Topic List 1 Flashcards
Surgical procedures - Kidney
- Nephrectomy (simple, radical, partial, laparoscopic, retroperitoneoscopic)
- Percutaneous nephrolithotomy
- Extracorporeal Shock Wave Lithotripsy (ESWL)
Surgical procedures - Ureters
- Nephroureterectomy
- Pyeloplasty (open, laparoscopic)
- Ureteroureterostomy
- Ureterocystoneostomy
- Megaureter operations
- Ureteroscopy
Surgical procedures - Bladder
- Tension free vaginal tape (TVT)
- Cystoscopy
- Transurethral resection of the bladder (TURB)
- Cystectomy (open, laparaoscopic)
- Conduit formation (ileum/colon)
- Ileum neobladder (studer/hautmann)
- Urostoma (Mainz-Pouch 1)
Surgical procedures - Prostate
- Biopsy
- Transurethral resection of the prostate (TURP)
- Laser treatment of BPH
- Prostatectomy (suprapubic, retropubic, simple, radical, laparoscopic)
Surgical procedures - Penis
- Circumcision
- Frenuloplasty
- Internal urethrotomy
- Urethral reconstruction
- Hypospadia repair (MAGPI, Tubularized incised plate urethroplasty (TIP), Mathiey, Duckett, Two-stage)
- Penectomy
- Inguinal lymphadenectomy
Surgical procedures - Testis
- Orchidopexy (shoemaker’s technique)
- Orchiectomy (scrotal, radical)
- Retroperitoneal lymphadenectomy
- Hydrocelectomy
- Spermatocelectomy
- Vasectomy
Developmental disorders - Kidneys
- Simple cyst
- PCKD
- Multicystic kidney
- Medullary sponge kidney
- Renal agenesis
- Duplex kidney
- Renal ectopia
- Horseshoe kidney
Developmental disorders - Ureter
- Ectopic
- Uretocele
- Uretopelvic junction (UPJ) obstruction
- Ureteral duplication
- Vesicoureteral reflux
- Megaureter
Developmental disorders - Bladder
- Periureteral diverticulum
- Bladder exstrophy (classical, cloacal)
- Patent urachus
- Posterior urethral valve
Developmental disorders - Urethra/Male Genitalia
- Hypospadia
- Phimosis
- Failure of testicular development
- Cryptorchidism
- Hydrocele - processus vaginalis fails to close
- Varicocele
- Epispadia
- Micropenis
- Urethra duplex
- Megalourethra
Injuries to - Kidney
- Blunt renal injuries (laceration)
- Penetrating renal injuries (gunshot/stab wounds)
- Minor renal trauma (84%)
- Major renal trauma (15%)
- Vascular injury (1%)
The injuries are graded 1-5
Indications for surgery after kidney trauma
Absolute:
1. Persistent bleeding
2. Expanding/pulsatile hematoma
3. Arterial injury
Relative:
1. Major urine extravasation
2. Penetrating injury
Injuries to - Ureter
- Iatrogenic factors
- Blunt trauma
- Penetrating trauma
Treatment after ureter trauma
- Ureteric stents + nephrostomy in minor trauma
- Debridement, mobilization, and spatulation of ureter
- Ureteroureterostomy
- Pyeloplasty
- Ureter-neoimplantation
- Bladder tube flap (Boari-Mezo)
- Psoas hitch
Injuries to - Bladder
- Iatrogenic
Blunt: - Contusion
- Extraperitoneal rupture - Pelvic fractures
- Intraperitoneal rupture - Full bladder and increased pressure
Lesions of the urethra
Female is rare normally iatrogenic
Male:
1. Anterior - Iatrogenic, Straddle injuries (bulbar urethra)
2. Posterior - Pelvic fractures
Lesions of the penis
- Penile fracture (distal to suspensory ligament)
- Penetrating penile injury (bites)
Lesions of the scrotum and testes
- Blunt trauma
- Penetrating injury
- Necrotizing fasciitis
Stenosis of urinary tract - causes
- Trauma (saddle injury)
- Infection
- Congenital anomaly
- Iatrogenic
Stenosis of urinary tract - treatment
- Dilatation
- Urethrotomy
- Anastomotic repair
- Reconstruction
- Catheterization
Fistulas of urinary tract - types
- Vesicovaginal
- Enterovesical
- Vesicouterine
- Uterovaginal
- Colovesical
- Rectovaginal
Urological causes of Acute Abdomen
- Ureteral stone
- Pyelonephritis
- Renal abscess
- Retroperitoneal bleeding or hematoma
- Kidney infarction
- Renal vein thrombosis
- Urinary retention
- Acute prostatitis
- Testicular torsion
- Congenital disorders
Urological emergencies
- Oliguria, anuria
- Acute renal failure
- Acute urinary retention
- Hematuria
- Kidney colic, pyonephrosis
- Testicular torsion
- Paraphimosis (foreskin doesn’t go back to normal)
- Priapism
- Necrotizing fasciitis
Oliguria
Reduced urine volume (<500ml/day)
Anuria
urine volume <100ml/day
Intrarenal causes of acute renal failure
- Glomerulonephritis
- Interstitial nephritis
- Hemolytic uremic syndrome
- Acute tubular necrosis
Causes of kidney colic/pyonephrosis
- Ureteral stone
- Ureteral stricture
- Ureteral tumor
- Extraureteral compressions
Pathophysiology of Priapism
- High flow: Non-ischemic/arterial priapism. Injury to central penile arteries cause loss of regulation. Painless. (secondary to perineal trauma)
- Low flow: (95%) Ischemic. Obstruction of the venous drainage. Deoxygenated blood in corpora cavernosa. Painful.
