Session 9- Obstruction and Urolithiasis and Disorders of the Prostate

Question 1

what is the difference between acute an chronic urinary retention

Answer 1

acute- painful

chronic- painless

Question 2

how can we manage acute urinary retention

Answer 2

catheter
record resuidual urinary volume 
urine dip
U&E
treat underlying cause

Question 3

management of chronic urinary retention

Answer 3

catheterise and record residual volume
urine dip
U&E
plan for long term catheterisation ot intermittent self-catherisation

Question 4

what is the difference between high and low pressure chronic urinary retention

Answer 4

high

• abnormal U&Es
• hypronephrosis

low

• normal renal function
• no hydronephrosus

Question 5

what is post-obstructive diuresis

Answer 5

following resolution of urinary retention through catheterrisation

kidneys can often over-diurese

can lead to AKI

Question 6

what is hydronephrosis

Answer 6

dilation of the renal pelvis and calyces due to obstruction at any point in the urinary tract causing increased pressure and blockage
unilateral or bilateral

Question 7

what causes unilateral hydronephrosis

Answer 7

caused by an upper urinary tract obstruction

Question 8

what causes bilateral hydronephrosis

Answer 8

caused by obstruction in the lower urinary tract

Question 9

what is hydronephrosis

Answer 9

obstruction at the pelviureteric junction

Question 10

what is hydroureter

Answer 10

obstruction at the ureter

Question 11

what kind of pain do you get in acute ureteric obstrcution

Answer 11

renal colic- from loin to groin

Question 12

what causes acute ureteric obstrcution

Answer 12

Calculus
blood clots
sloughed papila

Question 13

what is pyonephrosis

Answer 13

an infected obstructed kidney

Question 14

drainage of upper urinary tract

Answer 14

nephrostomy

jj stent

Question 15

what are the majority of urinary calculi

Answer 15

calcium oxalate stones

Question 16

treatment of renal calculi

Answer 16

adequate analgeisa and high fluid intake

extracorporeal sjock, uretoscopic destrction or removal, PCN;, surgery

Question 17

what is revealed upon rectal examination

Answer 17

soft
tender
enlarged prostate

Question 18

main pathogens in acute prostatitis

Answer 18

e coli
proteus and staphylococcus soecies

sexually transmitted pathogens- C. trachomatis and Neisseria gonorrhoeae

Question 19

what causes chronic prostatitis

Answer 19

results from inadequeately treated infection

Question 20

how is chronic prostatis diagnosed

Answer 20

histological examination showing neutrophils, plasma cells and lymphocytes

a positive culture from a sample of prostatic secretion

Question 21

what is BPH

Answer 21

non-neoplasic enlargement of the prostate gland, can eventually lead to bladder outflow obstruction

Question 22

when do symptoms develop in BPH

Answer 22

as the enlarging prostate gland compeesses on the prostatc urethra

Question 23

how can untreated BPH present

Answer 23

acute urinary retention
distended and tender bladder
desperate urge to pass urine

urge incontenine
progressive bladder distension

Question 24

how can we treat BPH surgically

Answer 24

transurethreal resection of protsate

Question 25

how can we treat BPH mediacally

Answer 25

alpha blockers, reax smooth muscle at bladder neck and within prostate

finasteride- prevents conversion of testosterone into diyhydrotestosterone