Urinary system & male genital tract

Question 1

Risk factors of urinary tract infections

Answer 1

Females>males
Sexual intercourse
Pregnancy
Diabetes
Urinary tract obstructions e.g. stones or catheters

Question 2

Define a UTI

Answer 2

the presence of pure growth of >10^5 organisms in fresh urine
in urethra = urethritis
in bladder = cystitis
in prostate = prostatitis
in kidney = pyelonephritis
E.coli is the most common causative organism, staphylococcus and proteus also

Question 3

What is bacteruria?

Answer 3

bacteria in the urine, may be symptomatic or asymptomatic

Question 4

Cystitis

Answer 4

Frequency, dysuria, urgency haematuria, suprapubic pain

Question 5

Pyelonephritis

Answer 5

fever, vomiting, loin pain and tenderness

Question 6

Prostatitis

Answer 6

flu-like symptoms, few urinary problems, swollen and tender prostate

Question 7

Manage of UTIs

Answer 7

drink plenty of fluids
urinate often
antibiotics
imaging
severe cases may require hospital admission

Question 8

The kidneys

Answer 8

Maintenance of water, electrolyte and acid-base homeostasis
Excretion of toxic metabolic waste products (urea and creatinine)
Hormonal function:
Renin – help control blood pressure
Erythropoietin- stimulates production of RBCs in the bone marrow and helps in the production of vitamin D.
- functional unit is the nephron (glomerulus and renal tubule)
- filtration of most small molecules from the blood in the glomerulus.
- selective reabsorption in the renal tubule of most of the water and some molecules
- maintenance of the acid-base balance

Question 9

Acute renal failure

Answer 9

A significant deterioration in renal function occurring over hours or days
low urine volume (<400ml/24 hours i.e oliguria)
rising plasma urea and creatinine levels
usually occurs in the setting of other severe illnesses

Question 10

Stages of renal failure

Answer 10

Causes:
- Pre-renal
hypoperfusion, sepsis
- Renal
ATN damage to tubules due to ischaemia or nephrotoxins
- Post-renal
Renal tract obstruction (eg stones, tumours)

Question 11

Acute renal failure management

Answer 11

find and treat the cause
treat exacerbating factors (hypovolaemia, sepsis)
stop nephrotoxic drugs (NSAIDs, ACE-I, gentamycin and Vancomycin)
may need renal replacement therapy (haemofiltration/dialysis)

Question 12

Chronic renal failure

Answer 12

5 stages depending on GFR (volume of fluid from the glomerular capillaries into the Bowman’s capsule per unit time)
symptoms usually occur by stage 4 - GFR 15-29

Question 13

Causes of chronic renal failure

Answer 13

Diabetes 
Renovascular disease 
Hypertension
Glomerulonephritis 
Polycystic disease

Question 14

Glomerulonephritis

Answer 14

A group of disorders where there is damage to the glomerular filtration apparatus = leak of protein or blood into the urine.

Question 15

Kidney stones

Answer 15

Crystal aggregates that form in the collecting ducts of the kidneys and can deposit anywhere in the renal tract.
Peak age 20-40 years.
Male: female = 3:1
Risk factors: dehydration, dietary factors, drugs (loop diuretics, antacids, corticosteroids, theophylline and aspirin), renal tract abnormalities, recurrent UTIs, metabolic abnormalities

Question 16

management of kidney stones

Answer 16

imaging
prompt pain relief
stones <5mm able to pass spontaneously within 48 hours
if >5mm = intervention

Question 17

Renal cancer

Answer 17

Renal cell carcinoma -
- 85@% of all renal cancers
- 50-70yrs, 2;1 male predominance
- smoking an important risk factor, obesity, hypertension, hereditary
presents as haematuria, loin pain, abdo mass, hypercalcaemia, hypertension
treatment = radical nephrectomy +/- chemo

Question 18

Transitional cell carcinoma of the bladder

Answer 18

Presentation:
-painless haematuria
-frequency, urgency and dysuria can occur
Tests:
-urine for cytology
-cystoscopy and biopsy
Treatment = depends on stage and ? spread
early stage - diathermy, cystoscopy
late stage - radical cystectomy, palliative chemo/radiotherapy

Question 19

Prostate

Answer 19

located at the base of the bladder and around the first part of the urethra.
normal adults weighs around 20gm
helps in the secretion and maintenance of semen and spermatozoa.

Question 20

Benign prostatic hyperplasia

Answer 20

increase in number of cells formation of nodules
prostate weighs 60-100gm
signs and symptoms: increased frequency, hesitancy, nocturia, terminal dribbling
increased risk of infection
enlarged prostate on PR
Treatment = alpha blockers , Transurethral Resection of the Prostate

Question 21

Prostate cancer

Answer 21

risk factors: age, race, family history, hormone levels, diet (increased risk with fat consumption)
signs and symptoms: nocturia, hesitancy, poor stream and terminal dribbling, examination shows a hard irregular prostate
Diagnosis = raised PSA, biopsy
Treatment = radical prostatectomy, hormonal therapy, radiotherapy for advanced cases

Question 22

Testicular torsion

Answer 22

Sudden onset of pain in 1 testis
Pain in abdomen, nausea and vomiting
Testis is hot, swollen and tender
The testis may lie high and transversely
Most common 11-30 years old
Tests: USS with Doppler, exploratory surgery
Treatment = surgery, urgent!!!

Question 23

Testicular tumours

Answer 23

Most common malignancy in males aged 15-44 years old
Risk factors: undescended testis, infant hernia and infertility
Presentation: painless testicular lump often noted after trauma or infection
Treatment = orchidectomy, radiotherapy/chemo

Question 24

What is dysuria?

Answer 24

Pain or discomfort when urinating