Study guide
Genitourinary Disorders: BPH, Urinary Incontinence, UTIs & Prostatitis
AANPCB Adult-Gerontology Primary Care Nurse Practitioner A-GNP
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1 Exam Structure, APRN Foundations & Geriatric Assessment
A-GNP Exam Logistics, Blueprint & Scoring Structure APRN Scope of Practice, Consensus Model & Interprofessional Collaboration Comprehensive Health History & Subjective Assessment Across Adult Lifespan Comprehensive Physical Examination & Clinical Assessment Skills
2 Health Assessment, Diagnostic Reasoning & Clinical Procedures
Diagnostic Reasoning, Test Interpretation & Clinical Decision-Making Screening Guidelines & Evidence-Based Health Promotion (USPSTF) Comprehensive Geriatric Assessment (CGA), Frailty & Function In-Office Clinical Procedures, ECG Interpretation & Minor Surgical Skills
3 Cardiovascular & Peripheral Vascular Disorders
Essential Hypertension & Hypertensive Urgency/Emergency Management Coronary Artery Disease, Acute Coronary Syndromes & Post-MI Care Heart Failure (HFrEF & HFpEF) Diagnosis, Staging & 4-Pillar GDMT Arrhythmias (Atrial Fibrillation), Valvular Heart Disease & PAD
4 Respiratory, HEENT & Dermatological Disorders
Asthma Management across the Adult Lifespan (GINA Guidelines) Chronic Obstructive Pulmonary Disease (COPD) Staging & Management (GOLD Guidelines) Community-Acquired Pneumonia & Lower Respiratory Tract Infections Common HEENT Disorders: Otitis, Sinusitis, Pharyngitis, Glaucoma & Macular Degeneration
5 Endocrine, Metabolic & Renal/Genitourinary Disorders
Type 2 Diabetes Mellitus Management Thyroid Disorders: Hypothyroidism, Hyperthyroidism & Subclinical Disease Chronic Kidney Disease (CKD) Staging & Diabetic/Hypertensive Nephropathy Genitourinary Disorders: BPH, Urinary Incontinence, UTIs & Prostatitis
6 Gastrointestinal, Hematologic & Immunologic Disorders
Upper Gastrointestinal Disorders: Dyspepsia, GERD, PUD & H. pylori Lower Gastrointestinal Disorders: IBS, IBD, Diverticulitis & Colorectal Screening Liver, Biliary & Pancreatic Disorders: NAFLD/MASLD, Cirrhosis & Cholecystitis Hematologic & Immunologic Disorders: Anemias, Anticoagulation & Immunizations
7 Neurological, Cognitive & Psychiatric Disorders
Cognitive Assessment: Delirium, Dementia & Mild Cognitive Impairment Neurological Disorders: Stroke, TIA, Parkinson's Disease & Headache Syndromes Major Depressive Disorder & Anxiety Disorders in Adults & Older Adults Sleep Disorders, Insomnia & Restless Legs Syndrome
8 Geriatric Syndromes, Polypharmacy & Deprescribing
The Beers Criteria & STOPP/START Criteria for Potentially Inappropriate Medication Use Polypharmacy Management, Pharmacokinetics/Pharmacodynamics in Aging & Deprescribing Protocols Fall Risk Assessment (CDC STEADI), Gait/Balance & Mobility Impairments Pressure Injury Prevention/Staging, Urinary/Fecal Incontinence & Frailty Assessment
9 APRN Professional Practice, Ethics, Quality & Healthcare Policy
Musculoskeletal Disorders: Osteoarthritis, Osteoporosis, Gout & Back Pain Dermatological Disorders: Lesions, Skin Cancers, Infections & Rash Evaluation Palliative Care, Advance Care Planning, Pain Management & End-of-Life APRN Professional Practice, Quality Improvement, Ethics & Healthcare Policy
Genitourinary Disorders: BPH, Urinary Incontinence, UTIs & Prostatitis
Key Takeaways Explain This Topic AI
BPH management includes Alpha-1 blockers (Tamsulosin) for fast smooth muscle relaxation and 5-alpha reductase inhibitors (Finasteride) to reduce prostate volume over 3-6 months.
Finasteride reduces serum PSA levels by approximately 50%; clinicians must double measured PSA values when evaluating prostate cancer risk.
