation of parathyroid hormone.
5.
Altered lipoprotein metabolism.
6.
Reduced spontaneous protein intake.
7.
Anemia.
8.
Left ventricular hypertrophy.
9.
Salt and water retention.
10.
Decreased renal potassium excretion; elevated serum
potassium >5.5 mEq/L.
B.
These complications gradually worsen as the person
moves to stage 4 CKD. The person will begin to display signs
and symptoms of complications:
1.
Changes in bone density.
2.
Fatigue and pallor related to anemia.
3.
Edema.
4.
Decrease in muscle mass.
C.
As the CKD progresses to stage 5, in addition to gradual
worsening of the signs/symptoms noted in stages 3 and 4, the
person will experience symptoms indicating chronic uremia:
1.
Impaired sleep.
2.
Nocturia.
3.
Fatigue.
4.
Anorexia, nausea, vomiting, and weight change.
5.
Decreased mental acuity.
6.
Pruritus.
7.
Edema.
8.
Respiratory symptoms, including orthopnea and dyspnea.
9.
Muscle cramps, twitching, and restless legs.
10.
Peripheral neuropathy.
SUBJECTIVE
A.
Review the client’s medical history to identify risk fac-
DATA
tors for CKD (previously noted in the “Predisposing Factors”
section).
B.
Elicit information about how well risk factors such as dia-
betes mellitus (DM) and HTN are controlled.
C.
Review the onset and duration of signs/symptoms of
CKD complications and uremia.
D.
Review all medications, including all over-the-counter
(OTC) medications, especially NSAIDs, and supplements.
Obtain specic information about dosing and length of time
the drug was used.
E.
Elicit smoking history.
F.
Determine if client was dehydrated during lab draw; this
could cause a falsely low GFR. If suspected, repeat in 1 to
2 weeks and make sure client is fully hydrated.
PHYSICAL
A.
Observe general demeanor, attentiveness, and signs of
EXAMINATION
fatigue.
B.
Measure:
1.
Height, weight, and body mass index (BMI).
2.
Vital signs, including orthostatic blood pressure (BP)
and pulse.
C.
Inspect:
1.
Skin for color, moisture, turgor, and signs of scratching
due to chronic pruritus.
2.
Neck for jugular venous distension.
3.
Abdomen for distension.
4.
Extremities for edema, muscle mass, and signs of pain
disorders such as arthritis.
D.
Auscultate:
1.
Lungs for crackles.
2.
Heart for cardiac heave, gallop, or rub.
3.
Abdomen for bruit.
E.
Palpate:
1.
Abdomen for masses and distension.
2.
Bladder; assess for ank tenderness.
F.
Perform neurologic examination:
1.
Assess for sensation and vibratory sense on both feet.
DIAGNOSTIC
A.
Laboratory testing is critical in ascertaining the stage,
TESTS
course, chronicity, and complications (and associated comorbid conditions) of CKD.
1.
Routine kidney function tests:
a.
Serum creatinine.
b.
Blood urea nitrogen (BUN).
c.
Urinalysis.
2.
Measuring GFR: The severity of CKD should be classi-
ed based on the level of the estimated GFR (eGFR). Serum
creatinine alone should not be used as a measure of kidney
function. Kidney function in clients with CKD should be
assessed by formula-based estimation of GFR (eGFR), preferably using the four-variable Modication of Diet in Renal
Disease (MDRD) equation. Clinicians who do not have
access to an automated tool may use a web-based tool which
is available at www.niddk.nih.gov/health-information/
communication-programs/nkdep/laboratory-evaluation
/glomerular-ltration-rate-calculators.
Calculate
eGFR using the actual MDRD equation:
eGFR
= 186 × (SCr) − 1.154 × (age) − 0.203 × (0.742 if
female) × (1.210 if Black)
(SCr,
serum creatinine concentration)
3.
Assessment of proteinuria:
a.
When screening adults at increased risk for CKD,
albumin in the urine should be measured in a spot
urine sample using:
i.
Albumin-specic dipstick.
ii.
Albumin-to-creatinine ratio (ACR):
1)
It is usually not necessary to obtain a timed
urine collection (overnight or 24 hours).
2)
First-morning specimens are preferred,
but random specimens are acceptable if
rst-morning specimens are not available.
3)
In most cases, screening with urine dip-
sticks is acceptable for detecting proteinuria.
4)
Standard urine dipsticks are acceptable for
detecting increased total urine protein.
5)
Albumin-specic dipsticks are acceptable
for detecting albuminuria.
b.
Clients with a positive dipstick test (1 or greater)
should undergo conrmation of proteinuria by a quantitative measurement (protein-to-creatinine ratio [PCR]
or ACR) within 3 months.
c.
Clients with two or more positive quantitative tests
spaced apart by 1 to 2 weeks should be diagnosed as
having persistent proteinuria and undergo further
evaluation and management for CKD.
OTHER
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TESTS TO DETERMINE CHRONIC KIDNEY DISEASE
COMPLICATIONS
A.
Complete blood count.
B.
Hemoglobin (Hgb): If Hgb level is less than 12 g/dL in
females and less than 13.5 g/dL in adult males, also do blood
cell indices, absolute reticulocyte count, serum iron, total
iron-binding capacity, percent transferrin saturation, serum
ferritin, white blood cell (WBC) count and differential, platelet count, and testing for blood in stool.
C.
Lipid prole and triglycerides.
D.
Comprehensive metabolic prole (serum total protein,
serum albumin, glucose, calcium, sodium, potassium, chloride, bicarbonate, BUN, creatinine, alkaline phosphatase,
alanine aminotransferase [ALT], aspartate aminotransferase
[AST], bilirubin).
E.
Prealbumin.
F.
Phosphorus.
G.
Parathyroid hormone.
H.
Urine immunoxation study.
I.
Antinuclear antibody (ANA), antineutrophil cytoplas-
mic autoantibody (ANCA), complement 3 and complement 4
(C3–C4):
1.
Test is done to rule out autoimmune disorder, lupus,
vasculitis, and cancer.
2.
No fasting is needed.
J.
Hepatitis B surface antigen (HBsAg) and hepatitis C
antibody.
K.
Anti-GBM antibody.
L.
Renal ultrasound to rule out postobstructive uropathy.
M.
Renal Doppler to rule out renal artery stenosis.
DIFFERENTIAL
A.
Evaluation is meant to determine whether kidney disease
DIAGNOSES
is acute or chronic and to determine prerenal, intrarenal, or
postrenal causation.
1.
Acute kidney disease.
2.
Alport syndrome.
