Clinical Topic 4: Benign Urological Disease Flashcards
What is the vertebral reference for the kidneys location? Are they retroperitoneal or intraperitoneal?
T12 to L3
Retroperitoneal
State the names of the six types of kidney stones
Calcium Oxalate stones Calcium Phosphate stones Uric acid stones Struvite stones Cysteine stones Xanthine stones
Which renal calculi are radioluscent?
Uric acid stones
Xanthine stones
Which renal calculi are radiopaque?
Calcium oxalate stones
Calcium phosphate stones
Struvite stones
Which renal calculi are semi-radiopaque?
Cysteine stones
What is the most common type of renal calculi?
Calcium oxalate
What three things are Struvite renal calculi made up of?
Magnesium
Phosphate
Ammonium
What are the symptoms of Renal Calculi?
Renal colic, loin pain, nausea and vomiting, haematuria, dysuria, fever
What is the most common analgesia prescribed for Renal colic? How is it administered?
Diclofenac, IM
Which Renal calculi are associated with strictly acidic urine?
Uric acid stones
Which Renal calculi are associated with strictly alkaline urine?
Struvite stones
Which Renal calculi are commonly associated with Infection? What is the infectious agent?
Struvite stones
Associated with Proteus miribalis, Proteus vulgaris, Morganella morgani
Which Renal calculi form “staghorn” structures?
Struvite stones
Which Renal calculi are associated with a genetic condition? What is the genetic condition? What is the inheritance pattern?
Cysteine stones, commonly associated with Cysteineuria (autosomal recessive)
What are the three risk factors of Oxalate renal calculi formation?
Hypercalcaemia
Hypercalcuria
Hyperoxaluria (increased intake of oxalate rich foods such as rhubarb, spinach, chocolate)
Uric acid renal calculi are associated with which other condition?
Gouty arthritis
The British Association of Urological Surgeons (BAUS) recommend which investigation of choice for suspected Renal Calculi? Under what time frame?
Non-contrast CT KUB within 14 hours
What is the treatment for removing Renal Calculi?
Most stones < 5 mm will pass spontaneously
Otherwise, Lithotripsy or Nephrolithitomy is indicated
If there is several stones together plus infection, decompression is needed via Nephrostomy, Ureteric catheters and Ureteric stents
What is the first most common causative agent of a Urinary Tract Infection?
E. coli
What are some risk factors to a UTI?
- Sexual intercourse (honeymoon’s cystitis)
- Being female
- Diabetes mellitus
- Post menopausal women
- Use of catheters
- Uncircumsized young men
- Urinary stasis
What is the treatment for a UTI in non-pregnant women?
3 day course of Nitrofuratoin or Trimethoprim
What are the four types of Incontinence?
Urge Incontinence
Stress Incontinence
Overflow Incontinence
Mixed Incontinence (Urge + Stress)
What is the first-line treatments for Urge Incontinence?
Bladder training exercises
Anti-muscarinic drugs
What is the first-line treatments for Stress Incontinence?
Pelvic floor kegel exercises
What are the common symptoms associated with Urge Incontinence?
Having a sudden urge to urinate due to an overactive bladder. Typically urination occurs whilst asleep
What are the common symptoms associated with Stress Incontinence?
Precipitated by coughing, sneezing, laughing, putting pressure on abdomen
RENAL STONES
- What are some bedside, blood and imaging tests used to investigate Renal Stones?
- What is the conversative, medical and surgical management of Renal Stones?
- Bedside: Baseline observations, urine dipstick, urine MC&S
Bloods: FBC, U&E, CRP, Coagulation screen, Cultures, Bone profile i.e. Ca2+, VBG for lactate ?sepsis
Imaging: Non-contrast CT KUB within 14 hours
- Conservative management: If below 5mm, allow to pass expectantly. Plentiful hydration, low salt diet, low purine diet (avoid red meat, shellfish), low oxalate rich foods (chocolate, rhubarb, spinach, beer)
Medical management: IV Fluids, IV anti-emetics, IM / PR diclofenac.
For prevention: Allopurinol for uric acid stones, Thiazides for Calcium stones, Cholestyramine and Pyridoxine for reducing oxalate secretion, urinary alkalinisation i.e. sodium bicarbonate
Surgical management: Shockwave lithotripsy, percutaneous nephrolithotomy (if staghorn / complex), ureteroscopy (if pregnant). If infective / multiple stones, consider decompression with nephrostomy, catheters and stents
