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Uro-Surgery > Urinary Tract Disorders > Flashcards

Urinary Tract Disorders Flashcards

1
Q

What is the incidence of urinary tract stones?

A

15% of population has urinary tracts stones

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2
Q

What are the types of renal stones?

A

Alkaline urine:

1-Calcium oxalate
2-Calcium phosphate
3-Struvite

Acidic urine:

1-Urate stone
2-Xanthine stone
3-Cysteine stone

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3
Q

What is the most common type of stones?

A

Calcium oxalate
(If recurrent and multiple Ca oxalate stones: familial and hyperoxaluria)

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4
Q

What is the most radio-opaque stone?

A

Calcium phosphate

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5
Q

What is the stone that are related to proteus infection forming a staghorn stone?

A

Struvite

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6
Q

What are the characteristics of urate and xanthine stones?

A

-The most radiolucent
-Associated with cell death “chemotherapy”

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7
Q

What are the manifestations of urinary stones?

A

-Renal stones: hematuria mainly, loin pain
-Ureteric stones: hematuria, pain from loin to groin
-Urinary bladder stones: hematuria, cystitis, Supra-pubic pain

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8
Q

Hemorrhagic cystitis May occur with certain medications like…

A

Cyclophosphamides

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9
Q

Recurrent painful hematuria in a young female=….

A

Interstitial cystitis

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10
Q

What is the rate of passage of stones: according to stone size?

A

1mm—85%
2-4mm—75%
5–7mm—60%

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11
Q

The most specific diagnostic tool for stones is …

A

CT

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12
Q

What is the treatment of each case…?

A

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)

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13
Q

What are the complications of urinary tract stones?

A

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)

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14
Q

What is the management of the followings?

A

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

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15
Q

…. is better than ….. specially in cases of failed transplant and damaged kidney.

A

MAG 3 renogram - DTPA Scan

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16
Q

What are the other causes of urine retention?

A

-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)

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17
Q

… of urinary tract injuries occur with pelvic fractures

A

85%

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18
Q

… injury is the most common injury and happens usually with straddle injury in bicycle riders (falling astride)

A

Bulbar uretheral injury

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19
Q

What is the mode of trauma in membranous urethral injury and bladder rupture?

A

Pelvic fractures

20
Q

What is the clinical picture of bulbar urethral injury and membranous uretheral injury?

A

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

21
Q

What is the clinical picture of bladder rupture?

A

-Hematuria
-Retention
-Suprapubic pain
-Free Fluid infra abdominally
-Empty bladder

22
Q

What are the investigations for urinary tract trauma?

A

-Ascending cystourethrogram
-Intravenous urography

23
Q

What is the treatment of bulbar and membranous uretheral injuries?

A

Suprapubic catheter
(Uretheral catheter is contraindicated)

24
Q

What is the treatment of bladder fracture?

A

-Extraperitoneal (conservative management)
-Intraperitoneal (laparotomy for fear of peritonitis)

25
Q

What are the urinary tract tumors?

A

-Renal cell carcinoma (renal adenocarcinoma)(renal hypernephroma)
-Transitional cell carcinoma
-Squamous cell carcinoma

26
Q

What is the incidence and associations of RCC?

A

-Most common 85%
-Associations:
• Varicocele
•Renal vein/IVC Thrombosis

27
Q

What are the incidence and associations of TCC?

A

Incidence:
•10% of renal tumors
•90% of bladder tumors

Associations:
•Occupational tumor (naphthylamine, rubber chemicals, textile, PVC)
•Smoking

28
Q

What are the incidence and associations of Squamous cell carcinoma?

A

Incidence:
•less than 5%

Associations:
•Chronic catheterization
•Schistosoma haematobium
•Staghorn stones
•Ectopica Vasica

29
Q

What are the characters and treatment of RCC?

A

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

30
Q

What are the characters and treatment of TCC?

A

Characters:
Filling defects and epithelia irregularities on CT IVU.

Treatment:
•Intravesical BCG
•Radical nephroureterctomy

31
Q

What are the characters and treatment of Squamous cell carcinoma?

A

Characters:
•Ectopica vasica is often associated with Epispedius

Treatment:
•Radical cystectomy

32
Q

All renal tumors are… in collie when examined grossly except TCC is…

A

Yellowish
Pink

33
Q

What is the incidence of stress incontinence, Mixed type, Urge incontinence “overactive bladder”?

A

50%
35%
15%

34
Q

What are the characters of stress incontinence?

A

-Increased intraabdominal pressure, with coughing and sneezing

35
Q

What are the characters of urge incontinence?

A

-Incontinence without any increased abdominal pressure due to Ferris or muscle instability

36
Q

What is the management plans for urinary incontinence?

A

-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

37
Q

… should be suspected in all females after prolonged labor and diagnosed by..

A

Vesicobaginal fistula
Urinary dye studies

38
Q

… is the most common renal cancer in children

A

Nephrobalstoma(wilms tumor)

39
Q

…is the most common cause of osteolytic metastasis in children

A

Neuroblastoma

40
Q

What are the sites of nehprobalstoma and neurobalstoma?

A

•nehprobalstoma-starts in kidney then adrenal gland
•neurobalstoma-starts in adrenal gland then kidney

41
Q

What is the clinical pictures and mode of soread in Nephroblastoma and neurobalstoma?

A

C/P:
•Nephroblastoma-Hypertension and fever
•Neurobalstoma-Calcification May occur

Metastasis:

•Nephroblastoma- Blood to lung
•Neurobalstoma-blood to bone (osteolytic)

42
Q

What is the treatment of Nephroblastoma and neurobalstoma?

A

•Nephroblastoma-Surgery and chemotherapy
•neurobalstoma-Surgery and Radiotherapy

43
Q

What is the epithelial lining of the followings:
Kidney
Urinary passages
At the end of the uretheral

A

-Glandular cells and columnar cells
-Transitional epithelium
-Columnar epithelium

44
Q

When to visualize the urinary tracts with antegrade approach?

A

-Mass obstruction
-Inserted drain

45
Q

What are the 4 parts of male urethera?

A

-Pre-Prostatic
-Prostatic
-Membranous urethera
-Bublar urethera/penile urethera

46
Q

What are the lobes of the prostate?

A

-Lateral lobes
-Median lobe (BPH)
-Anterior lobe
-Posterior lobe (cancer)

47
Q

What is the venous drainage of the right and left testis?

A

Right testis:
-Drains directly to the IVC

Left testis:
-Drains to the left renal vein (so higher incidence of Varicocele)

Uro-Surgery (4 decks)

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