3.
Chronic nephropathy.
4.
Multiple myeloma.
5.
Nephrolithiasis.
6.
Nephrosclerosis.
PLAN
A.
The treatment plan focuses on clients in earlier stages of
CKD: stages 1, 2, and 3. Persons with stages 4 and 5 CKD
need specialized interventions provided by nephrologists and
should be referred immediately.
B.
General interventions:
1.
Provide support to the client.
2.
Initiate appropriate referrals for a nephrologist, cli-
ent education, and social and nancial support as soon as
possible.
3.
For stage 4 or 5 CKD, access devices for hemodialysis,
such as a primary arteriovenous stula or graft, require
months to mature and should be in place for 6 months
before the start of dialysis.
C.
Client teaching: See Client Teaching Guide for this chapter,
“Kidney Disease: Chronic.”
1.
Instruct the client how the kidneys work and how their
body is affected by CKD.
2.
Emphasize the importance of following instructions to
prevent further kidney damage.
a.
Follow medication management instructions as
carefully as possible.
CHRONIC KIDNEY DISEASE IN ADULTS
b.
No OTC medications should be taken that are not
449
approved by the provider.
c.
Keep diabetes and HTN under control to maintain
kidney function.
d.
Prevent CV complications by lowering cholesterol
and BP.
e.
Smoking cessation is an important way to prevent
worsening kidney function.
f.
Routine follow-ups with provider are necessary to
monitor kidney function. Client should be educated
and encouraged to keep all appointments.
g.
Follow dietary instructions regarding protein, fats,
sodium, and minerals.
h.
Dietary intake of protein is usually restricted to 0.8
to 1.0 g/kg/d of high biologic value protein.
i.
Dietary sodium should be restricted to no more than
2 g daily.
j.
Potassium should be restricted to 40 to 70 mEq/d.
k.
Calories should be restricted to 35 kcal/kg/d. If
the body weight is greater than 120% of normal or the
client is older than 60 years, a lower amount may be
prescribed.
l.
Fat intake should be between 30% and 40% of total
daily caloric intake.
m.
Phosphorus should be restricted to 600 to 800mg/d.
n.
Calcium should be restricted to 1,400 to 1,600mg/d.
o.
Magnesium should be restricted to 200 to 300mg/d.
3.
Instruct when to notify the provider with urgent signs/
symptoms or changes in kidney function.
a.
Changes in urine volume.
b.
Hematuria.
c.
Anorexia, nausea, and vomiting.
d.
Increased edema.
e.
Shortness of breath.
f.
Increased fatigue.
g.
Difculty concentrating.
h.
Muscle weakness, cramping, or twitching.
i.
Fever.
j.
Chest pain.
D.
Pharmaceutical therapy: General principles of medica-
tions used to prevent progression of CKD and to manage
symptoms of complications of CKD:
1.
Always prescribe the smallest effective dose of any
medication.
2.
Start with a low dose and gradually increase. Dosage
intervals may need to be extended.
3.
Monitor the effect of any new medication on kidney
function with appropriate follow-up and with appropriate
laboratory follow-up.
4.
Educate the client on signs/symptoms to report to the
provider immediately regarding drug therapy.
5.
Avoid use of nephrotoxic drugs such as radio-
graphic contrast materials, aminoglycoside anti biotics,
and NSAIDs to prevent nephrogenic systemic brosis. If
radiocontrast material use cannot be avoided because the
benet outweighs the risks, protect the kidney with acetylcysteine (Mucomyst) 600mg orally BID on the day of
intravenous (IV) contrast.
6.
Immunizations: Some vaccines in usual doses provide
protection, while other vaccines require more frequent
dosing or larger doses to achieve and maintain protective
antibodies. Protective antibody titers may fall and booster
doses should be given if appropriate. In general, the recommendations are:
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12: GENITOURINARY GUIDELINES
a.
Annual inuenza vaccination.
b.
Pneumococcal vaccine with both Prevnar 13 and
Pneumovax 23 as recommended by the Centers for
Disease Control and Prevention (CDC).
c.
Hepatitis B vaccine series for clients before starting
dialysis.
d.
All other inactivated vaccines and toxoids according
to CDC schedule.
7.
HTN control and kidney protection: It is recommended
that BP goal of 130/80 mmHg or less should be achieved.
Use of an angiotensin-converting enzyme (ACE) inhibitor
or angiotensin II receptor blocker (ARB) therapy in early
stages of CKD with persons who have proteinuria can preserve kidney function. The clinician should monitor serum
potassium on initiation of the therapy. It is common for the
serum potassium to initially rise and then return to normal
levels in 2 to 3 months. Follow-up serum potassium levels are recommended. In the early stages of CKD, with no
proteinuria, the ACE inhibitors and ARBs have not been
shown to be effective in protecting kidney function. HTN
control can still be achieved with the ACE/ARB drugs, but
other antihypertensive drugs can be used as well.
8.
Fluid overload: Occurs when sodium intake exceeds
sodium excretion. The combination of sodium restrictions and a loop diuretic, such as furosemide (Lasix), can
lower intraglomerular pressure and provide some kidney
protection.
9.
Hyperkalemia: Hyperkalemia is managed with a low
potassium diet in combination with prescribing a loop
diuretic such as furosemide. If a client is on an ACE or
ARB, the addition of the loop diuretic will compensate for
the elevation of serum potassium related to the ACE/ARB
treatment.
10.
Metabolic acidosis: Buildup of hydrogen ions causes
bicarbonate levels to fall below acceptable levels. Sodium
bicarbonate in a daily dose of 0.5 to 1 mEq/kg/d is often
given. This medication prevents the symptoms of metabolic acidosis, which can increase muscle mass loss and
worsen bone disease.
11.
Renal osteodystrophy: The development of renal osteo-
dystrophy is caused by hyperphosphatemia and hypocalcemia that are secondary to decreased kidney function.
In order to compensate, the client develops secondary
hyperparathyroidism. Dietary restriction of phosphate to
800mg/d is recommended. In stage 3 CKD, the client will
usually require an oral phosphate binder like calcium carbonate or calcium acetate to prevent hyperphosphatemia.
Oral phosphate binders must be taken with meals to be
effective. It is imperative to avoid phosphate binders that
contain aluminum or magnesium. To suppress parathyroid hormone secretion, the client is given calcitriol, a vitamin D analog.
12.
Anemia: Use of elemental iron 200mg, such as ferrous
sulfate 325mg TID (65mg ofelemental iron per dose), is
recommended to maintain a percent transferrin saturation
greater than 20% and a serum ferritin level greater than
100 ng/mL.
a.
