Urological Emergencies and Outflow Tract Obstruction Flashcards
Define acute urinary retention?
Inability to urinate with increasing pain
What is acute urinary retention often a complication of?
Benign prostatic hyperplasia
First treatment of acute urinary retention?
Need a catheter
With acute loin pain as well as urinary tract what other causes should you consider?
AA Malignancy Ovarian/ testicular Torsion Ectopic pregnancy GI cause Lower resp pain
Intense loin to groin pain suggests?
Renal colic
Treatment of renal colic?
NSAIDS e.g. diclofenac
Small stones < 0.5cm diameter usually pass spontaneously if hydration is maintained
Larger stones may need intervention
Indications to treat renal colic urgently?
Pain is unrelieved by medication, pyrexia, persistent nausea/ vomiting, high grade obstruction
Frank haematuria =
Bladder cancer until proven otherwise
What must be ruled out in acute scrotum?
Testicular torsion
Testicular torsion peaks at what age?
13-15yo
Presentation of testicular torsion?
sudden, severe unilateral scrotal pain, associated vomiting
Only way to confirm something is testicular torsion or not?
Scrotal exploration
If torsion can untwist
What can mimic testicular torsion in slightly younger boys?
Torsion of the appendix testes (hydatid of Morgani)
Presentation of torsion of appendix testes?
Similar to testicular torsion potentially slightly less severe
There will be the blue dot sign
Blue dot sign?
Torsion of the appendix testes
Treatment of torsion of appendix testes?
Supportive
Describe benign prostatic hyperplasia?
This occurs often in men over 60 yo and aetiology not fully understood. Microscopically hyperplasia affects the glandular and connective tissue elements of the prostate.
Enlargement of the gland stretches and distorts the urethra obstructing bladder flow.
Describe symptoms men with benign prostatic hyperplasia may complain of?
When bladder is filling: frequency, urgency, nocturia
When trying to pass urine: hesitancy, poor flow intermittent flow, sensation of incomplete emptying, post micturition dribbling
What suggest high pressure chronic retention in those with BPH?
bedwetting
Red flag signs in suspected BPH that may actually suggest bladder cancer?
Haematuria
Suprapubic pain
Recurrent UTIs
With suspected BPH what should you make sure to ask about?
Pain in back and neurological symptoms
Need to rule out cauda equina etc
Describe exam and investigations for BPH?
Abdo exam > enlarged bladder
DRE > Benign prostate characteristically feels smooth
Investigations: urine culture, serum PSA, renal function, US, pressure flow studies of bladder emptying
Medical management of BPH?
Alpha blockers e.g. tamsulosin act to relax prostate and bladder smooth muscle
5 alpha reductase inhibitors e.g. finasteride which block conversion of testosterone to dihydrotestosterone the androgen primarily responsible for prostatic growth and enlargement
Anticholinergics which inhibit bladder smooth muscle contraction
Beta agonist inhibits bladder smooth muscle contraction
Describe surgical treatment of BPH?
Transurethral resection of prostate gland or holmium laser enucleation of prostate
Priorities in acute retention or retention with overflow in BPH?
Relieve pain and catheterise the bladder
3 things that can promote stone formation?
Urinary stasis, infection and indwelling catheters
Stones form if stone forming substances _________
reach high enough concentrations to crystallise out of solution
Most common stones?
Calcium stones
Predisposing factors to calcium stones?
Low urine volume
high urine calcium and oxalate
Low urine citrate (citrate usually helps inhibit stone formation)
Hypercalciuria occurs in _________ of patients with stones and usually idiopathic and due to ________
65%
increased intestinal calcium absorption
Urate stones form in what type of urine?
Acidic urine
Why may you get acidic urine and urate stones?
May be idiopathic
Due to enzyme defects
Rapid cell turnover/ death e.g. malignancy and chemo
Loss of alkaline bowel contents in diarrhoea, ileostomy, or laxative abuse
UTI stones are composed of ________ usually due to infection with __________
magnesium, ammonium phosphate with varying amounts of calcium
Proteus
Why do cystine stones form?
Due to autosomal recessive defect in the dibasic amino acid transporter which reduces cystine reabsorption causing cystinuria
What kidney diseases are associated with stones?
PKD, Medullary sponge kidney and renal tubular acidosis
Drugs associated with kidney stones?
Loops, antacids, vit d and c, acetazolamide and theophylline
Presentation of renal stones?
asymptomatic often Pain: renal colic Haematuria UTI Urinary tract obstruction
Calculi get stuck at 3 predictable sites which are ________
pelviureteric junction
pelvic brim (where ureter kind of turns as goes over the pelvis)
vesicoureteric junction
Investigations for stones?
XR US Contrast CT Check for UTI Check renal function
Stones _____ usually pass spontaneously
less than 0.5cm in diameter
Long term treatment of calcium stones?
Decrease calcium, sodium and animal protein in diet and maintain hydration
Long term treatment of urate stones?
Investigate if underlying cause, decrease dietary purines (eg. red meats) increase urine alkalisation with sodium bicarbonate or potassium citrate, allopurinol to inhibit rate production
Long term treatment of cystine stones?
Good fluid intake, alkalisation of urine with sodium bicarbonate
Acute pain relief for renal colic?
NSAIDS- diclofenac
Bladder stones are usually associated with ______ and present with _______
Bacteruira
Frequency dysuria and haematuria
Presence of renal stones is usually checked for with?
USS
