Special Operations Forces Medical Handbook

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is significant residual urine. If there is greater than 200-300 cc, leave the catheter in place and monitor urine
output. If urine output is greater than 200 cc/hour, suspect renal obstruction. Start an IV placed with NS
running at a maintenance level with boluses for resting pulse rate greater than 100/min.

Decrease prostate resistance with alpha-blockers: Hytrin (terazosin) 1-5 mg po q hs (start at low dose
and titrate up over several weeks), Cardura (doxazosin) 1-4 mg po q hs, Flomax (tamsulosin) 1 po qd
or Minipress 1-5 mg po q hs
After removing urethral catheter, perform intermittent (self-) catheterization (see Procedures: Bladder
Catheterization) q 4-6 hours to keep bladder volume under 300 cc.
For those patients in whom it is too difficult to pass a Foley catheter, use a straight or suprapubic catheter.
(see Procedure: Suprapubic Catheterization)
Alternative: For frequency and urgency, diazepam (Valium) 5-10 mg po q 6h can be very helpful.
Primitive: None
Empiric: Antibiotics for chronic suppression of infection, such as nitrofurantoin 50 mg po bid, Septra 1 po q
hs. Cipro 250 mg po q hs or Keflex 250 mg po q hs.

Patient Education
General: Avoid dehydration. Women tend to avoid fluids to minimize going to the bathroom and leaking,
leading to significant dehydration.
Medications: Cold medications and antihistamines for sinus problems will counteract alpha-blockers and vice
versa. Side effects of Ditropan include dry mouth, dry eyes and constipation.
No Improvement/Deterioration: If other neurologic symptoms such as visual disturbance, muscle weakness
or sensory loss become apparent, refer patient to hospital for further evaluation

Follow-up Actions
Return evaluation: Evaluate for effectiveness of therapy and the necessity for referral to a urologist for
surgery or other treatment.
Evacuation/Consultation Criteria: Evacuate all unstable patients and those with neurologic findings (i.e.
cauda equina) as soon as possible. Additionally, refer at some time all patients with overflow incontinence,
those with stress incontinence that is interfering with work, those with urge incontinence who deteriorate or fail
to improve, or any patient with a continuing requirement for medication.

GU: Urolithiasis (Kidney Stones)

CAPT Leo Kusuda, MC, USN

Introduction: Ureteral stone pain is generally acknowledged as one of the worst pains a person can suffer.
The majority of stones can be managed with hydration and pain control. Fever, vomiting and severe pain
not controlled by oral medication requires intravenous treatment. Evacuate these patients with persistent
symptoms beyond 24 hours.

Subjective: Symptoms
Intense, intermittent flank or inguinal pain radiating into the scrotum and not related to activity; nausea and
vomiting; urinary frequency and burning (if stone at ureter/bladder junction); fever.

Objective: Signs
Fever, severe costovertebral angle (CVA) tenderness which waxes and wanes, vomiting.
Using Basic Tools:

1. Examine the patient between the lower chest and scrotum/pelvis.


2. Check for a tender liver by pushing under the anterior right ribs while the patient takes a large breath.


3. Check for a hernia.


4. Examine the scrotum for epididymitis or torsion.


5. Examine above the prostate on the rectal exam for any fullness on the side of symptoms.