Although primarily used in clients with ESRD,
erythropoietic agents (EPO), such as epoetin alfa
(Procrit, Epogen) and darbepoetin alfa (Aranesp), are
used to correct anemia in those with CKD who do not
yet require dialysis. Dosages of the EPO agents should
be prescribed in order to maintain Hgb levels in the
range of 11 to 12 g/dL in predialysis clients with CKD.
13.
Dyslipidemia: Management of dyslipidemia has been
shown to slow progression of CKD. Statins and brates
are commonly prescribed to lower total cholesterol and
low-density lipoprotein and triglycerides. The incidence of
untoward side effects with statins and brates is increased
in persons with CKD; therefore, lower dosages and careful
monitoring are required.
FOLLOW-UP
A.
Regular, consistent follow-up appointments to monitor
progression of CKD, management of complications of CKD,
and management of comorbidities such as DM and HTN are
recommended.
CONSULTATION/REFERRAL
A.
Early referral to a nephrologist is recommended for anyone
who has CKD. The benets of early referral to a nephrologist
are well known, and early referral can improve client survival
and quality of life, as well as reduce hospitalization, length
of hospital stay, and medical costs. Referral to a nephrologist
must be done as quickly as possible for symptomatic clients
with stage 4 or 5 CKD. Consultation with an endocrinologist
or HTN specialist may be helpful in cases in which DM and
HTN continue to be poorly controlled.
B.
After the client is evaluated as a candidate for kidney
transplantation, counseling on renal transplantation should
be completed by a nephrologist on what types of transplant
are available and how the transplant process works.
C.
Referral to a dietitian for nutritional counseling and edu-
cation to assist the client to understand and follow complex
dietary instructions is recommended.
D.
Clients with stage 4 or 5 CKD need counseling regarding
the psychosocial and nancial impact of progressive renal disease. Referral to a renal social worker or case manager can
help the client understand their health insurance benetsand
how the transition to Medicare occurs after the health insurance benet changes, and to help the client deal with concerns
about work or family life.
E.
Clients should be referred to educational and support
organizations for further education regarding CKD.
F.
Websites:
1.
National Kidney Foundation: www.kidney.org.
2.
National Kidney Disease Education Program: www.
nkdep.nih.gov.
INDIVIDUAL
A.
Geriatrics:
1.
CONSIDERATIONS
Debilitated elderly clients will need education and coun-
seling about renal replacement therapy and the lack of efcacy in clients over the age of 80, or in those 70 and older with
concurrent congestive heart failure or other chronic diseases.
2.
Referral to a palliative care specialist can be helpful in
identifying goals and assisting with advance care planning
discussions.
RESOURCES
National
National
National
Kidney and Urologic Diseases Information Clearinghouse,
National Institutes of Health. (n.d.). Kidney disease. Retrieved from
https://www.niddk.nih.gov/health-information/kidney-disease
Kidney Disease Education Program. (n.d.). Glomerular ltration
rate (GFR) calculators. Retrieved from https://www.niddk.nih.gov/
healthinformation/healthcommunicationprograms/nkdep/labevaluation/gfr-calculators/Pages/gfrcalculators.aspx
Kidney Disease Education Program. (n.d.). Manage patients
with CKD. Retrieved from https://www.niddk.nih.gov/healthinfor
mation/health-communication-programs/nkdep/identify-manage/
manage-patients/Pages/manage-patients.aspx
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Diseases.
EPIDIDYMITIS
DEFINITION
A.
The epididymis is part of the genitourinary tract that
includes the testes, the vas deferens, the prostate, the urethra, and the bladder. Epididymitis is an infection or inam-
mation of the epididymis, the tubular structure located on
the posterior and superior aspect of the testis where sperms
mature prior to ejaculation. Epididymitis is a relatively common condition that can easily be confused with testicular torsion. Epididymitis is managed medically, whereas testicular
torsion is a surgical emergency and should be considered in
all cases.
1.
Acute epididymitis: clinical symptoms of pain, swell-
ing, and inammation of the epididymis that last less than
6 weeks.
a.
Acute epididymitis often involves the testis
(epididymo-orchitis).
2.
Chronic epididymitis: duration of symptoms lasts
more than 6 weeks.
a.
Inammation chronic.
b.
Obstructive chronic.
c.
Chronic epididymalgia.
INCIDENCE
A.
Epididymitis is the fth most common urologic diagno-
sis in males aged 20 to 40 years. There are more than 600,000
medical visits per year related to epididymitis. Chronic epididymitis may account for up to 80% of scrotal pain noted
in the outpatient setting. The mumps, measles, and rubella
(MMR) vaccine has markedly reduced the incidence of
mumps orchitis.
PATHOGENESIS
A.
The exact pathophysiology is unclear; however, epididy-
mitis most often occurs as a result of a bacterial infection. In
the case of a sexually transmitted disease, bacteria are introduced during sexual intercourse and migrate through the
genitourinary tract to the epididymis. Pathogens include
Chlamydia trachomatis, Neisseria gonorrhoeae, Escherichia coli,
Proteus species, Klebsiella species, Pseudomonas, Mycoplasma
species, and Treponema pallidum.
EPIDIDYMITIS
B.
In cases of infection due to urinary tract infection (UTI),
451
retrograde ow of urine or stagnation of urine along the genitourinary tract results in infection of the epididymis. Reux
may be induced by having the client perform the Valsalva
maneuver or may be from strenuous exertion.
PREDISPOSING
A.
Age:
1.
Age less than 35 years is generally associated with ure-
FACTORS
thritis with the following organisms:
a.
C. trachomatis (chlamydia).
b.
N. gonorrhoeae (gonorrhea).
2.
Benign prostatic hyperplasia is more common in cli-
ents older than 35 years and common organisms include:
a.
E. coli.
b.
Pseudomonas species.
c.
Proteus species.
d.
Klebsiella species.
3.
The older male populations usually have nonsexual
epididymitis related to urinary tract instrumentation, surgery, and immunosuppression.
4.
Boys prior to sexual maturity may experience epididy-
mitis as a result of an inammatory process induced from
repetitive activities such as running and jumping.
B.
Men having sex with men (MSM) who are the insertive
partner during anal intercourse have epididymitis with the
following organisms:
1.
E. coli.
2.
Pseudomonas.
3.
Coliform bacteria.
C.
UTIs.
D.
Tuberculosis (TB; should be considered if there is a history
of or recent exposure to TB).
E.
Vasectomy.
F.
Indwelling urethral catheter.
