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In men, urethritis are usually sexually transmitted with purulent discharge (gonorrhea infection), clear discharge (non-gonorrheal urethritis)●Urethritis in general causes bothersome LUT symptoms such as dysuria, frequency, urgency, similar to cystitis. ●In women, discharge may not be present●Drug treatments include trimethoprim/sulfamethoxazole (Bactrim), doxycycline (Vibramycin), ceftriaxone (Rocephin), and nitrofurantoin. ●Metronidazole (Flagyl) and clotrimazole (Mycelex) can be used for trichomonas infections ●Warm sitz baths can be used as well●Avoid intercourse until symptoms have subsideUrethral Diverticula ●Localized outpouchings of the urethra●Result from an enlargement of obstructive periureteral glands●Women have a higher chance than men and it protrudes into the anterior vaginal wall●Causes include: urethral damage from child bearing, urethral instrumentation, urethral dilation, and infection with gonococcal organisms●Symptoms: dysuria, post void dribbling, frequent urination, (more than every 2 hours), urgency, suprapubic discomfort or pressure, dyspareunia, and a feeling of incomplete bladder emptying●Urine may show grossly blood (hematuria), sediment and give a cloudy appearance●Anterior vaginal mass might be felt●Radiographic studies such as voiding cystourethrography (VCUG) can be used to confirm the diagnosis ●Surgical options may include transurethral incision of the diverticula neck, marsupialization ( creation of a permanent opening) of the diverticular sac into the vaginaInterstitial Cystitis/Painful Bladder Syndrome●Interstitial cystitis(IC) is a chronic, painful inflammatory disease of the bladder characterized by symptoms of urgency, frequency, and pain in the bladder and/or pelvis●Painful bladder syndrome (PBS) is suprapubic pain in bladder filling●IC/PBS- cases of urinary pain that cannot be attribited to other causes such as infection or urinary calculi 7
●More common in women than men●Etiology- remians unknown and most likely multifactorial●Possible causes include: neurogenic hypersensitivity of the lower tract, alteractions in mast cells in the muscle of the bladder, infection with an unusual organism, or productionof a toxic substance in the urine●Glomerulations (superficial ulcerations with pinpoint bleeding) and Hunners ulcers may occur on the bladder wallClinical Manifestations and Diagnostic Studies ●Two primary symptons are pain and bothersome LUTS (frequency, urgency)●People with severe IC/PBS urinate more than 60 times a day●Pain localized in the suprapubic area but may involve the vagina, labia, or entire perinealregion, including the rectum and the anus●Pain exacerbated by bladder filling, postponed urination, physical exertion, pressure against the suprapubic area, certain foods, emotional stress●Pain is relieved by urination ●Pain occurs before menstruation and during intercourse, or emotional stress●IC/PBS is an exclusion diagnosis●