304 Urology Flashcards
What is the most common urological emergency?
Acute urinary retention
What are some examples of bladder outflow obstructions (BOO’s)?
BPH
Prostate cancer
Stricture
Urethral stone
Clot retention
Pelvic organ prolapse
UTI / abscess
What are some common contractility problems that cause acute urinary retention?
Drugs
Pain
Cord compression
MS
Diabetes
Post-op
UTI
What is the treatment for acute bladder retention?
Insert catheter
- urethral
- suprapubic
Record residual volume
(MSU / blood cultures +/- antibiotics)
Admit if pain +++ / renal impairment
What is chronic urinary retention?
Patients can’t completely empty their bladder
May present with ‘acute on chronic retention’
Painless inability to void
May present with nocturnal incontinence alone
> 1L urine in bladder
What are the differences between high and low pressure urinary retention?
High Low
Painless Painless
Incontinent Dry
Raised creatinine Normal creatinine
Hydroureters / Normal ureters/
hydronephrosis kidneys
What is high pressure urinary retention?
Refers to the urinary retention causing such high intra-vesicular pressures that the anti-reflux mechanism of the bladder and ureters is overcome and ‘backs up’ into the upper renal tract leading to hydroureter and hydronephrosis, impairing the kidneys’ clearance levels
What is low pressure urinary retention?
Occurs in patients with retention with the upper renal tract unaffected due competent urethral valves or reduced detrusor muscle contractility / complete detrusor failure
Not as emergent as high pressure retention
What are some causes of haematuria?
Tumour (24% in macro, <5% in microscopic)
Infection
Trauma
Stones
What is a cystoscopy?
A procedure to look inside the bladder
What are some signs of trauma to the kidney?
Loin or abdominal bruising
Loin tenderness
Loss of loin contour
Loin mass
Macroscopic haematuria / clots
What is the management for renal trauma?
Largely conservative – bed rest, 5/7 antibiotics
More severe grades require intervention
- Surgical – nephrectomy
- Radiological – arterial embolisation
What is testicular torsion?
When a testicle rotates and twists the spermatic cord, which carries blood to the testicle
What are some differentials for scrotal pain?
-Torsion of testicle (twisting)
-Torsion of Hydatid of Morgagni / testicular appendix
-Epididymitis (where a tube (the epididymis) at the back of the testicles becomes swollen and painful)
-Orchitis (an inflammation of one or both testicles)
What are the symptoms of testicular torsion?
Twisting of spermatic cord and thus testicular artery; ischaemic pain
Causes:
Acute onset of painful testicle
Nausea / vomiting
Lower abdo pain
Horizontal lie
High lying in scrotum
How long does it take for the testicle to die from testicular torsion?
4-6 hours
What is the Hydatid of Morgagni?
A small embryological remnant at the upper pole of the testis
How do you treat Epididymo-orchitis?
Treat with antibiotics
< 30 yo – for chlamydia
> 50 yo – for coliform
What is Phimosis?
When the foreskin is forced back before it’s ready. This can cause a fibrous scar to form, which may prevent future retraction of the foreskin
What is Paraphimosis?
When the foreskin is retracted behind the corona (or crown) of the penis and cannot be returned to the unretracted position
Can cause ischaemia of glans
What is the Dundee method?
A technique for paraphimosis reduction
What is the composition of kidney stones?
Calcium oxalate (70%)
Calcium oxalate + phosphate (10%)
Urate (10%)
Struvite (10%)
Cystine (1%)
What are some inhibitors of kidney stone formation?
Urinary Macromolecules:
Urinary prothrombin fragment 1
Nephrocalcin
Bikunin
Tamm-Horsfall glycoprotein
osteopontin
Small molecules:
Citrate
Phytate
Pyrophosphate
Magnesium
What are the options for managing kidney stones?
Medical:
-Medical Expulsive Therapy – MET
-Chemolysis - Uric acid stones
-Shock Wave Lithotripsy – ESWL
-Ureteroscopy & Ureterorenoscopy
-Percutaneous Surgery - PCNL
-Laparoscopic Surgery
-Open Surgery
What is NCCT?
Non-contrast computerized tomography
Used to view the kidney, ureters, and bladder
When do you intervene with a kidney stone?
Uncontrolled & Persisting pain
Infection
Deteriorating renal function
Solitary Kidney
Failure to progress
Degree of obstruction
Patient circumstances or preference
What is (ESWL) Lithotripsy?
Shock waves are focused on the stone to break it up
What are some complications of (ESWL) Lithotripsy?
Steinstrasse
Residual fragment regrowth
Sepsis
Microhaematuria
Renal haematoma
What is Steinstrasse?
An accumulation of stone fragments or gravel in the ureter which may cause a downstream obstruction to urine flow
What is PCNL?
Percutaneous nephrolithotomy
A passageway from the skin on the back to the kidney to remove difficult kidney stones
