Urologic Flashcards
Neurological causes for urinary incontinence:
____
Spinal injury
Normal-pressure hydrocephalus
Multiple sclerosis
Potentially reversible causes for urinary incontinence:
diuretics
UTIs
____
Stool impaction
__ incontinence 2/2
urethral hyper-mobility
increased intra abd pressure
Stress
__ incontinence 2/2
autonomous contractions of the detrusor muscle
Urge
Treatment for urge incontinence
Anticholinergic (M3) medication (oxybutynin*)
Sympathomimetics (mirabegron**)
—————————————————-
*M3 antagonist causes antispasmodic effect on bladder smooth muscle
**Beta 3 agonist relaxes detrusor smooth muscle which increases the bladder’s storage capacity
\_\_ incontinence 2/2 Loss of or weak detrusor contractility due to: Neurogenic bladder (multiple sclerosis) Neuropathy (diabetes mellitus) Spinal cord injuries BPH
Overflow
Overflow incontinence 2/2
Absence of an urge to urinate/Incomplete bladder emptying → bladder overfilling → chronically distended bladder with ↑ bladder pressure → dribbling of urine (leak) when ___ pressure > sphincter outlet pressure
intravesical
Post void residual volume >50 ml in
Overflow incontinence treatment
Acute settings: ____
Long term: ___
intermittent catheterization
Scheduled voiding daily
Type of incontinence seen in multiple sclerosis or spinal cord injury
____ → simultaneous contractions of the detrusor muscle + urethral sphincter contraction → urine leaks
Detrusor sphincter dyssynergia
urinary retention and leaking without an associated urge to void
Work up for incontinence:
1st test → ____
If negative get:
→ ____
→ ____
- UA & urine culture (r/o UTI)
- Post void residual volume
- Renal ultrasound
1st line treatment for stress incontinence
Weight loss
decrease consumption of alcohol, caffeine
Kegel’s
1st line treatment for urge incontinence
Bladder training:
- scheduled voiding
- holding for as long as possible
- relaxation/distraction techniques
*If that fails or sxs affect ADLs give oxybutynin or mirabegron
Stress incontinence treatment if refractory to 1st line or affecting quality of life
mid urethral urinary sling
The most common (∼ 95%) type of cancer of the bladder, ureter, renal pelvis, and proximal urethra in males
Transitional cell (urothelial) carcinoma
*Present from proximal urethra to renal pelvis
Urinary tract cancer risk factors:
___ use
Prolonged (occupational) exposure to ____
_____ ( Africa and the Middle East)
cyclophosphamide
Tobacco
Carcinogens (dyes, heavy metals, plastics, aromatic amines like benzidine)
Schistosomiasis
Painless gross hematuria throughout micturition (most commonly)
&
Irritative voiding symptoms (dysuria, urinary frequency, urgency)
associated with ___ carcinoma
Bladder
Diagnostics for suspected Urinary tract cancer:
- ___ indicated in all patients with hematuria
- _____ Imaging modality of choice to examine the entire urinary tract.
- ___ & biopsy direct visualization of urethral and bladder mucosa
Urinalysis
CT urography
Cystoscopy
Treatment for bladder cancer:
____
+/-
chemotherapy or chemoradiation
Radical cystectomy
Painless gross hematuria at the beginning of micturition
Bladder outlet obstruction
Irritative voiding symptoms
associated with ___ carcinoma
Urethral
Painless gross hematuria throughout micturition
Flank pain
associated with Carcinoma of ____ & ____
Renal pelvis (Kidney)
&
Ureters
Upper urinary tract obstruction causes: \_\_\_ Renal pelvis carcinoma Ureteropelvic junction obstruction \_\_\_\_ Ureteral carcinoma
Nephrolithiasis
Ureteral stricture
(Stones, Strictures, Tumors
cause Upper urinary tract obstructions)
Lower urinary tract obstruction (bladder outlet obstruction) causes:
Bladder carcinoma Neurogenic bladder BPH/ prostate cancer \_\_\_\_\_ (Congenital) urethral stricture \_\_\_\_ (Mechanical)
posterior urethral valves
kinked/plugged catheter
Urinary retention
Suprapubic pain and mild distention
Palpable bladder
symptoms of what?
Lower urinary tract obstruction
bladder outlet obstruction
Labs in urinary tract obstruction
(↑/↓) BUN & Cr
(hyper/hypo)-kalemia
↑ BUN & Cr
hyperkalemia
Imaging modalities for diagnosing urinary tract obstruction:
Best initial test: ___
Best initial imaging study in cases of suspected nephrolithiasis: ____
Renal/Abd Ultrasound
CT abdomen/pelvis
First-line imaging study to diagnose patients with suspected vesicoureteral reflux (VUR).
Contrast Voiding Cystourethrography
Best workup for patients with suspected neurogenic bladder
Urodynamic studies
–Cystometry –Electromyelogram (EMG) –Pressure-flow study –Leak point pressure –Postvoid residual volume
Nephrolithiasis: conservative treatment:
–Nsaids
– Explusion Therapy drug (1)
Urological interventions (2) for: –Stones > \_\_ mm –ANURIA, intolerable pain, PO intolerance –Renal failure or Sepsis –Retained stone after \_\_\_ weeks
Tamsulosin (Alpha Antagonist); Nifedipine (CCB)
Lithotripsy Extracorporal shock wave (ESWL)
Uretero-renoscopy
10mm
4-6 weeks
2 kidney stones causing
↑ Urine pH (alkalic)
Calcium phosphate stone
Struvite stone
(STUpid PHads are basic)
3 kidney stones causing
↓ Urine pH (acidic)
Uric acid stones
Calcium oxalate stones
Cystine stones
Hyperparathyroidism is associated with what type of kidney stones?
