Changes in Micturition

Question 1

State possible causes of haematuria

Answer 1

• Cancer - renal cell carcinoma, bladder cancer, upper tract transitional cell carcinoma, advanced prostate carcinoma
• Stones
• Infection
• Inflammation
• Benign prostatic hyperplasia
• Sickle cell, haemophilia, anticoagulation

Question 2

Describe the investigations for haematuria

Answer 2

• Urine dipstick test - very sensitive, can detect single RBC in non-visible haematuria
• Urological examination - palpate abdomen, bladder, genitalia
• Flexible cystoscopy - look inside bladder with endoscope
• Ultrasound or CT of bladder - non contrast CT can detect stones

Question 3

Describe the management of haematuria

Answer 3

• Blood test including clotting levels
• 3 way catheter
  CT angiogram if significant bleed to find source

Question 4

Differentiate between acute and chronic urinary retention

Answer 4

• Acute urinary retention
  
  • Painful - may have impaired GFR
  • Need catheter to prevent permanent bladder damage
• Chronic urinary retention
  
  • Non-painful - patients do not empty their bladders completely
  • Palpable bladder - chronic retention due to pressure if urine not all excreted
  • Normal renal function so no catheterisation needed
    
    • However some chronic patients have high pressure chronic retention, which leads to impairment of renal function and thus require catheters

Question 5

Describe what acute on chronic urinary retention is

Answer 5

• Is when a patient who has chronic urinary retention suffers from acute urinary retention
• Patient would be unable to pass urine and requires catheterisation

Question 6

Describe the causes of urinary retention

Answer 6

• Mechanism - bladder outlet obstruction
  
  • Low bladder contractile power
  • Interrupted sensory or motor innervation of bladder and/or sphincter
• Causes - benign prostatic hypertrophy, prostate cancer, prostatic infection
  
  • Urethral stricture/damage
  • Prolapses, masses
  • Neurological - spinal cord compression, spinal cord injury, detrusor-sphincter dyssynergia
  • UTI
    
    • Constipation

Question 7

Describe the investigations of urinary retention

Answer 7

• History and examination
• Bloods
• Bladder scan
• Neurological documentation

Question 8

Describe the management of urinary retention

Answer 8

• Monitor urine output - give fluid replacement to compensate for diuresis
• Monitor renal function
• Catheterisation (urethral, supra-pubic)
  
  • Catheterise if painful acute retention, acute on chronic urinary retention or high pressure chronic retention
    
    • Also catheterise to monitor fluid balance, sepsis, trauma

Question 9

Describe what supra-pubic catheterisation is

Answer 9

• Preferable as long term option
  
  • Eg. Patients with MS, neurological patients
  • Urethral catheters predispose to UTI, disrupt sexual function
• Risk of bowel perforation with insertion
  - Should have ultrasound scan guidance

Question 10

Describe the cause and presentation of ureteric colic

Answer 10

• Stone formation from solutes precipitating from urine to crystals
  
  • Renal stones may drop into ureters and cause ureteric colic
• Ureteric colic - sharp pain common on the side of the body
  - Loin to groin pain

Question 11

Describe the consequences of ureteric calculi

Answer 11

• Obstruction can lead to infection due to non-moving urine
  
  • Stones itself can cause infection
  • Standing column of septic urine the upper urinary tract is called pyonephrosis

Question 12

State potential causes of urosepsis

Answer 12

Ureteric calculi, UTI, prostatitis, pyelonephritis, catheters, post operative complications

Question 13

Describe the treatment options for bladder stones

Answer 13

• Smaller stones can pass within 3 weeks, but lots of pain
• Early stent (catherisation) can help relieve pain
• Larger stones are removed surgically
• Transurethral cysytolitholapaxy - cytoscope with camera inserted through urethra to locate the stone, then lasers or ultrasound waves transmitted to break up the stone

Question 14

Describe the treatment options for urosepsis

Answer 14

• Need urgent stabilization and decompression of urinary tract
• Stenting - catheterisation
• Nephrostomy tube - inserted through the skin fromthe back into the hilum of the kidney to drain urine