Urinary Flashcards
Which stones are the most radiolucent?
Uric Acid stones and Cystine stones
Which stones are the most dense?
Calcium stones and Struvite stones
What test can be used to differentiate between testicular torsion and epididymo-orchitis ?
Cremasteric reflex. - it is lost in TT.
Stroking of inner thigh to cause the muscle to contract and pull the ipsilateral testicle up into the inguinal canal.
In under 35 males what is the most common cause of epididymo-orchitis?
STI - such as gonorrhoea
In over 35 males what is the most common cause of epididymo-orchitis?
E.coli
A man presents with painful testes. The pain is relieved when the testes are elevated. There is a swelling present which is not transilluminable. What would be the most likely diagnosis?
Epididymo-orchitis
What is the pathophysiology of Benign Prostate Hyperplasia?
Failure of apoptosis to occur therefore unrestricted growth occurs due to dihydrotestosterone
A 80 year old man presents to the GP with nocturia. On history he has other LUTS symptoms including increased frequency, dribbling and hesitation. Based on the most likely diagnosis what would be you next steps, DDx and treatment?
urine dip to exclude a UTI
Rectal - is it smooth and enlarged? and abdominal examination
PSA levels. CRP
DDx = BPH, prostate cancer, prostatitis, tumour.
If is BPH
1st line is alpha blocker = tamsulosin (muscle relaxation)
2nd line is 5-ARI = finasteride
If urgency is occurring then may want a anti-muscarinic (ipratropium) to reduce contractions.
Nocturia treatment = desmopressin - vasopressin analogue (be way of sodium levels)
Can surgery be done for BPH - what surgeries and in what cases?
Patients with high pressure retention
TURP (transurethral resection of the prostate)
Holmium laser enucleation of the prostate (HOLEP)
What are the risks for developing prostate cancer?
Being a black male 50+ age Family history of cancer (BRCA) Increased dietary fat Alcohol Smoking
What does prostate cancer usually present with?
LUTS
frequency, urgency, nocturia, hesitancy, dysuria, dribbling
If more advanced may also occur with haematuria, suprapubic pain.
What are the 2 types of prostate cancer?
Ductal adenocarcinoma
Acinar adenocarcinoma - MOST COMMON
With suspected prostate cancer what investigations are required?
DRE - asymmetry, nodularity, fixed irregular mass
PSA - good but can be raised by other things. PSA density
MRI
What scoring system is used for prostate cancer?
Gleason grade
What is the different treatment options for prostate cancer? Low, intermediate and high risk.
Low = surveillance (repeat tests), prostatectomy, EB radiation, Brachytherapy, Intermediate = Prostatectomy, EB radiation, Brachytherapy High = EBR and brachytherapy and hormones, prostatectomy, hormones only (goserelin - anti GrNh)
How are renal stones formed?
Concentrated urine crystallizes and forms calculi. The crystals deposit on the nucleus and grow from there. Increased levels of calcium, oxalate and uric acid and a lack of substances which prevent stones.
Name some causes of urinary tract stone disease? (6)
Urine stasis pH imbalance - Acid = uric and cystine. Alkali = calcium. Gout UTI Hyperparathyroidism IBD
A 40 yr old overweight male presents with acute onset pain that he describes began in his left loin and is now spreading to groin.
He has felt nauseous since this pain has come on and has vomited several times. He has also noticed some blood in his urine recently. He has no red flag signs. What would be your next steps and management based on the most likely diagnosis?
Urinalysis
Abdominal X ray
CT - if needed
Analgesia (NSAID/opioid)
Smooth muscle relaxants
Drainage may be required to bypass the stone and reduce stagnant urine. (stent nephropathy)
If a small stone = shock wave lithotripsy
if not worked = ureterorenoscopy and laser fragmentation.
If a larger stone = percutaneous nephrolithotomy
What type of diuretic can be used in the prophylaxis of renal stones?
Thiazide diuretics - chlorothiazide/hydrochlorothiazide
What is the most likely cause of bladder stones?
Bladder obstruction
e.g. prostate enlargement
What would the presentation of bladder stones look like and what would be the treatment
Haematuria and dysuria
Cystoscopy - remove stones with a laser
What can be some of the causes of urinary retention?
BPH Cancer Drugs Gynae malignancy Stricture Neuropathy
A patient comes in having not passed urine for 2 days what is the immediate treatment? And what would be the management after this.
CATHETERISE - record the residual. Can use a suprapubic catheter if required.
Treat the precipitating event and may need a alpha blocker to relax the bladder.
U+Es and ECG and correct electrolyte imbalance if required.
What are some causes of haematuria?
Infection - e.coli
Recent surgery
Previous urological condition
Anticoagulation.
How would haematuria be treated - generally?
3 way catheter to irrigate and clear.
Antibiotics - if required
cystoscopy
upper tract imaging.
What is fourniers gangrene and what are some possible causes?
Necrotising fasciitis of scrotum, penis or surrounding peritoneum.
Causes = catheter, biopsy, abscess, SGL2 use.
What is the treatment for fournier’s gangrene?
Antibiotics - amoxycillin/gentamycin/metronidazole
Surgical debridement and possible reconstruction
A patient comes in with a anterior urethral injury what is the most likely way that they did this?
Straddle trauma
A patient comes in with a posterior urethral injury what could this cause and what is the most likely way this has happened?
Pelvic fracture or bike injury.
Butterfly haematoma
Blood at meatus
What is the best method of diagnosing urethral injury?
Retrograde urethrography.
What bacteria is most likely to cause a UTI?
E.coli
Women are more likely to contract UTIs why is this?
They have a shorter and straighter ureter therefore bacteria can get in easier.
What is the difference between gram positive and gram negative UTI bacteria in how they adhere for colonisation?
Gram negative = pili/fimbrae
Gram positive = non-pilous adhesions
What are the symptoms of bacterial cystitis and what investigations would you carry out and what treatment?
Increased frequency and urgency. Dysuria, pain, haematuria. suprapubic pain and offensive urine.
Urine dipstick, microscopic urinalysis.
Lifestyle factors and antibiotics for 3-5 days
- Nitrofuratonin
- Trimethoprim
What are the symptoms of pyelonephritis and what investigations would you carry out and what treatment?
Flank pain, malaise, chills, sweats, rigors, nausea and vomiting, confusion, fever.
Possible sepsis. Tender abdomen. Tachycardic and hypotensive.
dipstick and micro urinalysis. Blood tests, culture and US/CT. IV or oral antibiotics (fluoroquinolones) - dependent on whether patient well or not.
What bacteria can cause UTI - which is most common for complicated UTI’s?
E.coli, staph, klebsiella, proteus, pseudomonas.
Enterococcus = complicated
