Chapter 5: Genitourinary

Question 1

What is ARU?

Answer 1

ARU is sudden inability to void despite presence of a full bladder.

Question 2

What are the causes of ARU?

Answer 2

1) Obstructive
- BPH
- Prostate tumour
- Bladder stones
- Bladder tumour
- Fecal impaction
- Phimosis
2) Pharmacologic
- Anti-histamines
- TCA
- A-adrenergic in decongestants
3) Neuro
- Spinal cord trauma/surgery/tumour
- Peripheral neuropathy in DM

Question 3

What is the management of ARU?

Answer 3

1) Hx: drug use, sx, constipation, LRT symptoms
2) PE: PR, Abdo palpation and percussion for masses and bladder, Neuro exam
3) Invg: UC9
4) Urinary catheterization with 14F Foley to ensure rapid and complete emptying of bladder. If no passage past bladder neck use 16F. (those with prostatitis benefit from suprapubic catheter)
5) Record Vol of urine drained and characteristics of urine.

Question 4

What are the common organisms responsible for UTI?

Answer 4

1) E.Coli
2) Proteus
3) Klebsiella
4) S.Saprophyticus

Question 5

What are the clinical features of L-UTI?

Answer 5

1) Supra-pubic pain
2) Hematuria
3) Frequency
4) Dysuria
5) Urgency

Fever is usually absent and acute phase reactants are not elevated.

Question 6

What are the clinical features of U-UTI?

Answer 6

1) Flank pain
2) Vomitting
3) Rigors
4) Fever
5) Signs of sepsis

Question 7

When is rx of asymptomatic bacteriuria indicated?

Answer 7

1) Pregnant women

2) Before urological interventions

Question 8

What organisms in pts with symptomatic -ve urine C/S?

Answer 8

Mycoplasma
Mycobacteria
Gonorrhea
Chlamydia 
Candida

Question 9

What are predisposing factors to getting a UTI?

Answer 9

1) Female
2) Pregnancy
3) Menopause
4) Instrumentation
5) DM
6) Immunosuppression
7) Genitourinary structural abnormalities

Question 10

What ddx are there for UTI?

Answer 10

Appendicitis
Urethritis
STD
Radiation-induced cystitis

Question 11

What invg would you do for pt with UTI?

Answer 11

1) Bloods: FBC, U/E/Cr, +- blood C/S
2) Urine:
- Dipstick (+ for nitrites, leukocytes/blood)
- UFEME
- MSU:>10^5 colony forming units(CFU/ml)

Question 12

What is the antibiotic regimen for patients with UTI?

Answer 12

1) Acute un-cx UTI
- PO Augmentin
- PO co-trimoxazole
2) Pyelonephritis/cx UTI:
- IV Ceftriaxone

Question 13

What is a urological emergency to take note of?

Answer 13

Obstructive uropathy in presence of UTI

Question 14

What is the advice you would give to prevent future UTI?

Answer 14

1) Encourage adequate fluid intake
2) Void after sex
3) Wipe from front to back after defacating
4) Void when the need is felt. Do not hold it back.

Question 15

What hx do you want to take in pt suspected with urolithiasis?

Answer 15

1) Dehydration/occupation?
2) renal impairment?
3) Recurrent UTI?
4) Gout?
5) Symptoms: Loin to groin pain(crescendo)+N/V+-hematuria and fever is absent

Question 16

What is the invg of pts with renal colic?

Answer 16

1) Bloods (not routinely done unless indicated): FBC, U/E/Cr
2) Imaging: U/S(to see hydronephrosis), Non-contrast CT imaging
3) Urine: Urine dipstick(should have hematuria and can look at pH to indicate the type of stone)

Question 17

What is the mgmnt of Ureteric colic?

Answer 17

1) Dietary modification
- Increase fluid intake
- Keep salt intake low
- Restriction of oxalate rich food such as nuts, chocolate, tea
2) Drugs:
- NSAIDs
- IM/IV Buscopan 40mg
- IM Stemetil if there is N/V

Question 18

What are some RFs of ectopic preg?

Answer 18

1) Prev ectopic preg
2) Prev tubal surgery/tubal ligation
3) Current IUD use
4) Hx of PID
5) Smoking

Question 19

What is the classic triad in ectopic preg?

Answer 19

1) Abdo pain
2) Amenorrhea(usually 8 weeks)
3) Vag Bleeding

Question 20

False positives and false negatives of urine HCG?

Answer 20

1) False +ve: Trophoblastic disease, HCG prod pit tumours and some drugs such as anticonvulsants and phenothiazines.
2) False -ve: Dilute urine/diuretics

Question 21

How do you manage a ectopic preg?

Answer 21

Depends on whether pt is stable or not:
Unstable pt: ABC, monitoring vital signs and fluid challenge 1 L of crystalloids. Keep pt NBM and draw bloods for 
-FBC
-U/E/Cr
-GXM 2-4 units 
-DIVC screen 
-Urine HCG

Insert urinary catheter for I/O
Inform OG reg

Question 22

What are the indications of dialysis?

Answer 22

1) Severe APO
2) Severe HTN from overload not responding to diuretics
3) Uremia with pericarditis/encephalopathy
4) Some poisoning (eg. methanol,ethylene glycol)
5) HyperK refrac to Rx
6) Metab acidosis refrac to Rx