Urinary Tract Disorders Flashcards
What is the incidence of urinary tract stones?
15% of population has urinary tracts stones
What are the types of renal stones?
Alkaline urine:
1-Calcium oxalate
2-Calcium phosphate
3-Struvite
Acidic urine:
1-Urate stone
2-Xanthine stone
3-Cysteine stone
What is the most common type of stones?
Calcium oxalate
(If recurrent and multiple Ca oxalate stones: familial and hyperoxaluria)
What is the most radio-opaque stone?
Calcium phosphate
What is the stone that are related to proteus infection forming a staghorn stone?
Struvite
What are the characteristics of urate and xanthine stones?
-The most radiolucent
-Associated with cell death “chemotherapy”
What are the manifestations of urinary stones?
-Renal stones: hematuria mainly, loin pain
-Ureteric stones: hematuria, pain from loin to groin
-Urinary bladder stones: hematuria, cystitis, Supra-pubic pain
Hemorrhagic cystitis May occur with certain medications like…
Cyclophosphamides
Recurrent painful hematuria in a young female=….
Interstitial cystitis
What is the rate of passage of stones: according to stone size?
1mm—85%
2-4mm—75%
5–7mm—60%
The most specific diagnostic tool for stones is …
CT
What is the treatment of each case…?
1–<5mm — Medical treatment (observative treatment)
2–5mm-2cm — ESWL (endoscopic shock wave lithotripsy)
3–5mm-2cm but in pregnant female — (Ureteroscopy)
4–Multiple-complex-staghorn stone (PCNL: percutaneous nephrolithotomy)
What are the complications of urinary tract stones?
Urinary tract obstruction
-Acute urine retention
-Chornic urine retention with sterile hydronephrosis
-Chronic urine retention with infected hydronephrosis (with long-standing retention and immune Om promised patients)
-Pelvi-Ureteric junction PUJ obstruction (loin to groin pain especially after caffeine and diuretic intake, it may lead to renal scarring)
What is the management of the followings?
1-Acute urine retention: Urinary catheter
2-Chronic retention with sterile hydronephrosis: stemming or pyeloplasty
3-Infected hydronephrosis: PCN (Percutanous nephrostomy)
4-PUJ obstruction management with possible scarring, but a urosurgeon must:
-Determine the cause: CT scan
-Exclude the complications (renal scarring): DMSA Scan
-Choose treatment according to renal function: DTPA or MAG3 renogram
•good renal function: pyeloplasty
•poor renal function: Nephrectomy
…. is better than ….. specially in cases of failed transplant and damaged kidney.
MAG 3 renogram - DTPA Scan
What are the other causes of urine retention?
-Postoperative urine retention: (mainly after spinal and epidural analgesia due to bladder neck inactivity)
-Post infection urine retention: (uretheral stenosis)
-Retention in diabetic patients: (under active bladder causing painless retention)
… of urinary tract injuries occur with pelvic fractures
85%
… injury is the most common injury and happens usually with straddle injury in bicycle riders (falling astride)
Bulbar uretheral injury
What is the mode of trauma in membranous urethral injury and bladder rupture?
Pelvic fractures
What is the clinical picture of bulbar urethral injury and membranous uretheral injury?
Both:
-Urine retention
-Perineal hematoma
-Blood at meatus
+Bulbar uretheral injury- Full bladder
+Membranous uretheral injury- Full bladder + high or non-palpable prostate on PR
What is the clinical picture of bladder rupture?
-Hematuria
-Retention
-Suprapubic pain
-Free Fluid infra abdominally
-Empty bladder
What are the investigations for urinary tract trauma?
-Ascending cystourethrogram
-Intravenous urography
What is the treatment of bulbar and membranous uretheral injuries?
Suprapubic catheter
(Uretheral catheter is contraindicated)
What is the treatment of bladder fracture?
-Extraperitoneal (conservative management)
-Intraperitoneal (laparotomy for fear of peritonitis)
What are the urinary tract tumors?
