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urology final boss > investigations in urology ( lab, instruements, biopsy,) > Flashcards

investigations in urology ( lab, instruements, biopsy,) Flashcards

1
Q

Gross anatomy of male urethra

A
  • male urethral length is between 20-25 cm long
  • The shape of the male urethra
    • penis is flaccid is the shape of an S
    • penis is erect the urethra takes the shape of U

From anatomical point of view, the male urethra is divided in to two anatomical parts:

Posterior urethra:

  • Prostethic urethra from bladder neck to prostatic apex. Longest part of urethra is about 2-4cm.
  • Membranous urethra is located from prostatic apex to urological diaphragm. Average of 1-2cm long.

Anterior urethra:

  • Bulbous urethra; widest part of male urethra
  • Penile urethra; length cannot be guessed but average is 16cm
  • Before external meatus in glans penis is fossa naviculars.
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2
Q

female urethra

A

Female urethra is 2-4 cm long.

Is wider than the male urethra

diameter of male urethra is about 7mm,

whereas female is 9mm

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3
Q

Instrumental Investigations = DIAGNOSTIC ONLY

A

Anterograde - normal route of urine i.e

kidneys –> ureter –> urinary bladder –> urethra

Retrograde - opposite to the normal route of urine

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4
Q

Anterograde examinations

NATE

A
  • Nephroscopy = inspection of the collecting system of the kidney via nephrostomy tube.
    • Can be done through previous channel after renal surrgery / or new channel via X-RAY
      • Percutaneous Nephrostomy - placement of a small, flexible (catheter) through your skin(flank/ back) into your kidney
  • Antegrade Pyelouretography = administration of contrast medium through nephrostomy tube to outline the collecting system
  • Tissue Biopsy - sample histological examinations
  • Exudates - urethral/ vaginal discharge
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5
Q

indiations of Antergrade Pyelouretography

A

defines the level of ligature of the ureter an degree of obstruction

if retrograde is contraindicated = Urethral trauma

if retrograde is difficult d/2 urethral changes = Tumor, Stenosis, Compression

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6
Q

indications for Nephroscopy

A

to check for residual stones in the collecting system after an open operation

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7
Q

Retrograde investigations to male urethra

A

Urethroscopy

  • urethroscopy is the initial step of urethrocystoscopy.
  • indications may be; stone in urethra, foreign body, very rarely urethral tumour

Drilling = placement of catheter in the UB that stops along the urethra

Calibration to urethra = to define the diameter of the urethra

  • May be performed by soft catheters (bouges), or hard metalic dilators
  • With these instruments we may find the anatomical part of the structure of the urethra
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8
Q

indications of Urethroscopy

A

stone in urethra,

foreign body,

very rarely urethral tumour

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9
Q

define the diameter of the urethra which intrument is used

A

Calibration of the urethra

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10
Q

Retrograde examination of Urinary bladder

A

Catheterisation of UB = catheter in UB

  • Main sign that catheter is in UB is leakage of urine
  • can be replaced by US
    • Retrogradecystography
      • active / passive
    • Micturating Cysto-Urethrogram (MCU) / VUR= imaging bladder and urethra on flouroscopy while passing urine using contrast

Cystoscopy

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11
Q

Indications of Catheretisation of the Urinary Bladder

A
  1. Ddx between anuria and retention of urine in patients with obesity
  2. Obtain Urine sample for labs/ culture
  3. urodynamic investigation of LUT
  4. For Imaging with contrast ( Cystography & MCU)
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12
Q

Idications for Retrograde Cystography

A

TRAUMA to UB

VUR

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13
Q

Indications of Micturating Cystography

A

VUR active or passive

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14
Q

4 Indications of Cystoscopy

A
  1. HAEMATURIA - mg of renal bladder
  2. Staging Cystoscopy – Colorectal / Cervical
  3. VesicoVaginal Fistulas
  4. Combined with Biopsy to determine Chronic Cystitis
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15
Q

