S10) Obstruction Flashcards
How can haematuria be detected in a patient?
- Visible haematuria
- Microscopic (3, 5 or 10 RBC’s)
- Dipstick +ve
Provide a differential diagnosis for haematuria
- Cancer: renal cell carcinoma, bladder cancer, advanced prostate carcinoma
- Stones
- Infection
- Inflammation
- BPH (large)
What are the causes of haematuria?
- Vascular
- Inflammatory
- Trauma
- Autoimmune
- Medications
- Infection
- Neoplasia
- Congenital
Describe the history one must take for a patient presenting with haematuria
Full urological history:
- SQITARS
- Presenting complaint
- Past medical history
- Drug history (OTC, prescription, illicit)
- Social and family history
What examinations are undertaken for a patient presenting with haematuria?
- Cystoscopy (look into bladder)
- Urological examination (abdomen, genitalia, PR exam, neurology)
- CT urography
What investigations are requested for a patient presenting with haematuria?
- Urine microscopy, culture & sensitivity
- Urine cytology
How can one manage a patient presenting with haematuria other than treating the underlying cause?
- ABCDE + stabillise
- Bloods
- 3 way catheter and irrigation
- CT angiogram (if significant bleed)
What are the different types of urinary retention?
- Acute urinary retention (painful)
- Chronic urinary retention (not painful)
How can one differentiate between acute and chronic urinary retention?
History, examination, clinical picture:
- Acute – painful, impaired eGFR (urological emergency)
- Chronic – non-painful, oliguria, urine in residual scan
Identify 4 circumstances when one should catheterise a patient?
- Painful acute urinary retention
- Acute on chronic urinary retention (unable to pass urine)
- High pressure chronic urinary retention (Pves > 30cmH2O)
- To monitor fluid balance, sepsis, trauma
Outline the clinical approach for a patient with urinary retention
- History
- Examination
- Bloods
- Bladder scan
- Neurological documentation
What is the mechanism for urinary retention?
⇒ Bladder outlet obstruction
⇒ Low bladder contractile power
⇒ Interrupted sensory or motor innervation of bladder (± sphincter)
What are the causes of urinary retention in men and women respectively?
- Men: BPH, prostate cancer, urethral stricture, prostatic infection
- Women: prolapses, masses, Fowlers syndrome
What are the causes of urinary retention in both men and women?
- Clots
- Drugs (anticholinergics, sympathomimetics)
- Pain
- Spinal cord compression/injury
- UTI
Describe how one treats patients presenting with urinary retention
Urethral catheterisation:
⇒ Clean the area
⇒ Use gloves and instillagel
⇒ Gently insert into urethral meatus (women) / into straight penis (men)
⇒ Inflate catheter balloon (& replace foreskin if retracted)
What difficulties patients can pose towards catheterisation?
- Men: phimosis, meatal stenosis, stricture, prostate, bladder neck
- Women: masses, prolapses, pelvic cancer
What is a suprapubic catheter?
A suprapubic catheter is a catheter that is left in place and involves the insertion of the catheter into the bladder through a hole in the abdomen
When are suprapubic catheters used?
- Long term conditions e.g. multiple sclerosis
- Urethra is damaged/blocked
- Patients have difficulties using an intermittent catheter
Identify 5 locations where stones can form in the urinary tract
- Kidney
- Ureter
- Bladder
- Prostate
- Urethra (men – rare)
What is ureteric colic?
Ureteric colic is severe and acute pain in the loin area due to the obstruction of the ureter by calculi
How does ureteric colic present?
- Pain
- Haematuria
- Infection
- Impaired renal function (obstruction)
Outline the clinical approach for a patient presenting with ureteric colic
- History
- Examination
- Urinalysis
- CT KUB (kidneys, ureter, bladder)
- Abdominal X-ray (if visible stone)
Symptoms and stone size guides treatment for uteric colic.
Regardless, outline the basic management
- Place a stent
- Uteroscopy
- Lasertripsy
- Stone ablation
What is pyonephrosis?
- Pyonephrosis is the infection of the kidney which leads to pus in the upper collecting system which can progress to obstruction
- It has a very high mortality if untreated
