Benign urological disease Flashcards
typicaly presentation of renal stones
-acute renal colic
signs and symptoms of renal stones (6)
- acute, severe flank pain
- colicky pain radiating to groin
- N&V
- urinary frequency and urgency
- haematuria
- testicular pain
chance of recurrance of renal stones
50%
what size stone can pass through ureter and urethra without symptoms
<5mm
what size stone can cause symptoms
> 5mm
nephrolithiasis=
formation of crystallised minerals in kidneys
why is urine concentrated (2)
- due to an increase mineral solutes
- decreased volume from dehydration
what happens to concentrated urine
becomes supersaturated
supersaturation=
urine solvent containing more solutes than it can hold in the solution
what does supersaturation cause
mineral crystals (nidus) to form which encourage aggregation and form a stone
what is supersaturation dependant on
urine pH
pH of urine for supersaturation to occur
acidic
2 chelating agents that inhibit nucleation and formation of crystals
magnesium
citrate
which stones can dietary magnesium and citrate inhibit
calcium oxalate
calcium phosphate
> 90% of stones =
calcium oxalate
risk factors for calcium stones
hypercalciruia
hyperoxaluria
2 conditions causing hypercalciruia
sarcoidosis and hyperparathyroidism
when is oxalate more readily absorbed from the gut
when dietary calcium is low
calcium oxalate stones on X-ray=
radiopaque
colour of calcium oxalate stones
dark brown
what type of stone does alkaline urine with hypercaclyiuria form
calcium phosphate
what does hypophosphatemia stimulate
calcitriol synthesis
what does excess calcitriol synthesis lead to
hypercalciuria
calcium phosphate stones colour
dirty white stones
calcium phosphate stones on X-ray
radiopaque
what stones does excess purine ingestion cause
uric acid stones
risk factors for uric acid stones (3)
- low urine pH
- low urine volume
- hyperuricosuria
colour of uric acid stones
red-brown
uric acid stones on X-ray
transulcent
struvite stones are made up of (3)
magnesium
ammonium
phosphate
why are struvite stones refered to as infectious stones
urinary tract infection precipitates their formation
what causes struvite stones
urea splitting microorganisms
-proteus, staphylococcus, Klebsiella
what do urea splitting microorganisms do to urea
hydrolyse it to produce ammonia and OH- forming alkaline urine
struvite stones appearance
stag-horn dirty white
struvite stones on X-ray
radiopaque
least common stones=
cysteine stones
what can cause cystinuria
iheritible autosomal recessive condition
risk factors for renal stones (6)
high protein high salt intake white ancestry male dehydration obesity
urinalysis for renal stones
microhematuria
nitrates
leukocytes
conservative management of renal stones
hydration
pain control
anti-emetics
antibiotic therapy for stones
trimethoprim
nitrofurantoin
3 treatments for renal stones
- surgical decompression
- medical expulsive therapy
- extracorporeal shock wave lithotripsy
medical expulsive therapy=
tamsulosin alpha blocker
surgical decompression for stones (2) =
- ureteric stent for renal drainage
- nephrostomy
what coordinates micturition
pontine micturition centre
at what level of bladder fullness is the pontine micturition centre activated
200-400ml (half-full)
3 bladder nerves
splanchnic nerve
hypogastric nerve
pudendal nerve
splanchnic nerve=
parasympathetics - M3 receptors
hypogastric nerve =
sympathetic nerve
pudendal nerve=
somatic nerve
in bladder contraction which nerves are active
the splanchnic nerve (PS)
in bladder contraction which nerves are inactive
hypogastric
Pudendal
pudendal nerve innervates
external sphincter
hypogastric nerve innervates
internal sphincter
destrusor bladder muscle
splanchnic nerve innervates
M3 receptor of bladder wall contraction
4 types of incontinence
urge
stress
overflow
neurogenic bladder
urge incontinence =
sudden urgency and need to urinate - overactive bladder
stress incontinence=
involuntary loss of urine during coughing, sneezing, laughing or exercise
common causes of stress incontinence (2)
- following pregnancy and birth -weakened internal sphincter and pelvic floor muscles
- post-menopause
overflow incontinence=
involuntary loss of urine without urgency
when can overflow incontinence occur (4)
- BPH
- prostate cancer
- urethral narrowing
- ineffective detrusor muscle
neurogenic bladder =
bladder dysfunction caused by neurological damage
symptoms of neurogenic bladder
- overflow
- frequency
- urgency
- urge
- retention
2 types of neurogenic bladder
flaccid
spastic
volume of urine in a flaccid bladder
large (750ml)
volume of urine in spastic bladder
low
main causes of flaccid neurogenic bladder (2)
- peripheral nerve damage
- cord damage at S2,3
main cause of spastic neurogenic bladder
brain damage or spinal cord damage above T12
prostatic carcinoma symptoms 6
- urinary frequency, hesitancy and dysuria
- nocturia
- weight loss
- lethargy
- bone pain
- palpable lymph nodes
BPH is
hyperplasia of epithelial and stromal prostatic components
in BPH anatomically which lobes are most enlarged
medial and lateral lobes due to higher glandular tissue
why is the prostate enlarged in BPH
increased activity of aromatase and 5-alpha reductase enzymes
risk factors for BPH (5)
- over 50 years old
- family history
- obesity
- type 2 diabetes
- erectile dysfunction
treatment of BPH
- alpha blocker (doxazosin)
- Slidenafil inhibitor
- NSAIDs
- Finasteride
Finasteride =
5-alpha reductase inhibitor