Which disease is a stong contraindication for Cystoscopy

A

ACUTE CYSTITIS

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16
Q

Therapeutic use of Catheterisation of the Urinary Bladder

A

Drain Urinary Bladder during retention

17
Q

Retrograde Instrumentation of the Ureters

A

Catheterisation of the ureter

  • Retrograde Ureto-Pyelogrphy

Ureterocystoscopy = endoscopic guidance

  • usually combined w/ Renoscopy + Pyelography = UretoRenoscopy
    • investigation of Ureter, Collecting system & calyx
18
Q

Indications of Catheterisation of Ureter

A
  1. NB- Obtain sample for cytology for Urothelial ca
  2. define level of obstruction in the ureter
  3. Administration of contrast medium fhrough uretric catheter for Retrograde Ureto-Pyelogrphy
    • ​​X-ray differences between ureteric tumours and stone in ureter, esp radiolluscent stone.
19
Q

x-ray ddx of stones and ca on RetrogradeUretero-Pyleography

A

tumor = Marked, irregular, filling defect, connected to the wall

stone = Regular, filling defect, NOT connected to wall

  • Urothelial Carcinoma/ Transitional Cell Carcinoma of Pelivs, Ureter & Valyces
20
Q

Ureteroscopy Indications

A

Stones in the Ureter

Urothelial ca

Foreign body in the the Ureter

21
Q

Retrograde Investigations of the Kidney

A

UreteroRenoscopy - Inspects ureter-> Renal Pelvis-> Renal Calyx

  • investigation of the Ureter and Renal collecting system
  • uses a Uretorenoscope
    • ​Indications
      1. ​​urothelial carcinoma
      2. stones in ureter
      3. foreign body in ureter
22
Q

2 kinds of CONTRAINDICATIONS for Retrograde investigations

A

Absolute

Trauma to the urethra shown by urethrorrhagia

Relative

Acute Inflammation of

  1. urinary bladder - > acute cystitis
  2. prostate -> acute prostatitis
  3. urethra -> Acute urethritis
  4. epididymis -> Acute epididymitis
23
Q

Biopsy in urology

A
  1. Renal biopsy - Fine Needle Aspiration Biopsy
  2. Prostate biopsy - Needle biopsy under local anesthetic, transab or transrectal
  3. UB biopsy - Cystoscope under General anesthetic
  4. Testicular Biopsy - General anesthesia w/ zylocaine to inhib spermatogenesis . & fix w/ bovin solution
24
Q

indications of Renal Biopsy

A

diagnosis of

  1. Nephrosis
  2. Chronic GlomeruloNephritis
  3. Lupus
  4. Colllagen disorders
  5. Malignancies
    1. Cytological exam of ; Urothelial and parenchymal tumors
    2. Staging and prognosis
25
Q

Contraindications of Renal Biopsy

A

Solitary Kidney

Hydroephrosis

Haemorrhagic diseases

26
Q

Indications of Prostatic biopsy

A

Pca diagnosis

  • type
  • staging - local/ advanced
  • Grading - gleason
  • rx option - according to IPSS - TURP, Open
27
Q

Indication of biopsy to the Urinary Bladder

A

suspicion of Uriniary Bladder tumors using a Resectoscope

28
Q

Non Invasive Imaging investigation in urology

A

US

X-ray

IVU

29
Q

US in urology

A
30
Q

X-ray in Urology

A
31
Q

IVU in urology

A
32
Q

Lab s in Urology

A

Urine specimens

BLood iinvesitgations

Genitourinary Secretions

33
Q

5 Routine Urine tests

A
  1. Diureses
  2. Ph
  3. Culture
  4. Sedimentation of urine
  5. Colour
34
Q

pH of urine

what is normal

causes of changed pH

A
35
Q

Culture of urine, what does it show amd why is it used

A
36
Q

which values are important Sedimentation

A
37
Q

Diuresis of Urine

normal diuresis / 24 hrs

Polyuria

A
38
Q

Colour of Urine

A
39
Q

Microbiological tests for Urine

-which diseases is it done

A

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urology final boss (22 decks)

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