11.2 (8.4 GU of PC) Obstructive urinary disorders Flashcards
What are the four major GU issues in PC?
Urinary tract obstruction (lower and upper)
intractable bleeding
fistulae
bladder associated pain
FOB-P
Name THREE non-uro & TWO uro causes of lower urinary tract obstruction
◆ Non-uro
- tx brain injury
- stroke
- brain malig/met
—
- demyelinating condition
- cord compression
—
- pelvic nerve injury
—
- BPH
- severe constipation (WP: weak!)
- malignancy: rectal, ovarian, uterine
◆ Uro
- urethral strictures
- malignancy: prostate, bladder, urethra
FS: TINS
Trauma - pelvic nerve injury, surgery, radiation, chemo
Infection
Neoplasm - GI, gyne, prostate, GU (bladder, urethra)
Structural - brain, spinal cord, constipation, GU (urethral stricture, stones)
A patient presents with suprapubic pain, urgency, and abdo distension.
List four initial investigations you might undertake (not including bloodwork)
List two advanced investigations urology may order
urinalysis/urine culture
Bladder volume scan for post void residual
renal ultrasound
abdo CT or MRI
New in 6th Ed:
- cystoscopy
- urodynamic studies
A pt presents with retention and an indwelling catheter is placed.
- What immediate complication must be monitored for?
- What is the management?
Post obstructive diuresis
——
monitor serum electrolytes and water losses
If able, free access to water & observe.
If not, IVF 0.45% NS @ less than maintenance + serial lytes
List the findings that would suggest need for abx in a patient with a catheter
fever
Localizing symptoms = flank pain, Costovertebral tenderness, suprapubic discomfort
Bacteriuria
FS: symptoms (systemic or localizing) + bacteriuria (culture with >10^5 CFU)
List FOUR causes of upper urinary tract obstruction
◆ Non-uro (extrinsic)
- malig/mets
- retroperitoneal fibrosis
◆ Uro (intrinsic)
- neprholithiasis
- ureteral stricture
- ureteropelvic junction obs
- urothelial carcinoma
◆ any lower urinary tract obstruction
FS: “structure” of TINS change to include above
patient presents with increasing flank pain, NV, and reduced renal function (via bwk).
List four investigations you would undertake
Urinalysis and culture
renal US
New in 6th Ed:
- CT/MRI to identify level/etio of obs
- renal scan w/ MAG3 tracer
List three complications of ureteric stents
colicky pain*
UTI symptoms - urgency, frequency, dysuria*
hematuria *
incontinence
urinary reflux (experienced as flank pain) w/ pelvis pressure
5th Ed. answers not in 6th:
eventual failure if progressive mass
placement risks - bleeding vasc injury
List three complications of nephro tubes
bag mgmt
leakage w/ skin breakdown*
tube encrustation* ie clog
recurrent UTIs*
5th Ed. answers not in 6th:
social stigma
placement risks - bleeding vasc injury, peripnephric hematoma
discomfort
Why would you choose a nephro tube over uretertic stent (list 2 reasons)
nephro tubes do not require GA
if advancing disease ureteric stent may obstruct
List four causes of GU tract bleeding
Upper tract:
RCC
urothelial ca
AVM
angiomyolipoma
hemorrhagic cyst
mets
Lower tract:
bladder tumor
hemorrhage cystitis (chemo, XRT)
XRT
prostatic varices
urethral trauma
TINS
List three treatment options for bladder bleeding
CBI - for symptomatic removal of clots*
Urology - bladder irrigation with silver nitrate*
Rads - XRT*
IR - embolization*
Alum instillation
episolon aminocaproic acid
formalin instillation
ligation of hypogastric artery
List 3 meds and 2 procedures for management of pelvic/bladder pain due to invasive masses
analgesics (opioid)
antimuscarinic meds
O&B supps
urinary catheter
nephro tubes
List 1st, 2nd and 3rd line tx for BPH
◆ 1st
- alpha blockers (flomax)
- 5 alpha reductase inhibitors aka 5 ARI (finasteride)
◆ 2nd
- TURP
◆ 3rd
- intestinal urinary diversion (ex: ileal conduit) -> high mortality
Fig 11.2.1
List 1st & 2nd line procedures for urethral obstruction (not responding to urethra catheter)
◆ 1st
- suprapubic catherization:
-> clean, intermittent
-> indwelling
◆ 2nd:
- perc. nephrostomy
- intestinal urinary diversion
Fig 11.2.1
