Podcast #216: Roller Coasters and Kidney Stones

Author: Aaron Lessen, M.D.

Educational Pearls:

  • Anecdotal evidence suggests that roller coasters may help with kidney stones.
  • A recent study used a model of a kidney and ureter with different sized stones and put it on Thunder Mountain roller coaster in Disney World.
  • There was “dramatic passage” of the kidney stones at the rear of the roller coaster.

References: Marc A. Mitchell, DO; David D. Wartinger, DO, JD. Validation of a Functional Pyelocalyceal Renal Model for the Evaluation of Renal Calculi Passage While Riding a Roller Coaster. The Journal of the American Osteopathic Association, October 2016, Vol. 116, 647-652. doi:10.7556/jaoa.2016.128. http://jaoa.org/article.aspx?articleid=2557373

 

Podcast #131: Antibiotics for a UTI

0242783e-863a-451d-a9e4-4455434c30daRun Time: 4 minutes

Author: Holly Anderson, PharmD PGY-1 Resident

Educational Pearls:

  • Patients with pyelonephritis typically show a leukocytosis, fever, nausea, HA, CVA tenderness. Patients with a lower tract UTI will have absence of systemic symptoms with predominantly voiding symptoms of frequency, urgency, dysuria, and hematuria. These 2 types of UTI require different antibiotics and treatment.
  • Based on IDSA guidelines, only patients with uncomplicated lower UTI should be receiving Macrobid.
  • For patients with uncomplicated pyelonephritis, fluoroquinolones and Bactrim are preferred.
  • Macrobid has good sensitivity for the classic bugs that cause UTI, while fluoroquinolones show increasing E. coli resistance and are not recommended for uncomplicated lower tract UTIs.
  • Macrobid should not be used for pyelonephritis because the medication penetrates to the bladder just fine, but not well enough to the kidneys.

Link to Podcast: http://medicalminute.madewithopinion.com/antibiotics-for-a-uti/ 

References: http://www.idsociety.org/Guidelines/Patient_Care/IDSA_Practice_Guidelines/Infections_by_Organ_System/Genitourinary/Uncomplicated_Cystitis_and_Pyelonephritis_(UTI)/

Podcast #116: Catch a UA in Infants

733e8ff1-5e09-4aff-ba9b-42d299223775Run Time: 2 minutes

Author: Dylan Luyten M.D.

Educational Pearls:

  • An upcoming study in the Journal of Pediatrics, to be published in July, looked at reducing unnecessary urinary catheterization rates in infants.
  • In the study they investigated bagged urines on infants and every infant got a catheter.
  • It was found that if you restricted true positive UA on the bagged kids to those with positive nitrites, and moderate to large leuk esterase; there were no missed UTIs if you only catheterized these kids.
  • This could potentially reduce the number of catheterizations necessary for infants coming to the Emergency Room.

Link to Podcast: http://medicalminute.madewithopinion.com/catch-a-ua-in-infants/

References: http://www.jpeds.com/article/S0022-3476(09)00010-9/fulltext

Podcast #113: ASB vs. UTI

4d6bc5b7-0b1d-4d12-abe4-c0bbc2e4bed5Run Time: 4 minutes

Author: Holly Anderson, PharmD PGY-1 Resident

Educational Pearls:

  • ASB is defined as an individual with a bacteria count >100,00 or pyuria present on UA.
  • Patients will likely present with another chief complaint and will have no localizing urinary symptoms.
  • ASB is common in elderly patient with an indwelling catheter which frequently will be colonized with bacteria, up to 100% positive presence of ASB in patients with a long-term indwelling catheter. However, this does not mean the patient has a true UTI.
  • For patients with a suspected UTI think of the following algorithm to determine if the patient is truly in need of antibiotics: Are there localizing UTI symptoms? No, then there is no need for UA/culture. Yes, then is there an alternative cause or diagnosis? Yes, evaluate the other suspected cause. No, send UA & urine culture, start the patient on empiric antibiotics, and follow up in 48 hours to determine if the patient truly needs the antibiotics.

