Urology Flashcards
What is hematuria?
presence of blood in urine
MICROSCOPIC: > 5 RBCs/HPF
MACROSCOPIC: hemorrhage into urinary tract will give urine red or brownish volor
What is false hematuria?
discoloration of urine from food (beetroot), myoglobin, & some drugs (rifampicin)
What are the classifications of hematuria?
1- microscopic of macroscopic (gross)
2- intermittent or persistent
3- initial, total, or terminal
4- painful or silent
What does initial, total, or intermittent hematuria indicate?
initial: lower UT cause
total: pre-renal, renal, or ureteric cause
terminal: severe bladder irritation (caused by stone or infection)
Which type of hematuria is more dangerous, silent or painful?
SILENT: malignancy
painful: stones probably
What are the causes of hematuria?
PRE-RENAL: bleeding disorder
RENAL
- urinary stones
- renal tumors
- renal injury
- renal infarct
- glomerulonephritis
POST-RENAL
- bladder tumor
- cystitis & UTI
- Benign Prostatic Hyperplasia
- carcinoma prostate
What investigations should be done for a patient presenting with hematuria?
LAB
- Urine analysis: to confirm & search for cause of hematuria
- Blood tests: CBC, bleeding profile, renal function tests (urea, creatinine)
RADIOLOGICAL
- ultrasound
- CT abdomen
- IVU
INSTRUMENTAL
- cystourethroscopy
What are the types of pain that could present in any urological pathology?
RENAL PAIN -> dull aching pain in loin
URETERIC COLIC -> acute pain felt in loin radiating to ipsilateral iliac fossa & genitalia
BLADDER PAIN -> suprapubic dull aching pain made worse by bladder filling
PERINEAL PAIN -> penetrating ache in perineum & rectum (associated with inguinal discomfort)
PELVIC PAIN -> chronic prostitis or chronic prostate pain syndrome or prostadynia
URETHRAL PAIN -> burning in vulva or penis (especially during voiding)
What are the causes of renal pain?
Stretching of capsule of kidney due to:
- renal inflammation
- acute obstruction
- stones
What is the cause of ureteric pain?
- passage of ureteric stone
- blood clot or sloughed renal papilla gives identical pain
the site of pain is a guide to the progression of a stone
What is the cause of bladder pain?
- inflammation of the bladder -> extreme discomfort at end of micturition
- irritation of trigone of the bladder -> sharp pain referred to the tip of the penis
What are the common symptoms in benign prostatic hyperplasia?
- hesitancy: difficulty to start micturition
- intermittency: interrupted micturition
- dribbling: slow leak of urine after finishing micturition
What’s the difference between precipitancy & incontinence?
- precipitancy: inability to hold micturition & increase desire
- incontinence: uncontrolled escape of urine without desire
What are the common LUTS?
- Dysuria: difficulty in starting micturition
- Urgency: intense desire to micturate due to bladder irritation
- Strangury: painful desire to micturate
- frequency: frequent passage of urine without actual increase in the total volume of urine
- anuria: complete absence of urine production
- retention: failure of the bladder to evacuate urine
- polyuria: increase urine output >3L/day
- oliguria: decrease urine output <400mL/day
What are the urine function tests that should be preformed?
- serum creatinine: 0.5-1.2mg
- blood urea: 20-40mg
- creatinine clearance test
What is PSA?
tumor marker specific to prostate
How should a patient be prepared for a plain x-ray?
- enema, laxative is given the day before
- patient asked to fast in order to reduce bowel gas shadows
What are the normal interpretations seen on a plain x-ray?
- boney parts
- kidney shadows
- ureteric line
- psoas shadow
What are the causes of an obliterated psoas shadow in an plain x-ray?
- scoliosis
- TB spine with cold abscess
- enlarged kidney
- malignancy
- splenic injury (in left sided shadow)
- retroperitoneal tumors
What does ultrasonography demonstrate?
- size of kidney
- thickness of cortex
- presence & degree of hydronephrosis
- intrarenal masses
- stones (bright ultrasonic reflection & acoustic shadow)
- volume of urine
What is the golden tool to visualize prostate & guide biopsy?
transrectal ultrasonography
What method of investigation is best for detection of ureteric stones?
CT
What is the significance of CT?
- diagnose ureteric stones
- in renal carcinoma -> size & site of tumor
- > degree of invasion
- > enlarged lymph nodes at renal hilum
- > invasion of renal vein & vena cava - CRUCIAL in initial staging & follow up of men with testicular cancer
How is IV urography used?
- renal function must be normal
- overnight fasting for 8 hours
- contrast UROGRAFFIN is injected IV
- x-ray is taken in 1-5 minutes then after 15 minutes then 20-30 mins
What interpretations are seen in IV urography?
- horse shoe kidney -> flower vase appearance
- ureterocele -> adder (cobra) head appearance
What are the indications for retrograde pyelography?
- failure of showing any secretions in IVU as late as 72 hours film
- doubt about intraluminal lesion
- renal function deficient
- urothelial tumors
better delineation of anatomy due to more concentration of dye
What is the indication of antegrade pyelography?
nephrostomy tube to drain obstructed infected kidney or provide access to percutaneous nephrolithotomy
What are the indications of micturating cystourethrography?
- vesicoureteric reflux
- posterior urethral valve
What is the procedure that should be done in micturating cystourethrography?
- catheter is passed into bladder
- dilute iodine dye is infused
- x-ray taken during micturition
- free reflux is looked for
What does urethrography demonstrate?
- ascending urethrography -> extent of a urethral stricture & presence of false passages & diverticula
- assess the extent of urethral trauma AFTER HEALING
- contraindicated in trauma & active infection due to danger of contrast passing into circulation
Which method of investigation is diagnostic & therapeutic?
CYSTOSCOPY
- examines urethra, bladder, ureteric orfice
contraindicated in -> acute cystitis & prostatitis
complications -> uretheral injury, bleeding, & water intoxication
