bladder

Question 1

when are hyaline casts in urine seen

Answer 1

normal, exercise, fever, loop diuretics

Question 2

when are brown casts seen in urine

Answer 2

tubular necrosis

Question 3

when is bland urinary sediment seen

Answer 3

prerenal uraemia

Question 4

when are red cell casts seen

Answer 4

nephritic syndrome

Question 5

causes transient non-visible haematuria

Answer 5

UTI, period, sex, exercise

Question 6

causes persistent non-visible haematuria

Answer 6

cancer, stones, BPH, prostatitis, chlamydia, renal (eg IgA, basement disease)

Question 7

how is persistent non-visible haematuria defines

Answer 7

blood in 2/3 samples 2-3 weeks apart

Question 8

urgent referral criteria haematuria (2 weeks)

Answer 8

45 AND unexplained visible haematuria // 45 AND visible haematuria that persists after UTI // 60 AND unexplained non-visible haematuria AND dysuria or raised WCC

Question 9

non-urgent cancer referral

Answer 9

60 years with recurrent or persistent unexplained urinary tract infection

Question 10

what patients with haematuria can be managed in primary care

Answer 10

<40, non-visible, normal RFT, no protein, normotensive

Question 11

most common causes polyuria

Answer 11

diuretics, coffee, alcohol, diabetes, lithium, HF

Question 12

who gets AUR

Answer 12

men >60

Question 13

biggest causes AUR

Answer 13

BPH

Question 14

other causes AUR

Answer 14

obstruction eg stricture, calculi, constipation // meds // neuro eg trauma

Question 15

meds that can cause AUR

Answer 15

anticholinergics eg antihistamines, TCAs // opioids // benzos

Question 16

symptoms + signs AUR

Answer 16

can’t pass urine // lower abdo pain // confused // palbable bladder // abdo tenderness

Question 17

inital + defitnitive invx AUR

Answer 17

urinalysis, U+Es, FBC // USS >300 = diagnostic

Question 18

mx AUR

Answer 18

catheter

Question 19

what volume of fluid drained from a catheter in suspected AUR would confirm diagnosis

Answer 19

if volume >400 leave in place // if <200 not AUR

Question 20

complications of AUR mx

Answer 20

post-obstructive diuresis (maybe give IV fluids)

Question 21

symptoms chronic urinary retention

Answer 21

painless and insidious onset

Question 22

findings of high vs low pressure chronic urinary retention

Answer 22

high pressure = impaired renal function + bilateral hydronephrosis // low pressure = normal function + no hydronephrosis

Question 23

what usually causes high pressure chronic urinary retention

Answer 23

bladder outflow obstruction

Question 24

what symptom can occur after catheterisation in chronic UR

Answer 24

decompression haematuria (no treatment required)

Question 25

invx chronic retention and bladder outflow obstruction

Answer 25

bladder + renal USS // urinalysis // prostate

Question 26

RF urinary incontinence

Answer 26

age // pregnancy + childbirth // high BMI // hysterectomy

Question 27

what causes overactive bladder / urge incontinence

Answer 27

overactive detrusor

Question 28

symptoms OAB + urge incontinence

Answer 28

desperate sudden need, provocative onset eg key in door, small leakage // OAB may not have incontinence

Question 29

physio + medical mx urge incontience

Answer 29

bladder retraining // antimuscarinics eg oxybutynon, tolterodine // mirebegron (FOR ELDERLY)

Question 30

surgical mx urge incontinence

Answer 30

bladder pacemaker // enterocystoplasty

Question 31

what causes stress incontinence

Answer 31

weak pelvic floor when raised intra-abdominal pressure

Question 32

causes stress incontinence

Answer 32

obese, multiparous

Question 33

symptoms stress incontinence

Answer 33

wet when coughing

Question 34

physio, med, surgical mx stress incotinence

Answer 34

pelvic floor (8x3/ day for 3 months) // duloxetine // surgical tape procedure

Question 35

what causes over flow incontinence

Answer 35

outflow obstruction eg prostate enlargement

Question 36

symptoms overflow incontinence

Answer 36

hesitant void, poor stream, incomplete emptying, bed wetting, nocturia

Question 37

ivx incontinence

Answer 37

bladder diary // vaginal exam // dipstick // urodynamics

Question 38

who usually gets bladder cancer

Answer 38

men 50-80

Question 39

RF for transitional cell bladder cancer

Answer 39

smoking!!! // hydrocarbins eg 2-naphthylamine (work in printing or textiles // rubber // cyclophosphamide

Question 40

types of bladder cancer

Answer 40

transitional cell carcinoma (90%) // SCC // adenocarcinoma

Question 41

subtypes of transitional cell carcinomas

Answer 41

70% papillary (superficial and better prognosis) // 30% mixed or solid growth (more aggressive)

Question 42

which nodes are first affected in bladder cancer

Answer 42

single node true pelvis (N1) --> multiple nodes true pelvis (N2)--> common iliac (bad) (N3)

Question 43

stages bladder cancer

Answer 43

T1 = confined to subepilelial connective tissue // T2 = muscularis propria (smooth muscle) // T3 = fat // T4 = local invasion

Question 44

symptoms bladder cancer

Answer 44

painless, haematuria // incidental non-visible haematuria in younger patients

Question 45

invx bladder cancer

Answer 45

cystoscopy + biopsy // local disease = MRI // distant mets = CT

Question 46

how are high grade bladder cancers mx

Answer 46

chemo

Question 47

how are T1+T2 bladder cancers mx

Answer 47

surgery or radiotherapy

Question 48

RF SCC bladder cancer

Answer 48

(shistosomiasis)

Question 49

most common cause of bladder injury

Answer 49

blunt trauma assoc with pelvic fracture (10% of pelvic fractures have bladder injury)

Question 50

symptoms of a bulbar urethral injury

Answer 50

most common: urianary retention + blood at meatus + perineal haematoma

Question 51

symptom membranous urethral rupture

Answer 51

penile or perineal oedema or haematoma // PR = prostate displaced upwards

Question 52

invx + mx urethral trauma

Answer 52

ascending urethrogram + suprapubic catheter

Question 53

symptoms bladder injury

Answer 53

haematuria, pain, cant void

Question 54

invx bladder trauma

Answer 54

IVU or cystogram