11.4 Benign and Malignant Urological Disorders Flashcards
Pathogenesis of kidney stone
- Supersaturated urine causes crystals made of calcium, phsphate, urate, and other substances to form
- They adhere to the urothelium and grow progressively over time, whereupon they can cause blockage in the upper (and lower) urinary tract
Risk factors for kidney stones
- Low fluid intake
- Hyper calciuria
- High salt diet
- Hyperparathyroidism (why?)
What percentage of people will get kidney stones? How do we prevent them?
- About 10% of the population will get them, and many will recur
- Prevent with high fluid intake and vegetarian diet
Signs and symptoms of kidney stones (incl. red flag)
- Sudden onset, colicky loin-to-groin pain, worse on urination
- Dysuria, haematuria
- Red flag symptom is fever (could indicate infection -> ?urosepsis)
Investigations for suspected nephrolithiasis (including other conditions)
- Urine dip stick (looking for indications of UTI; nitrites,WCC), and screening for AKI)
- Urine MCS
- Bloods (incl. CRP, EUC, ACR, CBC for WCC)
- CT KUB
Conservative vs non-conservative kidney stone management (including rough cutoff size between the two)
- > 5mm; surgical (call urology)
- <5mm; can be conventional. Give alpha antagonist to relax urethral smooth muscle, and repeat CT KUB in ~1 month
Name and describe the three types of urinary incontinence
- Urge: Detrusor overactivity causes sudden, uncontrollable urge to urinate
- Stress: weakening of sphincters, overcome by increasing intra-abdo pressure
- Overflow: urinary retention increases intravesical pressure, causing dribbling
Symptoms of the three kinds of urinary incontinence
- Urge: sudden, uncontrollable urge to urinate
- Stress: incontinence brought on by coughing, laughing, jumping etc
- Overflow: oliguria, suprapubic tenderness, dribbling
Beside, imaging, functional Ix for urinary incontinence
Bedside:
- Dipstick (UTI)
- Pre/post void bladder scan (why?)
Imaging:
- Renal tract US (gauge bladder function/anatomical variation)
Functional:
- Urine dynamics (tests how well, ureters, bladder, and urethra function to empty)
Management of Urinary Incontinence
- Lifestyle (decrease caffeine, stop smoking, bladder training)
- Pharm (cholinergic/beta adrenergic antagonists) [why?}
- Surg/interventional (botox injections [why?}, indwelling catheter, neuromodulation)
Pathogenesis/nature of diagnosis of BPH. How does the site of growth differ between BPH and cancer?
- Histological diagnosis (proliferation of smooth muscle and epithelium within prostatic transition zone [region around prostatic urethra])
- Aetiology not exactly known, but appears to increase in prevalence with age
BPH: grows inwardly and compresses urethra
Cancer: grows outward to invade (makes sense)
What are the signs/symptoms of BPH? What’s the caveat to this?
- Caveat: typically presents w/ no symptoms
- Can lead to symptoms like weak stream, dribbling, hesitancy, incomplete voiding
- Classic sign is enlarged prostate on DRE
Investigations for BPH
- Bloods (PSA)
- Imaging (Renal tract US, MRI)
- Functional urodynamics / PVR (post-void residual)
Which enzyme converts testosterone to DHT?
Alpha 5 reductase.
Alpha = DHT
5 = superior liver number
Reductase = contradiction
BPH management
- Alpha-5 reductase inhibitors, alpha blockers
- Surgery