-Renal cell carcinoma (renal adenocarcinoma)(renal hypernephroma)
-Transitional cell carcinoma
-Squamous cell carcinoma
What is the incidence and associations of RCC?
-Most common 85%
-Associations:
• Varicocele
•Renal vein/IVC Thrombosis
What are the incidence and associations of TCC?
Incidence:
•10% of renal tumors
•90% of bladder tumors
Associations:
•Occupational tumor (naphthylamine, rubber chemicals, textile, PVC)
•Smoking
What are the incidence and associations of Squamous cell carcinoma?
Incidence:
•less than 5%
Associations:
•Chronic catheterization
•Schistosoma haematobium
•Staghorn stones
•Ectopica Vasica
What are the characters and treatment of RCC?
Characters:
-Paraneoplastic features
•Hypertension
•Polycythemia
-Blood metastasis
•mainly to lung “cannon ball lesion”
Treatment:
(CT scan is mandatory)
Partial or radical nephrectomy according to stage+_chemotherapy
What are the characters and treatment of TCC?
Characters:
Filling defects and epithelia irregularities on CT IVU.
Treatment:
•Intravesical BCG
•Radical nephroureterctomy
What are the characters and treatment of Squamous cell carcinoma?
Characters:
•Ectopica vasica is often associated with Epispedius
Treatment:
•Radical cystectomy
All renal tumors are… in collie when examined grossly except TCC is…
Yellowish
Pink
What is the incidence of stress incontinence, Mixed type, Urge incontinence “overactive bladder”?
50%
35%
15%
What are the characters of stress incontinence?
-Increased intraabdominal pressure, with coughing and sneezing
What are the characters of urge incontinence?
-Incontinence without any increased abdominal pressure due to Ferris or muscle instability
What is the management plans for urinary incontinence?
-History taking
-If unclear or surgery considered: flow cytometry
-Bladder dairy for at least 3 days
-If bladder dairy in insufficient: urodynamic studies
For stress and mixed types specifically:
•Pelvic floor exercise: 3 months
•Uretheral sling (colpo-suspension)
For urge incontinence:
•Bladder retraining: 1.5 months
•Medical: Oxybutynin
•Sacral meuromodulationor botulinum toxin injection
… should be suspected in all females after prolonged labor and diagnosed by..
Vesicobaginal fistula
Urinary dye studies
… is the most common renal cancer in children
Nephrobalstoma(wilms tumor)
…is the most common cause of osteolytic metastasis in children
Neuroblastoma
What are the sites of nehprobalstoma and neurobalstoma?
•nehprobalstoma-starts in kidney then adrenal gland
•neurobalstoma-starts in adrenal gland then kidney
What is the clinical pictures and mode of soread in Nephroblastoma and neurobalstoma?
C/P:
•Nephroblastoma-Hypertension and fever
•Neurobalstoma-Calcification May occur
Metastasis:
•Nephroblastoma- Blood to lung
•Neurobalstoma-blood to bone (osteolytic)
What is the treatment of Nephroblastoma and neurobalstoma?
•Nephroblastoma-Surgery and chemotherapy
•neurobalstoma-Surgery and Radiotherapy
What is the epithelial lining of the followings:
Kidney
Urinary passages
At the end of the uretheral
-Glandular cells and columnar cells
-Transitional epithelium
-Columnar epithelium
When to visualize the urinary tracts with antegrade approach?
-Mass obstruction
-Inserted drain
What are the 4 parts of male urethera?
-Pre-Prostatic
-Prostatic
-Membranous urethera
-Bublar urethera/penile urethera
What are the lobes of the prostate?
-Lateral lobes
-Median lobe (BPH)
-Anterior lobe
-Posterior lobe (cancer)
What is the venous drainage of the right and left testis?
Right testis:
-Drains directly to the IVC
Left testis:
-Drains to the left renal vein (so higher incidence of Varicocele)