Calcium phosphate stone
makes sense since calcium & phosphate levels are affected by parathyroid hormone PTH
Gout, leukemia, & chemotherapy are associated with what type of kidney stones?
Uric acid stones
Hypocitraturia, Ethylene glycol (antifreeze), and IBD are associated with what type of kidney stones?
Calcium oxalate stones
*also with Vitamin C/ Hyperoxaluria
2 Diagnostics for kidney stones
Urine microscopy
X-ray (or CT): radiopaque (except uric- radiolucent)
Nephrolithiasis
Biconcave dumbbells or bipyramidal envelopes
Calcium oxalate stones
dumb Ox carrying envelopes to pyramids & caves
Nephrolithiasis
Rounded rhomboids, rosettes, or needle-shaped
Uric acid stones
Nephrolithiasis Rectangular prisms (coffin lid-appearance)
Struvite stones
In a rectangular coffin when you Stru-bite the dust
Nephrolithiasis
Wedge-shaped prisms
Calcium phosphate stones
Nephrolithiasis presents with Severe unilateral and \_\_\_\_ pain Radiates to lower abdomen or groin Nausea, vomiting Dysuria [\_\_-uria]
colicky flank (renal colic)
Hematuria
__ & __ are the preferred diagnostic imaging for nephrolithiasis.
NC-CT of abdomen & pelvis (1st line)
U/S of abdomen & pelvis
Consult urology urgently for interventional treatment in Large stones (> \_\_ mm)
> 10 mm
Conservative tx indicated for kidney stones < 10 mm
- Hydration
- Analgesia
- 1st line medical expulsive therapy (MET): ___
*Treat concomitant UTI, if present.
tamsulosin (alpha 1 Antagonist)
- Nifedipine (CCB) not 1st line
Consult urology for Nephrolithiasis interventional tx if:
Uncontrolled \_\_\_\_ Large stones (> 10 mm) Urosepsis Acute renal failure Solitary kidney complete obstruction If conservative mngmt is unsuccessful after \_\_ weeks.
pain
4–6 weeks
Consult urology for Nephrolithiasis interventional tx if:
Uncontrolled pain Large stones (> 10 mm) Urosepsis Acute renal failure \_\_ kidney \_\_\_ obstruction If conservative mngmt is unsuccessful after 4-6 weeks.
Solitary
Complete
2 non-surgical interventional procedures for ureteral stones
Uretero-renoscopy (URS)
extracorporeal shockwave lithotripsy (ESWL)
- acoustic pulse
non-surgical interventional procedures for:
Renal stones >20 mm →
lower renal pole stones >10 mm →
percutaneous nephrolithotomy (PCNL)
non-surgical interventional procedures for:
Lower renal pole stones 10mm or LESS→
Renal stones 20mm or LESS→
Lithotripsy extracorporeal shockwave (ESWL)
Uretero-renoscopy (URS)
Low calcium diets increase the risk of calcium-containing stone formation because they increase __ reabsorption.
oxalate
also IBD and CF b/c of poor calcium absorption in tract
Nephrolithiasis risk increases with pregnancy
bc urinary stasis s/t increased ___ levels
progesterone
Diagnostics → Renal U/S
BPH management:
Small prostate (< 40 mL) or PSA < 1.5 →
Large prostate (> 40 mL) or PSA > 1.5 →
Tamsulosin (Alpha blocker)
Finasteride (5-alpha reductase inhibitor)
*Inadequate response to monotherapy → Combination of both meds above.
___ ejaculation is a common complication of prostate surgery.
Retrograde
Features of metastatic prostate cancer:
- Lymphedema
Bone pain
mets to spine
The classical triad of renal cell carcinoma consists of
hematuria
flank pain
palpable flank mass
Paraneoplastic syndromes of RCC (4)
EPO (Polycythemia)
Renin (HTN)
PTHrP (Hypercalcemia)
ACTH (hypercortisolism-cushing’s)
*25% present with symptoms related to paraneoplastic syndromes or bone pain/fx & hemoptysis
Indicated in children with febrile UTI
Renal Ultrasound
(If they have another episode then get a
contrast voiding urethrogram)
initial imagine if there is a concern for hydronephrosis and dilated ureter
Renal Ultrasound
Imaging indicated if:
Child with 2+ episodes of febrile UTI
A renal anomaly detected on ultrasound
Contrast voiding cystourethrogram
micturating cystourethrogram
Imaging performed if urethral injury suspected in penile fractures
Retrograde urethrogram
Causes of Low-flow priapism (ischemic priapism)
-
Viagra (Sildenafil– PDE inhibitor)
TrazoBone
Sickle cell disease
Diagnostic for suspected testicular torsion
Duplex ultrasound of the scrotum
___ is contraindicated in boys with hypospadias (ventral/bottom of penis) that includes the foreskin.
Circumcision
*Foreskin may be needed for a skin flap when performing urethroplasty.
Epispadias: urethra on the dorsal (top) penis.
Can present with urinary ____.
incontinence