Anticholinergic drugs for Overactive Bladder (Oxybutynin) are listed on the Beers Criteria and should be avoided in older adults due to cognitive impairment; Beta-3 agonists (Mirabegron) are safer alternatives.
Uncomplicated cystitis in women is treated with Nitrofurantoin (5 days), TMP-SMX (3 days), or Fosfomycin (1 dose); fluoroquinolones are reserved for complicated infections due to severe black box warnings.
Acute bacterial prostatitis presents with fever, dysuria, and a boggy tender prostate; vigorous prostatic massage is contraindicated, and treatment requires 4-6 weeks of TMP-SMX or a fluoroquinolone.
Last updated: July 2026
Genitourinary Disorders: BPH, Urinary Incontinence, UTIs & Prostatitis
Genitourinary (GU) disorders are common in adult and geriatric primary care, spanning obstructive uropathies, functional bladder dysfunction, and urogenital infections.
Benign Prostatic Hyperplasia (BPH)
Benign Prostatic Hyperplasia is a non-malignant proliferation of prostatic stromal and epithelial cells in the transition zone surrounding the urethra. Dihydrotestosterone (DHT), converted from testosterone by 5-alpha reductase, is the primary androgen mediator of prostate growth.
Clinical Presentation & Diagnostic Evaluation
Symptoms are categorized into lower urinary tract symptoms (LUTS):
Storage Symptoms (Irritative): Frequency, urgency, nocturia, and urge incontinence.
Voiding Symptoms (Obstructive): Hesitancy, weak stream, intermittency, straining, incomplete emptying.
Evaluation Tools: International Prostate Symptom Score (IPSS) questionnaire. Digital Rectal Examination (DRE) reveals a symmetrically enlarged, smooth, firm/rubbery, non-tender prostate with a preserved median sulcus.
Diagnostic Testing: Urinalysis (rule out UTI) and serum Prostate-Specific Antigen (PSA).
Pharmacological Management Algorithm
Alpha-1 Adrenergic Antagonists (Selective: Tamsulosin, Silodosin; Non-Selective: Doxazosin, Terazosin):
Block alpha-1a receptors in prostate stroma and bladder neck, causing smooth muscle relaxation.
Provide rapid relief of voiding symptoms (within 1 to 2 weeks). They do not reduce prostate size .
Adverse Effects & Warnings: Orthostatic hypotension, dizziness, retrograde ejaculation. Intraoperative Floppy Iris Syndrome (IFIS) warning before cataract surgery.
5-Alpha Reductase Inhibitors (Finasteride, Dutasteride):
Inhibit 5-alpha reductase, blocking conversion of testosterone to DHT.
Reduce prostate volume by 20–25% , halt BPH progression, and decrease acute urinary retention risk.
Onset & PSA Pearl: Requires 3 to 6 months for symptom relief. Finasteride reduces serum PSA levels by ~50% . Clinicians must double measured serum PSA in patients on 5-ARIs for >= 6 months when screening for prostate cancer.
Combination & PDE5 Inhibitors: Combination therapy (Alpha-blocker + 5-ARI) is superior for large prostates. Tadalafil 5 mg daily is indicated for coexisting BPH and Erectile Dysfunction.
Urinary Incontinence Subtypes & Diagnostic Evaluation
Screen for reversible causes using the DIAPPERS mnemonic: D elirium, I nfection, A trophic vaginitis, P harmaceuticals, P sychological, E xcess output, R estricted mobility, S tool impaction.
Subtype Pathophysiology Key Symptoms First-Line Interventions Pharmacotherapy & Safety Warnings
Stress Incontinence Hypermobility of bladder neck; pelvic floor weakness Involuntary leakage with coughing, laughing, sneezing Pelvic floor muscle training (Kegels), weight loss, pessary Duloxetine (off-label); surgical mid-urethral sling
Urge Incontinence (OAB) Detrusor muscle hyperreactivity Sudden intense urgency followed by involuntary leakage Bladder training (timed voiding), fluid management Anticholinergics (Oxybutynin) or Beta-3 Agonists (Mirabegron)
Overflow Incontinence Bladder overdistension (BPH/neurogenic) Continuous dribbling, high residual (PVR > 200 mL) Decompress bladder; treat obstruction Alpha-blockers; intermittent catheterization
Functional Incontinence Intact GU tract; physical/cognitive impairment Inability to toilet due to arthritis or dementia Scheduled toileting, environmental changes Manage underlying physical/cognitive barriers
Diagnostic Diagnostics & Post-Void Residual (PVR)
Diagnostic evaluation of chronic urinary incontinence includes a detailed 3-day voiding diary, urinalysis to exclude UTI or hematuria, and measurement of Post-Void Residual (PVR) volume via bladder ultrasound:
PVR < 50 mL: Normal bladder emptying.
