Urinary problems Flashcards
Pathophysiology of testicular torsion (TT)
When the spermatic cord (blood flow to the testicle) rotates + becomes twisted
This causes testicular ischaemia
What is the most common age for TT
<30 years
Peak age is 13 years
What is bell-clapper deformity? (TT)
Caused by abnormal fixation of the tunica vaginalis to the testicle - so the testicle can rotate freely in the tunica vagninalis
Presentation of TT
Acute onset testicular pain
Abdo pain (+/- vomiting)
PAINFUL TO WALK!!
How may the testical appear in TT?
Red, swollen, tender hemi-scrotum
Affected testis is higher + transverse
What reflex is absent in TT?
Cremasteric reflex is absent in TT
Initial managment of TT
Analgesia (?anti-emetic)
KEEP FASTED!! they will need surgical intervention
Should you image in suspected TT?
NO! this will delay treatment
Surgical managment of TT
Orchidopexy (detorsion + fixation with suture) of BOTH SIDES!! the other testis is at increased risk of torsion
What is the most common cause of scrotal pain in men?
Epididymitis
How does epididymitis differ from torsion?
Think onset, symptoms, management etc
Epididymitis: Usually more gradual onset Can progress to testis Usually urinary symptoms too Treated with antibiotics
What are the most common causes of epididymitis in older men, sexually-active men and pre-pubescent boys
Old: usually enteric (e. coli)
Sexually active men: usually STI (chlamydia/ gonorrhoea)
Pre-pubescent: usually non-infective cause
What is another infective cause of epididymitis?
Mumps
How is epididymitis managed?
Treat the underlying cause!
e.g. treat STI with ceftriaxone + doxycycline
What is the most common type of renal stones?
What are these associated with?
Calcium oxalate (60%)
Associated with:
low urine volume, raised urine pH (alkalotic)
Give 4 other type of renal stones
Calcium phosphate (20%)
Struvite (stag horn calculi)
Uric acid (gout)
Cysteine (genetic disorders)
What are the 3 most common sites of renal stone obstruction?
Pelvi-uteric junction (PUJ)
Mid-ureter
Vesico-uteric junction (VUJ)
Renal stone obstruction leads to vasodilation and ureteric smooth muscle spasm - how do these present?
Vasodilation: leads to diuresis (increased urine production)
Muscle contraction: colicky pain
Give 4 risk factors for renal stones
Dehydration
Poor diet
Obesity
Gout
What analgesic is recommended for renal colic?
75mg Diclofenac (PR or IM)
What other immediate management is there for renal colic?
Anti-emetic (e.g. metaclopramide IM)
IV fluids
Antibiotics if co-existing infection
Investigations in suspected renal colic
Urine dip and MSU
Us+Es, creatinine, glucose, calcium phosphate + urate levels
Imaging
If renal stone is small enough to pass naturally, what should you tell the patient to do
Try and catch the stone in a sieve so it can be sent for analysis
If hospital admission is not required, what analgesia can be prescribed
NSAID
How big do stones have to be for interventional management (usually)
> 5mm diameter
What is MET and what drugs can be used for it?
Medical expulsive therapy
Alpha blocker or CCB - when stones are <10mm
With MET, how long should it take for stones to apss?
within 48 hours
If a patient with renal stones is unsuitable for medical management, what surgical options are there?
ESWL (extracorporeal shock wave lithotripsy) - outpatient
Percutaneous nephrolithotomy - stone fragmentation through a neohroscope
In renal colic, what are 3 indications for early intervention and admission?
Infection + obstruction (ureteric stent may be required)
Urosepsis
Impending AKI
What foods (oxalate rich) would you advise reduced consumption of in someone who has had renal stones?
Rhubarb, spinach, cocoa, tea leaves, nuts, soy, strawberries, wheat bran
General advice to someone who has had renal stones
Increase fluid intake (to produce 2-3L of urine a day, or to maintain colourless urine)
Balanced diet - reduce salt intake
Maintain a healthy weight
