Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
Alison C. Agner MD
Basics
Description
>8 voids in 24 hours and >1 void per night
More practical definition is greater number of voids than the woman is used
to.
Age-Related Factors
More common in older adults due to increased prevalence of pelvic organ prolapse.
Risk Factors
History of UTI
History of pelvic organ prolapse
Stroke
Multiple sclerosis
Pathophysiology
4 common categories:
Infection
Inflammation
Neoplasm
Neuromuscular
Associated Conditions
Dysuria
Urinary incontinence
Diagnosis
Signs and Symptoms
History
Assess urinary habits carefully with urinary diary:
o Ask about fluid intake and caffeine intake
Review of Systems
General:
o Fever, chills
GI:
o
GU:
o
Neurologic:
o
Weakness or numbness
Gynecologic:
o
Physical Exam
General:
o Fever
Pelvic exam:
o
Postvoid residual
Tests
Labs
Imaging
Not routinely needed
MRI if concern for urethral diverticulum
Differential Diagnosis
UTI
Stress or urge urinary incontinence
Overactive bladder
Interstitial cystitis
Diabetes mellitus
Diabetes insipidus
Infection
Most common cause:
Escherichia coli is most common pathogen in otherwise healthy female
Staph saprophyticus is nitrite negative
P.45
Metabolic/Endocrine
Diabetes may present with polyuria and polydipsia:
Type I DM, Type II DM
Diabetes insipidus
Tumor/Malignancy
Urothelial tumors are uncommon:
o Warning signs include gross hematuria
Drugs
Diuretics may cause frequency, especially soon after initiation of therapy:
Hydrochlorothiazide, furosemide
Other/Miscellaneous
Inflammation:
o Painful bladder syndrome (interstitial cystitis)
Lifestyle choices:
o
Pregnancy Considerations
Urinary frequency is a common symptom in early pregnancy.
Management
General Measures
Start by having patient keep a voiding diary for at least 1 week, which may be
completed prior to visit.
Medication (Drugs)
Antibiotics for UTI:
o TMP-SMX is first-line therapy
Surgery
Useful for stress urinary incontinence
Suprapubic catheter may be considered for neurogenic bladder with overflow
incontinence.
Followup
Disposition
Issues for Referral
Consider urology referral if:
Infection is not present
Lifestyle changes do not improve symptoms
Prognosis
UTIs are usually easily treated with oral antibiotics.
Patient Monitoring
Antibiotic prophylaxis is indicated if patient has recurrent UTIs.
TMP-SMX PO daily
Miscellaneous
Synonym(s)
Polyuria
Abbreviations
TMP-SMXTrimethoprim/Sulfamethoxazole UTIUrinary tract infection
Codes
ICD9-CM
253.5 Diabetes insipidus
595.0 Cystitis
788.42 Polyuria
Patient Teaching
For recurrent UTI, advise voiding prior to and immediately after intercourse.
Counseling on lifestyle changes:
Limiting fluid intake, especially 3 hours prior to bed time
Limiting caffeine and citrus
ACOG Patient Education PamphletUrinary Tract Infection