PVR 50–200 mL: Borderline; monitor clinically.
PVR > 200 mL: Incomplete bladder emptying / urinary retention; suggestive of overflow incontinence or severe bladder outlet obstruction.
Overactive Bladder Pharmacotherapy & Beers Criteria Safety
Anticholinergic Agents (Oxybutynin, Tolterodine, Solifenacin): Block M2/M3 receptors to relax detrusor muscle. Beers Criteria Risk: High risk of dry mouth, constipation, urinary retention, blurred vision, and cognitive decline/dementia in older adults. Avoid in older adults.
Beta-3 Agonists (Mirabegron, Vibegron): Stimulate detrusor relaxation during storage without anticholinergic side effects. Preferred in older adults. Monitor baseline and ongoing blood pressure.
Urinary Tract Infections (UTIs) Across the Lifespan
Over 80% of uncomplicated UTIs are caused by uropathogenic Escherichia coli .
Acute Uncomplicated Cystitis
Uncomplicated cystitis presents with dysuria, frequency, urgency, and suprapubic pain without systemic symptoms.
First-Line Antibiotics:
Nitrofurantoin (Macrobid): 100 mg PO BID for 5 days (avoid if eGFR < 30 mL/min/1.73m² or pyelonephritis).
Trimethoprim-Sulfamethoxazole (Bactrim DS): 160/800 mg PO BID for 3 days (if local resistance < 20%).
Fosfomycin: 3 grams PO single dose .
Fluoroquinolones (Ciprofloxacin): Do NOT use for uncomplicated cystitis due to severe black box warnings (tendon rupture, aortic dissection, QT prolongation).
Recurrent UTIs & Prophylaxis Strategies
Recurrent UTI is defined as 2 or more infections in 6 months or 3 or more in 12 months . Prophylactic strategies include:
Non-pharmacologic: Hydration, post-coital voiding, cranberry supplements (mixed evidence).
Postmenopausal Women: Topical vaginal estrogen cream reverses urogenital atrophy and restores lactobacilli protective flora.
Post-coital or daily low-dose antimicrobial prophylaxis (Nitrofurantoin 50 mg daily or TMP-SMX 40/200 mg daily) for refractory cases.
Complicated UTIs & Asymptomatic Bacteriuria
Complicated UTIs (males, pregnancy, catheters, pyelonephritis) require urine culture prior to treatment . Pyelonephritis is treated with oral Ciprofloxacin 500 mg BID for 7 days or Levofloxacin 750 mg daily for 5 days. Asymptomatic Bacteriuria (ASB) (>= 10^5 CFU/mL without symptoms) should NOT be treated in older adults or catheterized patients. Screen and treat ASB ONLY in pregnant women and before endourologic procedures with mucosal bleeding.
Bacterial Prostatitis: Acute vs. Chronic
Acute Bacterial Prostatitis: Abrupt onset of high fever, chills, perineal pain, dysuria, and urinary retention. Etiology: E. coli in men > 35; N. gonorrhoeae / C. trachomatis in men < 35. On DRE, the prostate is exquisitely tender, warm, and boggy . Vigorous prostatic massage is strictly contraindicated (risk of bacteremia/sepsis). Treatment requires extended therapy: Ciprofloxacin 500 mg BID or TMP-SMX DS BID for 4 to 6 weeks .
Chronic Bacterial Prostatitis: Recurrent UTIs with the same pathogen and chronic relapsing pelvic discomfort. Diagnostic confirmation utilizes post-prostatic massage urine culture (Meares-Stamey 4-glass test). Requires 4 to 6 weeks of fluoroquinolones or TMP-SMX.
Chronic Pelvic Pain Syndrome (CPPS / Non-Bacterial Prostatitis): Chronic pelvic pain with negative urine cultures. Treated with alpha-blockers, anti-inflammatories, and physical therapy.