Renal/uro Flashcards
Urinary tract obstruction - imaging
- Ultrasound is first line (sensitivity 45%)
- If this fails to pick it up but you still think it’s there, do non-contrast CT (99% sensitive) – note
that using contrast is bad because it obscures the view of the radio-opaque stone - INITIAL = USS
- BEST = non-contrast CT KUB
stones - <5mm
Medical management
- IM/oral diclofenac
- Alpha adrenergic blockers to aid passage of stone out the bladder neck (tamsulosin)
- Nifedipine can help in small stone as it relaxes the ureters.
- This solves most stones <5mm and they pass within 4 weeks. More treatment is required is
there is they are bigger, if there is obstruction, or if there is a horseshoe kidney or previous
transplant
stones - 5mm to 2cm
ECSL
stones >2cm/complex e.g. staghorn
percutaneous nephrolithotomy
Complicated stone (with hydronephrosis or pyrexia)
decompression with percutaneous
nephrostomy. Worry about stone later.
stone recurrence prevention -
calcium - thiazides
urate - allopurinol/ bicarb for urine alkalisation
oxalate - cholestyramine/pyridoxine
lower uti
Trimethoprim/nitrofurantoin
lower uti and preg
Trimethoprim/nitrofurantoin/cefalexin
upper uti
Ciprofloxacin/co-amoxiclav
upper uti and preg
Cefalexin
BPH
Conservative – Avoid caffeine + alcohol, void x2, bladder training
Medical
1st line = α blockers (tamsulosin)
2nd line = 5-α reductase inhibitor (finasteride)
3rd line = BOTH 🡪 LUTS + >30g prostates or PSA >1.4ng/ml
Surgical – TURP, TUIP, TULIP, open prostatectomy
PSA cut off values
40-49
≥ 2
50-59
≥ 3
60-69
≥ 4
≥70
≥ 5
Prostate cancer
Confined to the prostate:
Watchful waiting
Radical prostatectomy
Radical radiotherapy – External beam or brachytherapy
Hormone therapy
LHRH agonists (Goserelin) – Result in a flare
LHRH antagonists (Degarelix) – Effective for advanced cancer
Anti-androgens (Cyproterone acetate)
Orchidectomy
If metastatic - Hormone therap
bladder cancer
Mx
Tis/Ta/T1 – Diathermy via TURBT + chemo
T2-3 – Radical cystectomy
T4 – Palliative chemo/radiotherapy
varicocele
Surgical ligation, embolisation
hydrocele
Mx
Ligation of PPV
Aspiration +/- sclerosing agent
Jaboulay – Inversion of sac
Lord’s – Plication of sac
epidydimal cyst
Often not indicated, surgical excision if symptomatic
epidydimo orchitis
<35y/o Doxycycline (chlamydia) or ceftriaxone (gonorrhoea)
> 35y/o Ciprofloxacin (UTI)
testicular tumours
Radical inguinal orchiectomy
Radiotherapy (seminomas)
Chemotherapy (NSGCT)
aki definition
Rise in creatinine >26μmol/L in 48hrs
Rise in creatinine >1.5 x baseline
Urine output <0.5ml/kg/h for >6h
aki
Treat fatal consequences of AKI (↑K+ and pulmonary
oedema-morphine, o2, cpap, nitrates, diuretics)
Treat underlying cause!!
Stop nephrotoxic drugs e.g. metformin/nsaids/vanc/gent/acei
Supportive care
Fluid balance
Electrolyte balance
Acid-base balance
Nutritional support
> > Dialysis
ckd def
GFR <60 mL/min/1.73 m2
for >3months
obstruction
Treat underlying cause!
Upper – Nephrostomy or ureteric stent
Lower – Urethral or suprapubic catheter
retention
Mx
Voiding tricks – Running water, analgesia, privacy
Catheterise!
Tamsulosin
Treat underlying cause