Treatment of Necrotizing Fasciitis
Triple Drug Antibiotics:
1. Metronidazole, ampicillin, gentamycin
Surgery:
1. Debridement
2. Leave open with Dakin’s solution
Urine leaks (incontinence)
- Stress (mechanical problem)
- Urge (bladder problem)
- Mixed
- Overflow (bladder outlet obstruction)
- Overactive (increased frequency and urgency)
Urodynamics
Assesses how the bladder and urethra are performing.
1. Post-void residual volume
2. Uroflowmetry (Free=time till empty bladder; pressure=rate)
3. Multichannel cystometry: measures pressure in bladder and rectum
4. Urethral pressure profilometry: strength of sphincter contraction
5. Electromyography (EMG)
6. Pressure flow study: detrusor function
Pressure flow study results
Normal = high flow, low pressure
Obstruction = low flow, high pressure
Detrusor weakness = low flow, low pressure
High-flow obstruction = high flow, high pressure
Treatments for urge incontinence
Anticholinergics:
1. Oxybutynin (SE: xerostomia, constipation, headache)
2. Tolterodine
3. Solifenacin
B3 Agonist:
4. Mirabegron (SE: increased blood pressure, palpitations)
Randoms:
5. Botox
6. Sacral neuromodulation
7. Bladder augmentation
Treatments for stress incontinence
- Duloxetine (SNRI) off label DO NOT PRESCRIBE
- Kegel exercise
- TVT
- Artificial urinary sphincter
Dysuria etiologies
- Infectious: Cystitis, Urethritis, Pyelonephritis, STDs, Prostatitis, Epididymitis-Orchitis (Just name all the inflammations you dumbass)
- Foreign body/stone
- Anatomical: Stricture, BPH, Phimosis
- Neoplastic: Bladder, Renal, Prostate, Penile cc
- Iatrogenic: Surgery/Catheter, Post-irradiation
Acute kidney injury symptoms
- Azotemia
- Anorexia
- Nausea/Vomiting
- Seizures and coma
- Fluid, electrolyte, and acid-base disorders
Acute kidney injury etiologies
Pre-renal (60%)
1. Hypovolemia
2. Hypotension
3. Sepsis
4. Cardiogenic shock/heart failure
Renal (35%)
1. Acute tubular necrosis
2. Acute glomerulonephritis
Post-renal (5%)
1. Obstruction
2. Neurogenic bladder
3. Congenital malformations
Acute kidney injury stages
Stage 1: Creatinine 1.5-1.9 times baseline; Urine output is <0.5mL/kg/hr
Stage 2: Creatinine 2-2.9 times baseline; Urine output is <0.5mL/kg/hr
Stage 3: Creatinine >3 times baseline; Urine output is <0.3mL/kg/hr
Chronic kidney disease etiologies
- Diabetes
- Hypertension
- Glomerular disease
Stages CKD based on GFR:
Stage 1 with normal or high GFR (GFR > 90 mL/min)
Stage 2 Mild CKD (GFR = 60-89 mL/min)
Stage 3A Moderate CKD (GFR = 45-59 mL/min)
Stage 3B Moderate CKD (GFR = 30-44 mL/min)
Stage 4 Severe CKD (GFR = 15-29 mL/min)
Stage 5 End Stage CKD (GFR <15 mL/min)
Effects of CKD include:
- Hypocalcemia
- Hyperphosphatemia
- Metabolic acidosis
- Anemia
- Secondary hyperparathyroidism