Urology Flashcards
Commonest stone type
Calcium oxalate (85%)
hypercalciuria, hypercalcaemia, hyperoxaluria or hypocitraturia
Magnesium ammonium phosphate (struvite) stones
Secondary to UTI that breakdown urea into CO2 and ammonia
–> Alkalising urine
Proteus
Stone <0.5cm
Should pass conservatively
Pelviureteric junction obstruction (idiopathic hydronephrosis)
Moderate hydronephrosis causes ill-defined renal pain or ache that may be exacerbated by drinking large volumes of liquid (Dietls’ Crisis).
May produce a large painless mass in the loin;
Severest form: volume of urine in the hydronephrotic sac may simulate free fluid in the peritoneal cavity
Mx:
Either laparoscopic or open pyeloplasty
Retroperitoneal fibrosis
May cause ureteric obstruction and hydronephrosis
-Ureter often difficultto define on imaging
Causes:
Idiopathic
-Mediastinal fibrosis and Dupuytren’s contracture may coexist
-RAISED ESR
Malignant infiltration
Reactive fibrosis
-Radiotherapy, resolving blood clot, or extravasation of sclerosants
Innervation for detrusor contraction
S2- S4
Reach the sphincter either by the pelvic plexus or via the pudendal nerves
Intra-peritoneal rupture of bladder
Dome rupture –> intra-peritoneal leak
Ileus
Abdominal distension
Trauma with full bladder i.e. alcohol-fuelled fights
Management of bladder rupture
Intra-peritoneal
-laparotomy and repair
Extra-peritoneal
- Catheter to relieve any tension
- Conservative management, catheter in for minimum 6-10 days
Cancer of the bladder
Most common = transitional cell
Then: squamous cell carcinoma due to chronic inflammation e.g. schistomsomiasis
Rarely: Adenocarcinoma in urachal remnant in dome of bladder or form colorectal metastasis
Transitional cell carcinoma
Most common bladder and ureter cancer
Papillary tumours are less aggressive superficial cancers
Ulcerating are much more aggressive.
Management of superficial bladder tumours Ta, T1
Transurethral resection of the bladder tumour down to detrusor muscle is desired
If not endoscopic diathermy possible
Intra-vesical mitomycin C useful for multiple lesions
Regular check cystoscopies requried
Treatment of carcinoma in situ bladder cancer
Intra-vescial bacille Calmette-Guerin
BCG
Management of invasive bladder cancer T2-T3
<70 years –> Radical cystectomy
> 70 years –> Radiotherapy
Cystectomy always necessitates urinary diversion. Where the urethra can be retained, it may be possible to construct a new bladder from colon or small bowel
(orthotopic bladder replacement),
Treatment of T4 bladder cancer with fixed organ invasion
Palliative
Resection not possible
Mitomycin C
Single intra-vesical dose of mitomycin C post transurethral resection of superficial bladder cancer improves outcomes