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Surg Spec (Urology) > Urinary Tract Obstruction > Flashcards

Urinary Tract Obstruction Flashcards

1
Q

When may a unilateral urinary tract obstruction be clinically silent?

A

If the other kidney is functioning normally

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2
Q

What are some examples of when a urinary tract obstruction requires urgent treatment?

A

If the obstruction is bilateral, or there is obstruction with infection

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3
Q

How does an acute upper urinary tract obstruction typically present?

A

Loin to groin pain

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4
Q

Symptoms of loin pain, renal failure, superimposed infection and polyuria suggest what type of urinary tract obstruction?

A

Chronic upper urinary tract obstruction

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5
Q

Why does chronic upper urinary tract obstruction cause polyuria?

A

There is a reduced concentrating ability of the kidney

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6
Q

How does an acute lower urinary tract obstruction typically present?

A

Acute urinary retention

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7
Q

Overflow incontinence can be a feature of which type of urinary tract obstruction?

A

Chronic lower urinary tract obstruction

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8
Q

If a patient presents with any signs/symptoms of urinary tract obstruction, what two bedside tests must always be done?

A

Bloods for U&Es, urine for MC&S

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9
Q

What is the first line imaging modality of choice for someone with a suspected urinary tract obstruction?

A

Ultrasound

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10
Q

When should a CT scan be arranged for someone with urinary tract obstruction?

A

If there is hydronephrosis or hydroureter on ultrasound scans

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11
Q

What are the two main treatment options for an upper urinary tract obstruction?

A

Nephrostomy or ureteric stent

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12
Q

What medication can be used to help reduce the pain associated with a ureteric stent?

A

Alpha blockers

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13
Q

How is a lower urinary tract obstruction treated?

A

Insert a catheter and treat the underlying cause if possible

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14
Q

What are the two main causes of urinary retention?

A

Obstruction, or reduced detrusor muscle power

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15
Q

What are the two main causes of acute urinary retention?

A

Prostatic enlargement and urethral strictures

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16
Q

What group of medications are a recognised cause of acute urinary retention?

A

Anti-cholinergic medications

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17
Q

If a patient is in acute urinary retention and fails to void, how should they be treated?

A

Catheterisation and an alpha blocker (e.g. tamsulosin)

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18
Q

How are patients who are in acute urinary retention as a result of clot retention treated?

A

3-way catheter and bladder washout

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19
Q

Why should patient’s U&Es always be monitored closely after catheterisation for acute urinary retention?

A

Risk of post-obstructive diuresis and salt-losing nephropathy

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20
Q

Why may chronic urinary retention lead to renal failure?

A

Bilateral obstructive nephropathy

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21
Q

Treating the underlying cause is the best way to manage chronic urinary retention. What else can be used to help control the condition, regardless of the underlying cause?

A

Intermittent self catheterisation

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22
Q

In patients with chronic urinary retention, an episode of acute urinary retention may only be recognised when what symptom develops?

A

Overflow incontinence

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23
Q

After placing a catheter in someone with acute-on-chronic urinary retention, what may happen with regards to their renal function?

A

There may be a significant rise in creatinine, but this usually returns to baseline after a few days

24
Q

If you suspect obstructive uropathy, what imaging investigation should always be requested?

A

Renal ultrasound

25
Q

What can be done to try and avoid post-obstructive diuresis in patients who have been catheterised as a result of urinary retention?

A

Give resuscitation fluids, and then match input with output

26
Q

What can be done to try and avoid salt-losing nephropathy in patients who have been catheterised as a result of urinary retention?

A

Give isotonic (1.26%) sodium bicarbonate solution and withhold any nephrotoxic drugs

27
Q

What type of disorder is idiopathic retroperitoneal fibrosis?

A

Autoimmune

28
Q

What type of urinary tract obstruction is caused by retroperitoneal fibrosis?

A

Progressive, bilateral urinary tract obstruction

29
Q

What type of malignancy is a recognised secondary cause of retroperitoneal fibrosis?

A

Lymphoma

30
Q

Who does retroperitoneal fibrosis typically present in?

A

Middle aged males

31
Q

How does retroperitoneal fibrosis typically present?

A

Vague loin/back/abdominal pain and hypertension

32
Q

What is the first line imaging test for retroperitoneal fibrosis and what would it show?

A

Ultrasound- would show dilated ureters and hydronephrosis

33
Q

If an US scan is suggestive of retroperitoneal fibrosis, what is the next best investigation to do and what would it show?

A

CT or MRI- would show a peri-aortic mass

34
Q

How is retroperitoneal fibrosis treated?

A

Bilateral retrograde stenting

35
Q

Other than prostatic enlargement, what is another commonly recognised cause of bladder outflow obstruction?

A

Urethral strictures

36
Q

How is a urethral stricture causing bladder outflow obstruction usually managed?

A

Dilatation

37
Q

BPH causes hyperplasia of which cells of the prostate?

A

Both stromal and epithelial cells

38
Q

Which zone of the prostate is typically affected by BPH?

A

Transitional zone

39
Q

Is BPH a pre-malignant disease?

A

No

40
Q

What investigation can be used to identify incomplete emptying in those with suspected BPH?

A

Uroflowmetry

41
Q

What should always be done before a PR exam in someone presenting with suspected prostatic enlargment?

A

Bloods for PSA

42
Q

What investigations are done to exclude a malignancy in someone presenting with suspected BPH?

A

PSA bloods, TRUS +/- biopsy

43
Q

What is the first line group of drugs for the management of BPH- give an example?

A

Alpha blockers e.g. tamsulosin

44
Q

What is the second line group of drugs for the management of BPH- give an example?

A

5 alpha reductase inhibitors e.g. finasteride

45
Q

How does tamsulosin work in the treatment of BPH?

A

Decreases smooth muscle tone of the bladder and prostate

46
Q

How does finasteride work in the treatment of BPH?

A

Reduces dihydrotestosterone levels (and hence the size of the prostate)

47
Q

Finasteride can take up to how long to be effective in the treatment of BPH?

A

6 months

48
Q

What are some side effects of finasteride?

A

Impotence and decreased libido

49
Q

What is the surgical treatment of choice for bladder outflow obstruction caused by BPH?

A

Trans-urethral resection of the prostate (TURP)

50
Q

What happens in the complication of a TURP procedure known as trans-urethral resection syndrome?

A

Acute hyponatraemia

51
Q

What is a transient complication that sometimes occurs after a TURP procedure but rarely becomes a persistent problem?

A

Incontinence

52
Q

What are some potential complications of a TURP procedure, to do with sexual function?

A

Impotence and retrograde ejaculation

53
Q

For how long after a TURP procedure should patients avoid driving and sexual activity?

A

2 weeks

54
Q

What complication may be expected in the first 2 weeks following a TURP procedure, and patients should be warned not to worry about?

A

Haematuria

55
Q

Initially following a TURP procedure, patients may need to urinate more frequently than usual. How long will it take for the procedure to work and this complication to stop?

A

6 weeks

Surg Spec (Urology) (8 decks)

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