G.
Urethral stricture.
H.
Amiodarone: high drug concentrations (dose-dependent).
I.
Prolonged sitting (sedentary job, travel).
J.
Mumps.
COMMON
A.
COMPLAINTS
Swelling and tenderness of the scrotum (usually located
on one side).
B.
Fever.
C.
Chronic epididymitis:
1.
Epididymal pain and inammation that last more than
6 weeks.
2.
May be accompanied by scrotal induration.
OTHER
SIGNS AND SYMPTOMS
A.
Gradual onset of localized, unilateral testicular pain. The
client may get relief with elevation of the scrotum, which is a
positive Prehn sign.
B.
Urethral discharge.
C.
Dysuria, frequency, urgency.
D.
Hematuria.
E.
Fever and chills (found in only 25% of adults with acute
epididymitis but in up to 71% of children with the condition).
SUBJECTIVE
A.
Elicit the onset, duration, and course of the client’s
DATA
symptoms.
B.
Review the client’s history for vasectomy or trauma to the
groin.
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C.
Are there any other symptoms, including fever, dysuria, or
12: GENITOURINARY GUIDELINES
discharge?
D.
What makes the pain better? Ask about elevating the
scrotum.
E.
Does the client’s sexual partner(s) have any symptoms or
discharge?
F.
Has there been any recent instrumentation or catheterization?
G.
Is the pain unilateral or bilateral?
H.
Review medication history for amiodarone.
I.
Does the client have a recent TB exposure?
PHYSICAL
A.
Check temperature, blood pressure, and pulse.
B.
Inspect:
EXAMINATION
1.
Examine the client generally for discomfort before and
during examination.
2.
Check the urethral meatus for discharge. Retract fore-
skin (if present) and assess for hygiene and smegma. Check
the shaft of the penis, glans, and prepuce for lesions.
3.
Check the inguinal and femoral areas for bulges and
hernias; have the client bear down and cough and reexamine them.
C.
Palpate:
1.
Palpate testes and epididymides for inammation, ten-
derness, and masses. In chronic cases, the epididymis feels
rm and lumpy. Vas deferens may be beaded.
2.
Check Prehn sign by elevating the affected hemiscro-
tum. This action relieves the pain of epididymitis but exacerbates the pain of torsion.
3.
Elicit a cremasteric reex. Stroking the inner thigh
should result in rise of the testicle and scrotum on the
affected side. A normal cremasteric reex indicates that
testicular torsion is less likely.
4.
Palpate the scrotum for hydrocele or varicocele.
5.
Check for costovertebral angle tenderness.
6.
Examine the abdomen for masses, urinary distension,
tenderness, and organomegaly.
7.
Palpate lymph nodes in the groin.
8.
Evaluate for an inguinal hernia.
D.
Perform rectal examination:
1.
Check for symmetry, swelling, tenderness, and
enlarged prostate.
DIAGNOSTIC
A.
Gram stain of urethral secretions.
B.
Urinalysis and urine cultures.
C.
Urethral swab (before void, after prostate massage) for
TESTS
gonorrhea and chlamydia culture.
D.
In clients older than 40 years: expressed prostatic
secretions.
E.
TB skin test to rule out TB.
F.
Complete blood count.
DIFFERENTIAL
A.
Testicular torsion (surgical emergency).
B.
Testicular tumor.
C.
Prostatitis.
D.
Incarcerated inguinal hernia.
E.
Orchitis (occurs with parotitis).
F.
Trauma.
G.
Epididymal congestion following vasectomy.
H.
Folliculitis.
I.
Herpes outbreak.
J.
Hydrocele.
K.
Spermatocele.
DIAGNOSES
PLAN
A.
General interventions:
1.
Encourage and stress the importance of adequate uid
intake.
2.
Stress importance of taking all antibiotics as directed.
B.
Client teaching: See Client Teaching Guide for this chapter,
“Epididymitis.”
1.
Offer supportive therapy.
C.
Pharmaceutical therapy:
1.
Antibiotic therapy (both partners must be treated for
sexually transmitted infection [STI]): Treat empirically
until laboratory test results are available.
2.
The Centers for Disease Control and Prevention cur-
rent guidelines (2015) for acute epididymitis recommend
treatment with antibiotics for 10days (Table 12.2).
3.
Chronic epididymitis should be treated for 4 to 6 weeks
for bacterial pathogens, especially chlamydia.
4.
Nonsteroidal anti-inammatory drugs are used for
pain management.
5.
Antitubercular triple therapy consists of rifampin, iso-
niazid, and pyrazinamide for 6 months.
a.
Rifampin (Rifadin) 450 mg orally every day for
2 months, then 900mg orally every day for an additional 4 months.
b.
Isoniazid (Laniazid) 300 mg orally every day for
2 months, then 600mg orally every day for an additional 4 months.
c.
Pyrazinamide 25mg/kg/d orally for 2 months only.
6.
Amiodarone epididymitis usually responds to a dos-
age reduction or discontinuation.
TABLE
12.2 THE 2021 CENTERS FOR DISEASE CONTROL AND PREVENTION RECOMMENDATION
REGIMENS FOR ACUTE EPIDIDYMITIS
For acute epididymitis all clients should receive:
•
Ceftriaxone 500mg IM in a single dose
PLUS
•
Doxycycline 100mg orally BID for 10 days
For acute epididymitis most likely caused by STI and/or enteric organisms, males who practice insertive anal sex:
•
Ceftriaxone 500mg IM single dose
PLUS
•
Levofloxacin 500mg orally once a day for 10 days
For MSM who report insertive anal intercourse and are at risk of enteric organisms only:
•
Levofloxacin 500mg once a day for 10 days
IM,
intramuscular;MSM, men having sex with men; STI, sexually transmitted infection.
HEMATURIA
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FOLLOW-UP
A.
See the client in 2 to 7 days depending on severity of
infection:
1.
Pain typically improves within 1 to 3 days but may
take up to 2 to 4 weeks.
2.
Inadequate treatment can result in abscess formation
and decreased fertility.
B.
Culture urine at theend of treatment (test of cure).
C.
Failure to recognize and treat both partners for STIs is a
potential legal pitfall; test for all STIs and do not just focus on
chlamydia and gonorrhea.
D.
Consider testing for HIV.
E.
Tuberculous epididymitis should be suspected if clinical
signs worsen despite appropriate antibiotic therapy.
F.
Males older than 50 years should be evaluated for urethral
obstruction secondary to prostatic enlargement.
CONSULTATION/REFERRAL
A.
