Changes in Micturition Flashcards
What are the causes of haematuria?
Cancer = renal cell carcinoma (RCC), upper tract transitional cell carcinoma (TCC), bladder cancer, prostate carcinoma
Stones
Infection
Inflam
BPH
Sickle cell
How would you investigate haematuria?
Dipstick
Microscopy
Visible
Full urological history
Urological exam = abdo, genitalia, PR exam, neurology, palpable bladder
CT
What is the management of a pt with haematuria?
Investigations
Admit to hospital = clot retention, lion pain
How do we diff between acute and chronic urinary retention?
Acute = painful, impaired GFR, bladder damage if untreated, urological emergency
Chronic = non-painful, high/normal pressure
What are the causes of urinary retention?
Bladder outlet obstruction
Low bladder contractile power
BPH, prostate cancer
Prolapse
Clots
Drugs = anticholinergics, spinal anaestesia
Spinal cord compression/injury
UTIs
Constipation
How is urinary retention diagnosed?
History and examination
Bloods
Bladder scan
Neurological documentation is incredibly important
Men = have to check saddle area, PR tone, prostate
Women = have to check for large messes in vagina and anus
When is catheterisation needed?
Pain acute retention
Acute on chronic retention (unable to pass urine)
High pressure chronic retention
To monitor fluid balance, sepsis, trauma
What is supra-pubic catheterisation?
Surgically created connection between the urinary bladder and the skin
May be a preferable long-term option
Risk of bowel perforation
Ultrasound guidance
How do urinary stones present?
Pain
Haematuria
Infection
Obstruction of renal tract
What are the risk factors for renal calculi?
Middle age
Men
Caucasian or Indian
Sedentary
Fluid balance
Summer months (vit D lower than urine pH)
Genes
Diet
What composition of renal stone is the most common?
Calcium oxalate
What is ureteric colic?
Acute severe loin pain
Associated with the obstruction of the urinary tract by a stone
Medical emergency
How is ureteric colic associated with obstruction and sepsis?
Calculi = obstruction = urine backs up = infection = can result in sepsis
What is the gold standard method for diagnosing renal/ureteric stones?
CT KUB = CT kidneys, ureters, bladder
What are the treatment options for bladder stones?
Can pass with no treatment
Extracorporeal shockwave lithtotripsy
Cystoscopy
Percutaneous nephrolithotomy (PCNL)
