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Y2 - Urinary > Lecture 16 - Urinary Obstruction And Prostate Disorders > Flashcards

Lecture 16 - Urinary Obstruction And Prostate Disorders Flashcards

1
Q

What are the most common locations for stones obstructing the urinary tract?

A

Pelvic brim
Pelviureteric junction
Vesicouteric junction

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2
Q

What is a stag horn calculus?

A

The calcification/hardening that occurs in the renal pelvis taking on a stag horn shape

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3
Q

What do urinary obstructions increase the risk of?

A

UTIs
Urinary Reflux
Stone formation

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4
Q

What can cause urinary retention?

A

Calculi (stones)
Pregancy
Benign prostatic hyperplasia
Recent surgery
Drugs
Urethral strictures
Tumours
Neurogenic disorders
Inflammation

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5
Q

What are some broad types of neurogenic disorders that can cause urinary retention?

A

Congenital abnormalities affecting spinal cord
External pressure on cord or lumbar nerve roots
Trauma to spinal cord

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6
Q

How does acute urinary retention present?

What is their residual volume like?

A

PAIN (cant void)

Residual volume (300ml - 1500ml)

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7
Q

How does chronic urinary retention present?

What is their residual volume?

A

PAINLESS

Possible to still be voiding by not completely so can have a large residual volume

300 - 4000ml

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8
Q

What is acute on chronic?

A

Have chronic urinary retention but you then get something else casuing acute urinary retention

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9
Q

How is an acute urinary retention managed?

A

Catheter is and record residual volume

Hx
Abdo (shouldn’t normally be able to palpate bladder, ext genitalia and Digital Rectal Exam)
Urine dip
U&Es
Treat obvious cause
Give alpha blockers if BPH

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10
Q

How is chronic urinary retention managed?

A

Catheter is and record residual volume
Hx
Exam
Urine dip
U+Es

Often long term catheterisation

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11
Q

Why are U+Es abnormal (urea + electrolytes) when a patient has hydro nephrosis in chronic urinary retention?

A

Kidney can’t function properly so things like K+ may build up

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12
Q

How does a high pressure chronic urinary retention present differently to a low pressure chronic urinary retention?

A

High pressure:
-abnormal U+Es (hydronephrosis)
-repeat episodes can causes permanent renal scaring and CKD

Low pressure:
-normal renal function
-no hydronephrosis

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13
Q

What are some questions you may ask a patient with urinary retention?

A

Last void
Does it feel like a complete
Any pain
Fluid intake
Stream (hesitant flow, dribble)

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14
Q

What is a potential complication of catheterising a patient with urinary retention?

A

Post-obstructive diuresis

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15
Q

What is post-obstructive diuresis?

A

After a patient with urinary retention is catheterised the kidney can excreted excessive amounts of water which can worsen an AKI

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16
Q

Why can a patient with post-obstructive diuresis worsen an AKI?

A

More electrolytes are lost in the excess water they’ve lost

Can lead to hypovolaemia

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17
Q

How should post-obstructive diuresis be managed?

A

Urine output monitored for 24hrs post catheterisation

IV fluids if high urine volumes

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18
Q

What is hydronephrosis?

A

Dilation of renal pelvis and calyces due to an obstruction at anal point along the urinary tract causing increased pressure and blockage

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19
Q

Where is the obstruction usually with a unilateral hydronephrosis?

A

Upper urinary tract obstruction like ureter of the kidney

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20
Q

Where is the obstruction usually with a bilateral hydronephrosis?

A

Obstruction in lower urinary tract (e.g prostate)

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21
Q

What happens to GFR in hydronephrosis?

A

Declines

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22
Q

What causes GFR to decline in hydronephrosis of the kidney?

A

The hydrostatic pressure in the Bowmanns capsule is increased
This acts against the filtration from the glomerulus decreasing the GFR

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23
Q

How can Hydronephrosis lead to an AKI?

A

Kidney progressively undergoes atrophy due to the back pressure of the obstruction being transmitted to the distal parts of the nephron

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24
Q

Look at the last slide image labelled 1:

What is indicated by the CT scan?

