Obstructive uropathies Flashcards
Ureteric colic symptoms
Flank to pelvis
Associated N&V
Pain radiates to testis, scrotum, labia or anterior thigh
Haematuria symptoms
Microscopic
Concurrent infection symptoms
rigours, fever lethargy
Initial management of renal stones
80% pass spontaneously
Fluid resus if dehydrated
Analgesis (opiates and NSAIDs per rectum)
-Buscopan for colicky pain
If evidence of infection- IV antibiotics and urology referral
Management of large stones or associated hydronephrosis
Extracorporeal Shock Wave lithotripsy (contraindicated with pregnancy and if over a bony landmark like pelvis)
Percutaneous nephrolithotomy. For large renal stones. Treatment of choice for renal calculi and stag horn
Flexible uretero-renoscopy- used in pregnancy or morbidly obese or patients with coagulopathy
Admission criteria for urolithiasis
Post renal AKI
Uncontrollable pain from simple analgesics
Evidence of ingection
Stone >5mm
Complications of stones
Acute-
Infection
Post renal AKI
Recurrent-
Renal scarring
CKD
What are some temporary measures used in significant infection or obstructive nephropathy to relieve obstruction nd avoid renal damage
Retrograde stent insertion- Placeme t of stent within ureter via cystoscopy
Nephrostomy- Tube placed directly through skin on the back into the renal pelvis and collecting system.
How to manage recurrent calcium stones
All stones- stay hydrated
Check PTH (rule out hyperparathyroidism) Avoid excess salt
How to manage recurrent calcium oxalate stones
Avoid high purine and oxalate foods like nuts, rhubarb, sesame
How to manage recurrent urate stones
Avoid high purine foods (red meat, shellfish)
Urate lowering med (allopurinol)
How to manage recurrent cysteine stones
Genetic testing
Gold standard for diagnosing stones
non contrast CT KUB scan
Symptoms of renal cell carcinoma
Haematruaia
Pain, mass in loins
What does a renal cell carcinoma form
Parathyroid hormone related protein so patients may get pathological fractures
Diagnosis of renal cell carcinoma
Solid mass on USS. Also seen on CT
Bloods show anaemia and may show raised ALP and ESR
Treatment of renal cell carcinoma
Radical nephrectomy
No role for chemo or radio. Tyrosine kinase inhibitors can be useful. As can renal artery embolisation
Bladder outlet obstruction causes
BPH Bladder stones Urethral strictures Prostate cancer Tumours of rectum, uterus or cervix
Causes of bladder stones
Urine stasis such as
- Chronic retention
- Infections
- Passed ureteric stones
- Foreign bodies such as catheters
Presentation of bladder stones
Lower urinary tract symptoms such as hesitancy, poor or intermittent stream, straining, prolonged micturition, incomplete bladder emptying, post micturition dribbling, frequency, urgency, urge incontinence, nocturne
Chronic irritation of bladder epithelium increases Transitional Cell Carcinoma risk
Investigation for bladder stones and management
Same as renal stones
Cystoscopy, stone drainage
Lithotripsy
Presentation of bladder cancer
Painless haematuria, male, smokers, old age, dyes/rubber, schistomiasis
Pathology of bladder cancer
Prolonged carcinoma contact
Diagnosis of bladder cancer
Screening for those in at-risk industries
Visually with biopsies on Flexi-cytoscopy
Treatment of bladder cancer
Cytoscopic removal of tumour +/- intravesical BCG
Radical cystectomy in extensive cases
Recurrence of bladder cancer
50% chance of recurrence so follow-up is life-long
Symptoms of BPH
Hesitancy Retention UTI Nocturia Frequency terminal dribbling poor flow
Treatment of BPH
Alpha blockers if a small prostate
5a reductase inhibitors if larger prostate
If medical management fails, then TURP
Most common presentation of prostate cancer
Raised PSA
Where does prostate cancer metastasise
Bone and iliac-para-aortic nodes
Diagnosis of prostate cancer
Trans-rectal biopsy
Graded with Gleason scoring
Staging of prostate cancer
T1- incidental
T2- within capsule
T3- Through capsule/seminal vesicle
T4- other
Treatment of prostate cancer
Small, well differentiated disease volume =active surveillance
Endocrine therapy to reduce testosterone in locally advanced/ bony disease +/- Radiotherapy
surgery- TURP or radical prostatectomy
What Is Wilm’s tumour
Nephroblastoma - primitive embryonic tumour which spreads via blood.
Peaks at 2yo
What is renal cell carcinoma
Adenocarcinoma from tubular system. Spreads via blood and invades along renal vein.
risk- smoking, obesity, HTN, renal disease, FH
What is transitional cell carcinoma
Mosly in bladder but can occur anywhere from renal pelvis to bladder
Risk- male, smoking, dye/pesticide,rubber exposure, schistomiasis
