Renal Stones and Urological Haematuria Flashcards

Question

What is the management of ureteric stones?

Answer 1

``` 75% will pass without intervention Passage related to - Size <5 mm - Site: lower >upper - Shape: smooth >ragged - PHx ```

Answer 2

Obstruction with infection/sepsis Large calculus >6 mm Ongoing pain Failure to progress Solitary kidney/bilateral ureteric calculi Social/occupational; eg: impending travel/airline pilot

Answer 3

Nephrostomy drainage Ureteric stent Extracorporeal shockwave lithotripsy Ureteroscopy with fragmentation

Answer 4

``` Initial (at start of stream) - Urethral/prostate Terminal (starts near end of stream) - Bladder neck Total - Bladder - Ureter - Kidney ```

Answer 5

Round - bladder | Wormlike - kidney/ureter

Answer 6

Flank - kidney/ureter | Suprapubic - bladder

Answer 7

Dysuria | Frequency

Answer 8

``` Urine - Microscopy - RBC morphology - Misshapen - glomerular - Fairly regular - non-glomerular - Protein casts - Cytology - test urine for malignant cells - specific for transition cell carcinoma - Culture Imaging - US urinary tract - CT urogram Endoscopy - Cystoscopy - +/- retrograde pyelogram - Ureteropyeloscopy +/- biopsy ```

Answer 9

CT urogram - do pre- and post-contrast | Picks up any collecting defects/masses

Answer 10

Coagulopathy

Answer 11

Glomerulonephritis Renal neoplasm Trauma

Answer 12

Transitional cell carcinoma SCC - much less common Calculus Infection

Answer 13

Transitional cell carcinoma | Calculus

Answer 14

Transitional cell carcinoma Cystitis Calculus Trauma

Answer 15

+ve urine culture | Usually have other urinary symptoms

Answer 16

Stricture | Infection

Answer 17

Renal cell carcinoma

Answer 18

Parenchyma, usually proximal tubule

Answer 19

``` Incidental - most common presentation Classic triad - rarely seen - Haematuria - Mass - Pain Systemic symptoms - Weight loss - Appetite loss Metastatic disease - Bone - Lung - Liver - Brain Paraneoplastic syndrome - Hypercalcaemia - HTN - Pyrexia - Hepatoxicity - abnormal LFTs Haematological - Anaemia - Polycythaemia IVC obstruction - Local extension of tumour - Lower limb oedema - Varicocoele ```

Answer 20

``` Surgical, if - Primary disease - Single metastasis Medical, if - Palliation of metastatic disease Radiation, if - Palliation of metastatic disease ```

Answer 21

``` Radical nephrectomy - Removal of contents of Gerota's fascia = - Kidney - Adrenal gland - Perinephric fat Partial nephrectomy - Preferred, especially if small, incidental finding - Performed if - Solitary kidney - Poorly functioning contralateral kidney - Bilateral tumours - Small peripheral tumours ```

Answer 22

Tyrosine kinase inhibitor; eg: sunitinib

Answer 23

Bony/soft tissue mets

Answer 24

Renal pelvis Ureter Bladder/prostatic urethra

Answer 25

``` Cigarette smoking Industrial exposure - Dyes - Leather - Rubber - Hydrocarbons Papillary necrosis Pelvic radiotherapy Cyclophosphamide Field effect = transitional cell carcinoma elsewhere in urinary tract FHx ```

Answer 26

Cytotoxic drug used in some malignancies and autoimmune conditions

Answer 27

Haematuria Pain Mass

Answer 28

``` CT urogram - Filling defect - Dilatation/non-function - Parenchymal invasion of mass Retrograde pyelogram - Cytology - Lavage - Brush biopsy Ureterorenoscopy - Direct visualisation - Biopsy ```

Answer 29

Nephro-ureterectomy and cuff of bladder removal Surveillance cytoscopy - 35% risk of bladder transitional cell carcinoma

Answer 30

Haematuria | Flank pain

Answer 31

``` CT urogram - Filling defect - Hydronephrosis/non-function Retrograde pyelograpm Cytology Ureteroscopy > biopsy ```

Answer 32

Nephro-ureterectomy, including cuff of bladder Segmental lower ureterectomy Surveillance cystoscopy

Answer 33

``` Ta = mucosa T1 = sub-mucosa T2 = muscle T3 = extravesical fat T4 = adjacent organs ```

Answer 34

``` Low grade High grade Carcinoma in situ = high grade - Usually quite flat - If untreated, progresses to invasive disease - Needs aggressive treatment ```

Answer 35

``` Painless haematuria Symptoms of cystitis - In absence of infection - Recurrent infection Incidental ```

Answer 36

US CT urogram Urine cytology Cystoscopy/resection biopsy - into bladder wall to try and get some muscle

Answer 37

``` Transurethral resection of bladder tumour - Curative for grades 1 and 2 - 75% recur - Surveillance cystoscopy Multiple/frequent recurrences - Intravesical therapy - BCG - Mitomyic - Adriamycin - Thiotepa ```

Answer 38

Intravesical BCG weekly for 6 weeks | If fail local therapy, high risk of progression to muscle invasion > radical cystectomy

Answer 39

Transurethral resection of bladder tumour for diagnosis Staging - CT abdomen - CXR Radical cystectomy and ileal conduit/neobladder Radiotherapy Chemotherapy with cis-platinum based drugs

Answer 40

``` FBE UEC Creatinine Serum Ca and uric acid MSU CT-KUB X-ray KUB ```

Answer 41

``` Pain relief - NSAIDs - Opioids - Paracetamol Hydration Does patient need acute intervention? - Yes > admission - No > surveillance ```

Answer 42

Gram negative bacteria; eg: E coli

Answer 43

Systemic inflammatory response syndrome/shock

Answer 44

``` IV Abs, covering Gram -ves and Enterococcus Urgent decompression - Nephrostomy - Stent Supportive care - Fluids - Monitoring - ICU if necessary ```

Answer 45

``` Alpha-blockers - relax ureteric wall - Increase stone passage - Decrease time to stone passage by 2-4 days - Decrease pain Eg: tamsulosin ```

Answer 46

``` Adequate fluid intake Dietary modification Urinary alkalinisation Medical therapy - Allopurinol - Thiazide diuretics ```

Answer 47

Myoglobinuria