A

Right hydronephrotic kidney

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25
Q

When can a patient with hydronephrosis go into renal failure?

A

With bilateral hydronephrosis

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26
Q

What is hydroureter?

A

Urine accumulation in the ureter due to an obstruction

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27
Q

What occurs if theres an obstruction at the pelviureteric junction?

A

Hydronephrosis without hydroureter

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28
Q

What occurs if theres an obstruction at the ureter junction?

A

Hydroureter which then develops into hydronephrosis

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29
Q

What occurs if there’s an obstruction at the neck of the bladder/urethra?

A

Bladder distension/hypertrophy
Leads to hydroureter
Then hydronephrosis

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30
Q

What sort of pain does acute uteric obstruction cause?

A

Renal colic

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31
Q

What is renal colic pain?

A

Pain that occurs when the smooth muscle of the ureter contracts

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32
Q

What usually causes acute ureteric obstruction?

A

Calculus (stones)
Blood clots
Slough papillae

33
Q

What happens if theres a bilateral acute ureteric obstruction?

A

Acute renal failure

(Presents as Anuria or oliguria)

Can get pyonephrosis

34
Q

What is pyonephrosis?

A

When an obstructed kidney becomes infected

35
Q

Why is pyonephrosis a urological emergency?

A

Failure to decompress may lead to death from sepsis and permanent loss of renal function

36
Q

How can you diagnose an upper urinary tract infection?

A

CT
Ultrasound

Diuretic renography (radio opaque tracer given which then gets taken up by the kidney then monitored, a diuretic is then given)

37
Q

Go to last slide and label the 4 graphs:

Which one indicates normal, obstructed, dilatation + non obstructed and partially obstructed?

A

1 = normal
2 = obstructed
3 = dilated, non-obstructed
4 = partially obstructed

38
Q

What are 2 ways to drain the upper urinary tract?

A

Nephrostomy (into renal pelvis)

JJ Stent (passed up urethra all way to renal pelvis)

39
Q

What is nephrostomy?

A

When a catheter is directly inserted into the kidneys to drain urine into a nephrostomy bag

40
Q

What is a JJ Stent?

A

A urethral stent inserted through the urethra to the ureter inserting into the kidney

41
Q

What is urolithiasis?

A

Formation of urinary calculi

42
Q

What is a risk factor for urolithiasis/urinary calculi?

A

Men
Caucasian

Dehydration (HIGH CONC URINE)

43
Q

Where are the 3 most common sites for urine stones?

A

Pelviureteric junction
Pelvic brim
Vesicoureteric junction

44
Q

How do you diagnose kidney stones/urinary calculi?

A

CT of kidneys, ureters and bladder

45
Q

What are the types of calculi?

What is the most common type?

A

Most common = Calcium Oxalate stones

Uric acid stones (associated with gout and myelproliferative disorders)

Cystine stones (inherited cystinuria)

Mg Ammonia PO4(3-) stones

Mixed calcium phosphate and calcium oxalate stones

46
Q

What are the most common calcium oxalate stones associated with? (Blood levels)

A

Hypercalcaemia
And]primary hyperparathyroidism since increases Ca2+ and phosphate levels

47
Q

How do renal stones present?

A

Depends on site oof stone

Continous dull ache in loins

Ureteric stones = renal colic

Bladder stones cause strangury

Recurrent and unstable UTIs, Haematuria or renal failure

Asymptomatic

48
Q

What is meant by renal colic experience with ureteric stones?

A

Pain experienced with peristalsis in ureters
Radiates from loin to groin

Patient sweaty, apple and restless with nausea and vomiting

49
Q

How are urinary calculi treated?
(Urinary stones)

A

Analgesia
High fluid intake
Urine sieved for analysis

Large stones surgery

50
Q

What type of diuretic can be given to help with Urinary calculi by reducing urinary Ca2+ levels?

A

Thiazide diuretics

51
Q

How do thiazide diuretics work to help urinary calculi?

A

Reduces urinary calcium levels

BLOCKS Na+/Cl- symporter in DCT
Less Na+ moved into DCT cell
Na+/Ca2+ antiporter on basolateral membrane works more moving more Na+ into DCT cell from lumen so more Ca2+ moved into cell from lumen into the vasa recta (less Ca2+ in lumen/urine)

52
Q

What are some interventional treatments for urinary stones?