Obtain an immediate consultation with a urologist if tes-
ticular torsion, scrotal abscess, or failed medical treatment is
suspected.
B.
Consult aphysician for the following:
1.
Intravenous pyelography.
2.
Doppler ultrasonography.
3.
Scrotal ultrasonography.
4.
Radionuclide scrotal imaging.
C.
For pediatric clients, refer for evaluation of an underlying
congenital anomaly.
INDIVIDUAL
A.
Partner:
1.
B.
Pediatrics:
1.
CONSIDERATIONS
Treat sexual partners for STI; consider testing for HIV.
Epididymitis is rare prepubertal, and testicular torsion
is more common in this age group.
2.
Infection cannot be ruled out due to the possibility of
sexual abuse.
C.
Geriatrics:
1.
Epididymitis in the elderly is often caused by an
enlarged prostate gland.
2.
Trouble voiding can be an early nding.
3.
Retrograde ow of urinemay be seen.
4.
Fluoroquinolones may be used in older clients where
an enteric organism is suspected or likely.
BIBLIOGRAPHY
Centers for Disease Control and Prevention. (2021, JULY 22). Sexually
transmitted diseases treatment guidelines, 2021: Epididymitis. https://
www.cdc.gov/std/treatment/guidelines/epididymitis.htm
Louette, A., Krahn, J., Caine, V., Ha, S., Lau, T. T. Y., & Singh, A. E. (2018).
Treatment of acute epididymitis. Sexually Transmitted Diseases, 45(12),
e104–e108. https://doi.org/10.1097/olq.0000000000000901
National Kidney Foundation. (2015). KDOQI clinical practice guideline
for hemodialysis adequacy 2015 update. American Journal of Kidney
Diseases, 66(5), 884–930. https://doi.org/10.1053/j.ajkd.2015.07.015.
www.kidney.org/professionals/guidelines/hemodialysis2015
Rupp, T., & Leslie, S. (2018). Epididymitis. StatPearls [Internet]. National
Institute of Health. https://www.ncbi.nlm.nih.gov/books/NBK430814/
Rupp, T. J., & Leslie, S. W. (2019, December 20). Epididymitis. StatPearls
Publishing. Nih.gov;. https://www.ncbi.nlm.nih.gov/books/NBK43
0814/
HEMATURIA
DEFINITION
A.
Hematuria is blood in the urine. Hematuria is a symptom of
an underlying disease/condition; however, routine screening
is not recommended. Microscopic hematuria is dened as
three or more red blood cells (RBCs) per high-power microscope eld (HPF) in urinary sediment from two of three properly collected clean-catch midstream urine specimens.
B.
Asymptomatic microscopic hematuria can range from
minor ndings that do not require treatment to highly signicant, life-threatening lesions. Microscopic hematuria is an
incidental nding. The American Urological Association recommends an appropriate renal or urologic evaluation with
asymptomatic microscopic hematuria for clients who are at
risk of urologic disease or primary renal disease.
C.
If the excretion rate exceeds one million RBCs, macro-
scopic or gross hematuria is noted. Gross hematuria (macroscopic hematuria) is suspected when red or brown urine is
present. Glomerulonephritis is associated with brown urine,
while bleeding from the lower urinary tract is suggested
by pink or red urine. Gross hematuria with passage of clots
almost always indicates a lower urinary tract source.
INCIDENCE
A.
The prevalence of asymptomatic hematuria is from 1% to
20% of the general population. Less than 3% excrete 10 RBC/
HPF. Every disease of the genitourinary (GU) tract can produce hematuria.
PATHOGENESIS
A.
Prerenal pathology:
1.
Coagulopathy: hemophilia or idiopathic thrombocyto-
penia purpura (ITP).
2.
Drugs: anticoagulants, aspirin.
3.
Sickle cell disease or trait.
4.
Collagen vascular disease, lupus.
5.
Wilms tumor.
B.
Renal pathology
1.
Nonglomerular pathology:
a.
Pyelonephritis.
b.
Polycystic kidney disease.
c.
Granulomatous disease, tuberculosis (TB).
d.
Malignant neoplasm.
e.
Congenital and vascular anomalies.
2.
Glomerular pathology:
a.
Glomerulonephritis.
b.
Berger disease.
c.
Lupus nephritis.
d.
Benign familial hematuria.
e.
Vascular abnormalities, vasculitis.
f.
Alport syndrome, familial nephritis.
C.
Postrenal pathology:
1.
Renal calculi.
2.
Ureteritis.
3.
Cystitis.
4.
Prostatitis.
5.
Benign prostatic hypertrophy (BPH).
6.
Epididymitis.
7.
Urethritis.
8.
Malignant neoplasm.
D.
False hematuria:
1.
Vaginal bleeding.
2.
Recent circumcision.
3.
Pigmentation:
a.
Food: beets, blackberries.
b.
Medications: quinine sulfate, phenazopyridine,
rifampin.
E.
Other causes:
1.
Trauma.
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2.
3.
PREDISPOSING
A.
See the“Pathogenesis” section.
B.
Risk factors for malignancy:
1.
2.
3.
12: GENITOURINARY GUIDELINES
Strenuous exercise (marathons).
Fever.
FACTORS
Age greater than 35 years.
Smoking (current use or history).
Chemical exposure (cyclophosphamide, benzenes, aro-
matic amines).
4.
History of pelvic irradiation.
5.
Prior urologic disease or treatment.
6.
Chronic urinary tract infections (UTIs).
7.
Male.
COMMON
A.
COMPLAINT
Pink or red urine (clots may be present) or brown,
cola-colored urine on toilet tissue is the common complaint.
OTHER
SIGNS AND SYMPTOMS
A.
Pain may or may not be present. Colicky ank pain radiat-
ing to the groin suggests a kidney stone. Signicant ank pain
of renal colic is usually secondary to renal calculi but may
occasionally be associated with passage of clots.
B.
Frequency, dysuria, urgency, and suprapubic pain occur
with cystitis and inammatory lesions of the lower urinary tract.
C.
Dull ank pain with fever and chills may accompany
pyelonephritis.
D.
Hesitancy and dribbling of urine suggest BPH.
SUBJECTIVE
A.
Elicit the onset, duration, and occurrence (beginning, end-
DATA
ing, or during voiding) of hematuria. Describe the color and
amount: Is it “pink on tissue” or bright red in the toilet and
tissue?
B.
Question the client regarding medical history of renal dis-
ease, systemic disease such as lupus, or sickle cell disease.
C.
