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CS4: Exam 2 > 25: Diseases of the Prostate, Kidney, and Bladder - Pothoven > Flashcards

25: Diseases of the Prostate, Kidney, and Bladder - Pothoven Flashcards

1
Q

define urinary calculi

A

Kidney stones are solutes that occur in amounts too high to stay dissolved (supersaturated) in urine

most commonly calcium oxalate but could also be uric acid

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2
Q

best imaging modality to detect urinary calculi

A

CT is best imaging modality to detect urinary calculi. Detects over 96% of stones

renal US is study of choice if pregnant - can detect intrarenal and hydronephrosis but not ureteral stones

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3
Q

Physiology of Renal Obstruction

A

Initial 2 hours

    • Increased renal pelvic pressures
    • Increased renal blood flow
    • As renal pelvic pressure increases, glomerular filtration (GFR) decreases

At 6-24 hours

    • Renal pelvic pressures remain elevated
    • Renal blood flow diminishes

> 24 hours

    • Renal pelvic pressures trend down towards baseline (but remain elevated)
    • Renal blood flow continues to diminish.
    • If persistent, the obstruction (high grade complete obstruction) leads to renal ischemia and permanent damage typically occurs within 2 weeks
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4
Q

____ of ureteral stones will pass w/i 4 wks of symptom onset

A

2/3

Complete obstruction is rare so risk of renal deterioration from observation is low

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5
Q

Medical Expulsion Therapy

A 
Alpha blockers (relax ureteral smooth m.) 
Calcium channel blockers
NSAIDS
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6
Q

Oral stone dissolution

A

Uric acid stones only
Urinary alkalization
Potassium citrate, sodium bicarbonate

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7
Q

Indications for Urgent Intervention for Urinary Stones **

A
    • Obstructed upper tract with infection
    • Impending renal deterioration
    • Pain refractory to analgesics
    • Intractable nausea/vomiting
    • (Patient preference)
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8
Q

Surgical Stone Intervention

A

Extracorporeal Shock Wave Lithotripsy (ESWL)

    • 4-15 mm stones in kidney or proximal ureter
    • Stone must be radio-opaque

Ureteroscopy +/- laser lithotripsy
– All stones amendable but large renal stone treatment is tedious

Percutaneous Nephrolithotomy (PCNL)

    • Renal calculi >15-20 mm
    • More invasive and requires hospital observation

Open or laparoscopic lithotomy
–Most invasive, Rarely necessary

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9
Q

stone prevention

A

ADEQUATE HYDRATION!! (2.5-3 L/DAY) *

Dietary modifications

  • -Low animal protein, – low sodium, low oxalate diets
    • Normal dietary calcium
    • Citrate therapy

Full metabolic evaluation for patients with recurrent stones or strong family history

    • Serum chemistries
    • 24 hour urine collection
    • Medications and additional therapies directed at metabolic abnormalities
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10
Q

Irritative/Storage s/s for lower urinary tract

A

Frequency
Urgency
Nocturia
Dysuria

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11
Q

obstructive/voiding s/s for lower urinary tract

A 
Hesitancy
Intermittency
Straining
Weak stream
Terminal dribbling
Sensation of incomplete bladder emptying
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12
Q

anatomy of prostate

A

18-20 grams in young men

Composed of glandular (70%) and fibromuscular stromal (30%) elements

α-1A receptors predominantly in stroma mediate prostatic smooth muscle tone

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13
Q

which zone of prostate gives rise to BPH? to prostate cancer?

A

transition zone

peripheral zone

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14
Q

which hormone promotes prostate growth?

A

DHT is a more potent androgen than testosterone which binds to prostatic androgen receptors with higher affinity

DHT stimulates prostate differentiation and growth

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15
Q

complications of BPH

A

Acute urinary retention

Renal insufficiency

Chronic/recurrent UTIs

Uncontrolled gross hematuria/clot retention

Bladder calculi

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16
Q

pharmacotherapy for BPH

A

α antagonists: relaxes smooth muscle of prostate to alleviate LUTS *first choice

5 α-reductase inhibitors: reduces prostate size over 6-12 months

Combination therapy: most beneficial men with large prostate and incomplete emptying

Herbal supplements

17
Q

normal bladder will hold ______ at capacity

A

400-600 ml

18
Q

acute and chronic s/s urinary retention

A

Acute

    • inability to urinate
    • painful, urgent need to urinate
    • pain or discomfort in the lower abdomen
    • bloating of the lower abdomen

Chronic

    • urinary frequency—urination eight or more times a day
    • trouble beginning a urine stream
    • a weak or an interrupted urine stream
    • an urgent need to urinate with little success when trying to urinate
    • feeling the need to urinate after finishing urination
    • mild and constant discomfort in the lower abdomen and urinary tract
19
Q

complications of urinary retention

A

UTI
bladder decompensation
renal damage

tx = initial bladder damage with catheterization, treatment of underlying cause

20
Q

different types of UTIs

A

Uncomplicated UTI - infection in a healthy patient with normal GU tract

Complicated UTI - infection associated with factors that increase chance of acquiring bacteria and decrease efficacy of therapy.
Abnormal GU tract (BPH, stone, bladder diverticulum, neurogenic bladder, etc)
Immunocompromised host
Multi-drug resistant bacteria

Recurrent UTI - occurs after documented infection that had resolved

Reinfection UTI - a new event with reintroduction of bacteria into GU tract

Persistent UTI - recurrent UTI caused by same bacteria from focus of infection

21
Q

s/s cystitis vs. s/s pyelonephritis

A 
Urinary urgency
Frequency 
Dysuria
Hematuria 
Foul-smelling urine 
Suprapubic pain
May have associated urethritis , prostatitis  or epididymitis 
PYELO:
Typical symptoms of cystitis
Fever
Rigors
Flank or abdominal pain
Nausea and vomiting
22
Q

most common bacteria causing UTIs

A

e. coli (80%)

23
Q

define microscopic hematuria

A

greater than 3 RBC per high powered field

24
Q

signs nephrologic/glomerular heamturia

A

Significant proteinuria (>1 gm/24 hours)

Dysmorphic red blood cells

Red cell casts

Warrants nephrology evaluation

25
Q

risk factors for significant cause of heamturia

A 
** smoking
over 40
male
chemical exposure
pelvic radiation
irritative voiding symptoms
prior urologic dz
26
Q

____– % of pts evaluated for hematuria will be diagnosed with urologic malignancy

A

10-20%

CS4: Exam 2 (15 decks)

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