urological history and examination Flashcards
what are the causes of pain in the loin/ flank?
obstruction
- stones - starts rapidly and radiates to groin
- retention
- tumour
inflammation
- pyelonephritis
- epidiymitis
- prostatis
testicular or scrotal pain
- torsion
- epididymitis
- orchitis
- uteric stones
- hernia
other non urological causes
- pancreatitis
- back or spinal pain
- irritation of costal nerves
- aneurysm
what is haematuria and what are the different types
the presence of blood in the urine
gross haematuria = visible blood
microscopic haematuria = identified in dipstick or microbiological testing
what does a history and examination in haematuria consist of?
history
- age
- duration
- onset
- associated symptoms- urinary and systemic
- painless or painfull
- amount of bleeding and presence of clots
- trauma
- bleeding from other sites
- bleeding disorders, TB, bilharzias, stone disease
- family histroy of malignancy andd haemotological disorders
- drugs
- coloured food or drinks
- smoking
- occupation - dye industry, rubber industry
examination
- abdominal exam
- genital exam
- PV/DRE if suspicious of prostate cancer
what investigations should you do in haematuria?
urine dip urine culture bloods - FBC, U&E, PSA, INR? flexible cystoscopy upper tract imaging - USS or CT urogram
what are the lower urinary tract symptoms?
you can split them into irritative and obstructive symptoms
irritative
- frequency
- urgency
- urge incontinece
- nocturia
obstructive
- hesitency
- intermittency
- weak prolongues stream
- straining
- incomplete emptying
- urinary retention
- overflow incontinece
what do you need to include in a histroy of scrotal swelling?
pain age swelling duration how it was noticed changes does it disappear associated symptoms increased by cough? heavy lifting chronic cough, constipation, urinary symptoms other masses
what is varicocele
expanded veins around the testicles due to malfunction of valve. it is similar to varicose veins and the causes are useually unknown. it is not useually painful but may feel like a bag of worms and can present problems with fertility
what is urinary retention and what are the different types?
urinary retention is the inability to void urine intentionally
acute urinary retention - this has a new onset and presents with pain that is relieved by drainage through urinary catheter. Large residual volume
chronic urinary retenion - this is less painful due to sensitisation
acute on chronic urinary retention - an acute presentation in a patient with chronic urinary retention
high pressure urinary retention - the high pressure in the bladder causes backflow which goes to the kidneys and causes derranged renal function
low pressure urinary retention - the upper urinary tract is not affected due to competent urethral valves or reduced detruser muscle contraction
what are the causes of urinary retention?
constipation BPH Prostate cancer urethral stricture haematuria drugs - anaesthetics, anticholinergics, sympathomimetics pain - causes adronergic stimulation spinal injury or tumours cauda equina pelvic surgery pelvic fracture neurological - MS, spina bifida post surgury for SUI pelvic mass pelvic prolapse
how is urinary retention treated
immediate catheterisation
measure the volume that is drained
treat the underlying cause
chronic - monitor after catheterisation for post obstructive dieurisis and check renal function
when are catheters used?
for diagnosis
- collection of urine to prevent contamination by skin flora (usually in females)
- measurement of post volume retention useually by ultrasound
- instilation of radiographic contrasts for cystograms or athrograms
- urodynamic studies
for treatment
- relief of obstruction
- management of haematuria
- drainage of bladder after surgery
- act as a stent after surgery
- CISC in neurological conditions
- accurately monitor urine output
- administer intravesical treatments
what are the different types of catheters?
suprapubic
urinary
what catherter related problems may occur?
infection blockages bladder stones haematuria malignancy bladder spasm tissue reaction
what is the typical presentation of kidney/ uteric stones?
severe pain - useually loin to groin colic nature nausea restless haematuria
investigations
- urinalysis
- MSU
- bloods
- CT KUB
how is kidney / uteric stones managed
conservative management
- pain management
- NSAIDS, opioids
- antiemetics
- antibiotics
urgent decompression is needed in
- sepsis
- renal failure
- persisting pain
- failure to progress
- solitary kidney
- bilateral calculi
invasive treatment
- uteric stent insertion
- uteroscopy and laser fragmentation
- ESWL
- PCNL