Review all medications including over-the-counter and
herbal products. Evaluate specically for the use of aspirin,
ibuprofen, anticoagulants, especially warfarin (Coumadin),
and laxatives containing phenolphthalein. Rifampin and
phenazopyridine HCl (Pyridium) can change the color of
urine to orange or red.
D.
Review other symptoms, such as dysuria, fever, chills,
pain, and hesitancy with voiding.
E.
Female clients:
1.
Establish whether the blood was urinary or vaginal
(after intercourse or during menstruation).
2.
Is the client postpartum?
3.
Is there a history of endometriosis?
F.
Does the client bruise easily? Does the client have bleeding
when ossing or brushing teeth?
G.
Has the client had a recent bout of pharyngitis
with a rash, hematuria, edema, or hypertension (HTN
[glomerulonephritis])?
H.
Have they had any recent trauma, car accident, or strenu-
ous exercise (e.g., running a marathon)?
I.
Does the client know if there was any exposure to TB?
J.
Is there any family history of kidney disease, stones, and
familial nephritis?
K.
Does the client have any current outbreaks of herpes or
other sexually transmitted infections?
L.
Review the client’s smoking history.
M.
Review occupational exposure to chemicals or dyes (ben-
zenes or aromatic amines).
N.
Review food intake of foods such as beets and blackberries.
O.
Does the male client have any hesitancy and dribbling
(signs of prostatic obstruction)?
P.
Evaluate if there is rectal bleeding from hemorrhoids from
straining with a bowel movement (BM).
PHYSICAL
A.
Check temperature, blood pressure, and weight in the
EXAMINATION
presence of recent weight gain or edema.
B.
Male or female clients:
1.
Inspect:
a.
Inspect mouth: Check tonsils for enlargement and
gums for petechiae.
b.
Examine skin for signs of bleeding or bruises and
pallor.
c.
Examine for edema.
2.
Palpate:
a.
Check the back and abdomen for costovertebral
angle tenderness.
b.
Check the abdomen for masses, urinary distension,
tenderness, and organomegaly.
c.
Palpate groin lymph nodes for enlargement.
3.
Auscultate:
a.
Heart and lungs.
b.
For abdominal bruits.
C.
Female clients:
1.
Inspect:
a.
Direct visualization of the external genitalia for inam-
mation, ulcerations, nodules, lesions, and hemorrhoids.
b.
Ask the client to bear down to check for cystocele
and rectocele.
c.
Speculum examination: Observe for atrophic vagi-
nitis, torn tissue, discharge, and friable cervix.
2.
Palpate:
a.
Milk urethra for discharge.
b.
Bimanual examination: Check for cervical motion
tenderness (CMT) and adnexal masses.
c.
Rectal examination: Check for the presence of
hemorrhoids.
D.
Male clients:
1.
Inspect:
a.
Direct visualization of the genitals; check the ure-
thral meatus for discharge.
b.
Retract the foreskin (if present) and assess for
hygiene and smegma. Check the shaft of the penis,
glans, and prepuce for lesions or urethral meatal
erosion.
2.
Palpate:
a.
Palpate the testes and epididymides for inamma-
tion, tenderness, and masses; palpate the scrotum for
hydrocele or varicocele.
b.
Check the inguinal and femoral areas for bulges and
hernias; have the client bear down and cough and reexamine them.
c.
Rectal examination:
i.
Check for swollen or tender prostate.
ii.
Check for the presence of hemorrhoids.
DIAGNOSTIC
A.
Urinalysis: An efcient specimen would consist of a ran-
TESTS
dom midstream clean-catch after discarding the rst 10mL.
Urine specimens that should not be examined to assess for
microhematuria are rst void in morning or the rst voiding
after vigorous physical or sexual activity.
1.
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Centrifuge the urine specimen to see if the red or brown
color is in the urine sediment or supernatant.
2.
If the supernatant is red to brown, test for heme (hemo-
globin or myoglobin) with a urine dipstick. Semen is in
urine after ejaculation and may cause a positive heme
reaction on the dipstick.
3.
A positive dipstick must always be conrmed with a
microscopic examination.
4.
Urine culture and sensitivity.
5.
Urine cytology.
6.
Complete blood count (CBC) with differential.
7.
Blood urea nitrogen/creatinine.
8.
Prothrombin time, partial thromboplastin time, plate-
let count, and bleeding time (if indicated).
9.
Sickle cell testing (if indicated).
10.
CT urography (CTU) is considered the preferred ini-
tial imaging in most clients for any unexplained persistent
hematuria. CT is considered the best imaging modality
for evaluation of urinary stones, renal and perirenal infections, and associated complications. Intravenous pyelography and ultrasound are not as sensitive in the evaluation.
11.
Cystoscopy (the combination of a CTU and cystos-
copy) provides a complete evaluation.
12.
A CT scan of the abdomen or pelvis should be considered
with a history of trauma to determine the source of blood.
B.
Based on history, consider the following tests:
1.
Strep testing to detect poststreptococcal
glomerulonephritis.
2.
Antinuclear antibody to detect lupus nephritis.
C.
Urologic referral testing includes:
1.
CTU and cystoscopy.
2.
MRI if a mass is suspected.
3.
Renal biopsy.
DIFFERENTIAL
A.
See the“Pathogenesis” section for differential diagnoses.
DIAGNOSES
PLAN
A.
General interventions:
1.
Investigate and diagnose cause(s). Only a limited
workup (electrolytes, CBC) is needed in clients younger
than 35 years with normal physical examination.
2.
Clients older than 35 years and history of tobacco use
need detailed investigation and referral.
3.
Microhematuria with clients on an anticoagulant
requires a urologic/nephrology workup regardless of the
type or level of anticoagulation.
4.
Repeat urinalysis in 2 weeks.
B.
Client teaching:
1.
There is no one specic treatment for all cases of
hematuria.
2.
Treatment is aimed at the specic underlying cause, if a
cause can be identied.
C.
Pharmaceutical therapy:
1.
None recommended for hematuria unless an infection
is diagnosed.
FOLLOW-UP
A.
For clients at risk of malignancy who have a negative
workup:
1.
Evaluate in 1 year.
2.
After two consecutive negative urinalysis tests, discon-
tinue the follow-up.
3.
If gross hematuria occurs after the initial negative uri-
nalysis, repeat a full evaluation.
HEMATURIA
B.
For clients with HTN, proteinuria and/or an increase in
455
creatinine need to be reevaluated for renal disease.
C.
For persistent asymptomatic microhematuria, after a neg-
ative workup by a urologist, a yearly urinalysis is needed.
D.