A

Extracorporeeal SHOCKWAVE Lithotripsy
Ureteroscopy
Percutaneous Nephrolithotomy

53
Q

What is Extracorporeal Shock Wave Lithotripsy?

A

Non invasive procedure where shockwaves are sent to the stone causing it to break down into smaller more passible fragments

54
Q

What is ureteroscopy?

A

Thin instrument visualisers and access the stones removing them or fragmenting them

55
Q

What is Percutaneous nepholithotomy?

A

For larger stones

Invasive

Small incision needed to access and remove or break down the stones

56
Q

Where is the prostate located?

A

Inferior to the bladder

57
Q

How should a healthy prostate feel?

A

Semi firm

58
Q

What is acute prostatitis?

A

Inflammation of the prostate usually as a result of infection

59
Q

What are the main pathogens causing acute prostatitis?

A

E.coli = main

Proteus spp
Staphylococcus spp

Normally caused by UTIs or STis

60
Q

How does a patient with acute prostatitis present?

A

General symptoms:
-malaise
-rigours
-fever

Local symtoms:
-difficult passing urine (location of prostatic urethra)
-dysuria
-perineal tenderness

61
Q

What does a Digital Rectal Exam reveal if a patient has acute prostatitis?

A

Soft, tender and enlarged prostate

62
Q

What causes Chronic prostatitis?

A

Inadequately treated infection

Since antibodies can’t penetrate the prostate effectively

Some can not have acute phase

63
Q

How do you diagnose chronic prostatitis?

A

Histological exam showing neutrophils, plasma cells and lymphocytes

Positive culture from sample of prostatic secretion

64
Q

What is the most common type of prostatitis?

A

Chronic non—bacterial prostatitis

65
Q

What is the usual cause for chronic non-bacterial prostatitis?

A

Chlamydia trachomatis

66
Q

What is seen on histological exam with chronic non bacterial prostatitis?

A

Fibrosis due to chronic inflammation

67
Q

What is Benign prostatic hyperplasia?

A

Non neoplastic enlargement of the prostate gland whihc can eventually obstruct bladder outflow

68
Q

Who does BPH normally happen to?

A

Men over 60

69
Q

What is thought to be the cause of BPH?

A

Levels of male sex hormones testosterone

70
Q

What are some obstructive lower urinary tract symptoms of BPH?

A

Difficulty or hesitancy starting urination
Poor stream
Dribbling post micturition
Frequency and nocturia

71
Q

How does the prostate feel on digital rectal examination with BPH?

A

Firm smooth and rubbery

72
Q

How can a patient present with untreated BPH?

A

Acute urinary retention
Distended and tender bladder

Or progressive bladder distension leading to chronic painless retention

Bilateral upper tract obstruction and renal IMPAIRMENT causing CKD

73
Q

What medical treatments are given for BPH?

A

Alpha blockers

Finasteride

74
Q

What is the function of alpha blockers used to treat BPH?

A

Relax the internal urethral sphincter and the smooth muscle at the neck of the bladder within the prostate

75
Q

What is an example of an alpha blocker given to treat BPH?

A

Tamsulosin

76
Q

What type of drug is finasteride?

How does finasteride treat BPU?

A

5a REDUCTASE inhibitor

Prevents the conversions of testosterone into its more potent androgen for:dihydrotestosterone

77
Q

What 2 drugs are normally given to treat BPH (Benign Prostatic Hyperplasia)?

A

Finasteride (5a REDUCTASE inhibitor)

Tamsulosin (alpha blocker)

78
Q

What surgical treatment can be done for BPH?

A

Transurethral resection of the prostate (TURP)

Removes part of prostate giving urethra more space

79
Q

What is the typical causative organism of a previous UTI infection can lad to chronic non-bacterial prostatitis?

How does a culture appear if a semen prostate secretion sample is taken?

A

Chlamydia trichomatis

No bacteria appear on swab/agar

Y2 - Urinary (24 decks)

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