 

Link to Podcast: http://medicalminute.madewithopinion.com/asb-vs-uti/

References: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3534219/

Podcast #73: Imaging for Kidney Stones

Run Time: 3 minutesscreen-shot-2013-04-17-at-12-45-57-pm

Author: Dr. Jared Scott

Educational Pearls:

  • From 1992 to 2009, the number of CTs used to diagnose kidney stones has tripled. The radiation given by a CT of the abdomen and pelvis is roughly equivalent to the radiation given by 100 chest Xrays.
  • American College of Radiologygg reports even one CT scan increases your lifetime risk of getting cancer.
  • An ultrasound can visualize hydronephrosis, which indicates a large kidney stone is present.

Link to Podcast:  http://medicalminute.madewithopinion.com/imaging-for-kidney-stones/

References:  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3587076/

https://www.auanet.org/education/kidney-stones.cfm

Podcast #66: Medications for Kidney Stones

Run Time: 4 minutesblausen_0595_kidneystones

Author: Dr. Jared Scott

Educational Pearls:

  • NSAIDS should be prescribed for all patients with kidney stones. This helps to reduce the hyperactivity of your ureter.
  • Narcotics work well for treating kidney stone pain. This should be accompanied by NSAIDS for best results.
  • Using diuretics or fluid therapy do not significantly treat kidney stones.
  • Alpha-blockers, despite currently being used to treat kidney stones, have been shown to have no efficacy or limited efficacy for stones greater than 5 mm.

Link to Podcast:  http://medicalminute.madewithopinion.com/meds-for-kidney-stones/

References:  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3313741/

http://www.cochrane.org/CD006027/RENAL_nonsteroidal-anti-inflammatory-drugs-are-effective-treatment-for-acute-renal-colic

http://www.cochrane.org/CD004292/RENAL_increased-water-intake-may-help-reduce-the-risk-of-recurrence-of-kidney-stones-but-more-studies-are-needed

http://www.cochrane.org/CD008509/RENAL_alpha-blockers-as-medical-expulsive-therapy-for-ureteral-stones

Podcast #47: Broken Penis

Run Time: 2 minutesbroken-penis

Author: Dr. Erik Verzemnieks

Educational Pearls:

  • During an erection the corpus cavanosum fills with blood, when enough stress is placed on the penis during an erection the surrounding tissue can rupture.
  • A broken penis most often occurs during intercourse in the “reverse cowgirl” position.
  • This condition requires surgical repair of the penis to prevent tearing of the penile veins or the urethra.

Link to Podcast: http://medicalminute.madewithopinion.com/broken-penis-1/


References: 
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1472832/

Podcast #28: Flomax and Kidney Stones

b8015bae-2f8a-4977-837e-2e4ab1a17011Run Time: 4 minutes

Author: Dr. Samuel Killian

Educational Pearls:

  • Greater than 1 million visits per year in American for kidney stones.
  • 12% men and 6% women will have kidney stone at some point during their lifetime.
  • Most studies that discredited Flomax were not properly organized – there was no placebo, the study was not blind, etc.
  • New study from the Annals of Emergency Medicine showed that 87% of patients who received Flomax passed there stone at 28 days and 82% who received the placebo also passed their stone at 28 days, regardless of stone size.
  • The difference was at 5-10mm stones. 82% w/ Flomax passed their stone at 28 days and only 60% who received the placebo passed their stone at 28 days.

Link to Podcast:  http://medicalminute.madewithopinion.com/flomax-and-kidney-stones/

References:  http://www.annemergmed.com/article/S0196-0644(08)02183-5/fulltext

Podcast #21: Priapism Management

Priapism 2Run Time: 4 minutes

Author: Dr. Donald Stader

Educational Pearls:

  • Priapism originates from the Greek god of fertility, Priapus.
  • Causes of Priapsim include: chemically induced – Viagra, Cialis, spinal injury, low flow state, and Leukemia.
  • Treatment of priapism Phenylephrine, Tributyltin, Epinephrine – can cause penile necrosis, and drainage and irrigation from the corpus callosum of the penis.
  • A long term risk of priapism is infertility.

Link to Podcast:  http://medicalminute.madewithopinion.com/priapism-management/

References:  http://www.hindawi.com/journals/criu/2015/187831/