UTI, Kidney Stones and BPH
Common urinary problems
Urinary tract infection
- Cystitis: burning, frequency, urgency, suprapubic pain, cloudy or foul urine. Older adults: may show only new confusion or falls.
- Pyelonephritis: fever, chills, flank pain, costovertebral angle tenderness, nausea.
- Urinalysis (nitrites, leukocyte esterase) and urine culture before antibiotics.
- Treat: nitrofurantoin, TMP-SMX or fosfomycin for simple cystitis; phenazopyridine for burning (orange urine, ≤2 days).
- Prevent: fluids, void after intercourse, wipe front to back, don't hold urine. Don't treat bacteria in urine without symptoms (except pregnancy and before urologic procedures).
Kidney stones
- Sudden, severe flank pain radiating to the groin, nausea, hematuria. Non-contrast CT.
- Pain control first (NSAIDs such as ketorolac; opioids as needed); tamsulosin helps some ureteral stones pass.
- Strain all urine; send the stone for analysis.
- Fluids so urine output is >2–2.5 L/day.
- Fever with an obstructing stone = emergency (infected, blocked kidney).
- Procedures: lithotripsy (shock waves: bruising, blood in urine), ureteroscopy.
Preventing stones by type
| Stone | Prevention |
|---|---|
| Calcium oxalate (most common) | Keep normal dietary calcium (1,000–1,200 mg/day: low calcium diets make stones more likely). Limit sodium, animal protein and high-oxalate foods (spinach, rhubarb, nuts, chocolate, beets, tea). Thiazides and citrate may be prescribed |
| Uric acid | Limit purines (organ meats, shellfish, red meat, beer); allopurinol; potassium citrate to make urine less acidic |
| Struvite | Linked to UTIs: treat infection |
Benign prostatic hyperplasia (BPH)
- Frequency, nocturia, weak stream, hesitancy, dribbling, retention.
- Alpha-1 blockers (tamsulosin): dizziness, orthostatic hypotension; tell the eye surgeon before cataract surgery.
- 5-alpha reductase inhibitors (finasteride): take 6–12 months to work; pregnant people shouldn't handle crushed or broken tablets.
- Avoid decongestants and anticholinergics (cause retention).
- Prostate cancer screening (PSA) for ages 55–69 is an individual decision.
After TURP: continuous bladder irrigation
- Purpose: flushes clots out of the bladder.
- Titrate the irrigation to keep urine light pink to clear. Bright red with clots → increase flow and notify.
- True urine output = total drainage − irrigant used.
- Bladder spasms are common (antispasmodics); check for clots blocking the catheter.
- Watch for hyponatremia from absorbed irrigation (confusion, nausea, slow pulse).
- After discharge: avoid straining and heavy lifting; fluids; some dribbling is temporary.