For persistent or recurrent asymptomatic microhematuria
after the initial negative workup, consider repeating the evaluation within 3 to 5 years.
E.
Culture urine for acid-fast bacillus if sterile pyuria and
hematuria persist.
CONSULTATION/REFERRAL
A.
If all benign causes of hematuria have been ruled out,
found conditions treated, and it persists, referral to a urologist
or a nephrologist should be made.
B.
The presence of signicant proteinuria (excretion of more
than 1,000 mg per 24 hours), red cell cast or renal insufciency,
or a predominance of dysmorphic RBCs in the urine should
prompt an evaluation for renal parenchymal disease by a
nephrologist. Red cell casts are considered virtually pathognomonic of glomerular bleeding.
C.
New gross hematuria should be promptly reevaluated.
INDIVIDUAL
A.
Females:
1.
CONSIDERATIONS
Nonpregnant: Rule out menstruation and sexual
activity.
2.
Pregnant: Rule out vaginal bleeding such as threatened
abortion, abruptio placentae, or placenta previa.
3.
Ultrasound can be used to evaluate the pregnant client.
CTU should not be used secondary to radiation exposure.
B.
Pediatrics:
1.
UTI is the most common cause of hematuria in chil-
dren. Irritation or ulceration of the perineum or urethral
meatus is the next most common cause, followed by
trauma.
2.
The majority of children who present with gross hema-
turia have an easily recognizable and apparent cause. The
underlying etiology is generally easy to establish by a
complete history, physical examination, and urinalysis.
3.
Renal ultrasound is the preferred modality for evalua-
tion in children.
4.
Cystoscopy is rarely indicated for hematuria in chil-
dren. It is usually reserved for a child with a bladder mass
noted on ultrasound and a child with urethral abnormalities due to trauma.
5.
Hematuria might develop after streptococcal infection
(strep throat or impetigo), which could indicate poststreptococcal glomerulonephritis.
C.
Geriatrics:
1.
The risk of malignancy increases among older indi-
viduals with a signicant history of smoking or analgesic
abuse.
2.
The use of anticoagulants increases in this population,
so a careful review of medications is imperative.
BIBLIOGRAPHY
American Urological Association. (2012, revised 2016). Diagnosis, evalu-
ation and follow-up of asymptomatic microhematuria (AMH) in adults:
AUA guideline. https://www.auanet.org/education/guidelines/
asymptomatic-microhematuria.cfm
Bignall, O., & Dixon, B. (2018). Management of hematuria in children.
Current Treatment Options in Pediatrics, 4(3), 333–349. https://doi.org
/10.1007/s40746-018-0134-z
Feldman, A. (2018, July 20). Etiology and evaluation of hematuria in
adults. UpToDate. https://www.uptodate.com/contents/etiology-and-
evaluation-of-hematuria-in-adults
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Testis
Noncommunicating
Communicating
(A) (B) (C)
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12: GENITOURINARY GUIDELINES
Ghandour, R., Freifeld, Y., Singla, N., & Lotan, Y. (2019). Evaluation of
Hematuria in a Large Public Health Care System. Bladder Cancer
(Amsterdam Netherlands), 5(2), 119–129. https://doi.org/10.3233/
BLC-190221
HYDROCELE
DEFINITION
A.
Hydrocele is the collection of uid between layers of the
processus vaginalis producing swelling in the scrotum or
inguinal area. Cystic masses containing uid or sperm often
develop spontaneously. Inguinal hernia and hydrocele share
a similar etiology and pathophysiology and may coexist
(Figure 12.2).
Normal
Abdomen
Intestine
Scrotum
FIGURE
12.2 Hydrocele. (A) Normal scrotum. (B)
Non communicating hydrocele. (C) Communicating
hydrocele.
INCIDENCE
A.
The incidence is unknown; hydrocele occurs in 6% of the
male pediatric population at birth or in the neonatal period. It
occurs infrequently in adulthood.
B.
Incidence according to age:
1.
11 to 20 years old: 3.63%; 21to30 years old: 18.18%;
31to40 years old: 34.54%; 41to50 years old: 7.27%; 51to70
years old: 18.18%.
C.
Filariasis, a parasitic infection caused by Wuchereria ban-
crofti, is the cause in more than 120 million people worldwide.
hydrocele
hydrocele
B.
Rarely does a hydrocele become infected and cause pain.
SUBJECTIVE
A.
Elicit the onset, duration, and course of swelling: Is scro-
DATA
tal sac full all day, or does the client have a at scrotum in the
morning and a gradual increase in uid during the day?
B.
Was the hydrocele noted in the neonatal period?
C.
How old is the client? Has this ever occurred before? If so,
what happened and how was it treated?
D.
Review the client’s history for injury to the scrotum.
E.
Is there any pain or other symptoms related to hernia with
the swelling?
F.
Review other symptoms such as discharge, dysuria, fever,
or backaches.
G.
Review birth control method (vasectomy).
PHYSICAL
A.
Check temperature (if indicated) and blood pressure.
B.
Inspect:
EXAMINATION
1.
Careful examination is necessary to rule out masses or
tumor. Examine in the supine and standing positions.
2.
Genital examination: Note amount of swelling, symme-
try, lesions, discharge, hernias, varices, and color of scrotum.
3.
Transilluminate the scrotum to determine if the lesion
is cystic, solid, or a varicocele. In a dark room, transillumination light appears as a red glow with serous uid. If
normal, blood and tissue do not transilluminate; however,
the bowel may transilluminate.
C.
Auscultate:
1.
Scrotum for bowel sounds to rule out hernia.
D.
Palpate:
1.
Check warmth, tenderness, swelling, and any nodular-
ity. If mass is present, check if it has a solid versus cystic
feel.
2.
Palpate lymph nodes: supraclavicular, chest, abdomen,
and groin.
3.
Check for inguinal hernia.
4.
Palpate the abdomen for masses, rebound, and
tenderness.
DIAGNOSTIC
A.
Laboratory evaluation is not required for evaluation of
TESTS
hydroceles.
B.
Scrotal ultrasonography.
PATHOGENESIS
A.
Congenital: patent processus vaginalis (PPV).
B.
Reactive: inammatory condition in the scrotum (e.g.,
trauma, torsion, infection).
C.
Idiopathic: arises over a long period (most common).
D.
Hydroceles are believed to arise from an imbalance of
secretion and reabsorption of uid from the tunica vaginalis.
PREDISPOSING
A.
Males; most commonly seen in childhood.
B.
W. bancrofti parasite.
C.
Viral illness.
D.
Chronic increased intra-abdominal pressure.
E.
Increased abdominal uid production.
COMMON
A.
Swollen scrotum is the common indication.
OTHER
SIGNS AND SYMPTOMS
A.
Painless swollen scrotum; pain increases with the size of
FACTORS
COMPLAINT
the mass.
DIFFERENTIAL
A.
Varicocele: Varicocelefeels like a “bag of worms.”
B.
Hernia: Herniated bowel makes gurgling sounds upon
DIAGNOSES
auscultation of the scrotum.
C.
Testicular tumors tend to occur in young males and are
the most common tumors in males from ages 15 to 30 years.
Consider a tumor if the onset is acute. Tumors feel rm, nontender, and xed and do not transilluminate. Inguinal lymphadenopathy may also be seen. The client may complain of
heaviness with a tumor.
D.
Testicular torsion.
E.
Orchitis: Orchitis is rare except with mumps. Orchitis is
usually unilateral and is associated with fever, swelling, pain,
and tenderness. On occasion, parotitis is absent.
F.
Epididymitis: Inammation is often concurrent with a uri-
nary tract infections (UTI). Epididymis is very tender; scrotal
elevation may relieve the pain.
G.
Spermatocele: Spermatocele is characterized by cystic
swelling of the epididymis. It is not as large as a hydrocele,
but it also transilluminates.
PLAN
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A.
General interventions:
1.
Monitor children every 3 months until resolution or
until a decision is made to refer to a specialist for evaluation.
2.
Factors that indicate surgical repair:
a.
Failure to resolve by age 2 years.
b.
Continued discomfort.
c.
Enlargement or waxing and waning in volume.
d.
Unsightly appearance.
e.
Secondary infection.
B.
Client teaching:
1.
Most hydroceles are painless.
2.
In adults, if there are no symptoms, it can be left alone
and monitored.
C.
Pharmaceutical therapy:
1.
None recommended.
FOLLOW-UP
A.
Monitor every 3 months.
CONSULTATION/REFERRAL
A.
Refer to a urologist for evaluation, as needed.
B.
A persistent hydrocele or the association of discomfort
may indicate the need for a surgical referral.
INDIVIDUAL
A.
Pediatrics:
1.
CONSIDERATIONS
An infant testicle usually measures 1 cm. The parent
may notice a hydrocele that uctuates slightly in size and
usually resolves on its own by 6 months of age.
B.
Adults:
1.
If an adult experiences a hydrocele, they should
be instructed to return for evaluation if the hydrocele
becomes larger or uncomfortable, or if it interferes with
sexual intercourse.
BIBLIOGRAPHY
Ghandour, R., Freifeld, Y., Singla, N., & Lotan, Y. (2019). Evaluation of
Hematuria in a Large Public Health Care System. Bladder Cancer
(Amsterdam Netherlands), 5(2), 119–129. https://doi.org/10.3233/
BLC-190221
Parke, J. (2018, July 26). Hydrocele. Medscape. https://emedicine.medscap
e.com/article/438724-overview
Sarla, D. G. S. (2019). Hydrocele: Side Incidence and Age Group Affected.
Journal of Medical Science and Clinical Research, 7(6). https://doi.org/
10.18535/jmscr/v7i6.51
INTERSTITIAL
CYSTITIS
DEFINITION
A.
Interstitial cystitis (IC) is a chronic condition that is dened
as a recurring pelvic discomfort, or suprapubic pain related
to bladder lling, or chronic pelvic pain and pressure accompanied by frequency. IC is also commonly known as painful
bladder syndrome (PBS). IC/PBS includes all cases of urinary
pain with persistent urge to void or urinary frequency that
cannot be attributed to other causes (e.g., infection, stones, or
other pathology).
B.
The persistent urge to void helps to distinguish the symp-
toms of IC/PBS from those of overactive bladder (OAB). IC/
PBS affects quality of life related to social activities, lost work
productivity, sleep deprivation due to urinary frequency,
fatigue, and even depression.
C.
The Society for Urodynamics and Female Urology (SUFU)
has stated that the symptoms should last more than 6 weeks
in order for therapy to begin.
INTERSTITIAL CYSTITIS
D.
IC/PBS clients void to avoid or relieve pain, whereas cli-
457
ents with OAB void to avoid incontinence.
INCIDENCE
A.
Actual prevalence is unknown due to variability in diag-
nostic criteria. It is not uncommon for clients to experience
a lag time of 5 to 7 years before diagnosis. It is estimated
that in the United States 3.3 to 7.9 million females older than
18 years are affected by the symptoms of IC/PBS. Of these
females, however, only 9.7% report being assigned a diagnosis of IC/PBS. The majority of the affected persons are females
(10:1 rated over males). The symptom complex is the same for
males. IC also occurs in children.
PATHOGENESIS
A.
The pathophysiology of IC/PBS remains unclear. It is
not established whether IC/PBS is a localized condition that
involves only the bladder or whether it is a systemic disease
that affects the bladder.
B.
Clients frequently exhibit several mental health disor-
ders and negative personality traits. Therefore, in addition
to targeting the bladder pathologic condition, psychologic
intervention focusing on personality traits and anxiety mood
status should alsobe provided to improve quality of life of IC
clients.
PREDISPOSING
A.
Both sexes, with a higher prevalence in females.
B.
Mean age of diagnosis 42 to 45 years.
C.
Urinary tract infection (UTI).
D.
Prostatitis.
E.
Chronic yeast infections.
F.
Posthysterectomy or other pelvic surgery.
G.
Medications:
1.
Calcium channel blockers.
2.
Cardiac glycosides.
H.
Other hypersensitivity conditions that coexist with IC:
1.
Fibromyalgia.
2.
Irritable bowel syndrome (IBS).
3.
Chronic headaches.
4.
Vulvodynia.
5.
Sjögren syndrome.
I.
Depression/mood disorders.
J.
Hypothyroidism.
COMMON
A.
Mild discomfort to intense pain with bladder lling and/
FACTORS
COMPLAINTS
or emptying is the hallmark symptom. The pain is not limited
to the bladder/suprapubic area and also includes symptoms
throughout the pelvic area, lower abdomen, and back.
B.
Persistent urge to void/frequency.
C.
Frequency.
D.
Urgency.
E.
Nocturia.
OTHER
SIGNS AND SYMPTOMS
A.
Combination of urgency and frequency.
B.
Pressure.
C.
Increase in symptoms during menstruation.
D.
Pain during vaginal intercourse.
E.
Low back pain with bladder lling.
SUBJECTIVE
A.
Review the onset, frequency, duration, and severity of
DATA
symptoms.
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