Urology Flashcards
Kidney stones:
Anatomical factors-in form of blockage or obstruction. If stagnation of urine then this can lead to form of kidney stone
Biochemical-hyperthyroid, hypercalcaemia, gout
-Over 80% are calcium oxalate
Why are they important?
- Gram neg sepsis is life threatening
- Kidney stones can lead to diagnosis of metabolic disorders like PUJ obstruction or strictures or horse shoe kidneys.
Diagnosis:
Non visible haematuria-good positive but bad negative
WBC and nitrates to rule out infection that could be involved with kidney stone
CT KUB-no contrast, safe unless pregnant and short and gold standard for giving diagnosis. Do without contrast as stones are white on CT and so is contrast so would be hard to see
Radioopaque shadow in left kidney. Plain KUB xray
Right-non contrast CT scan. White inside kidney is bilateral kidney stones
Renal colic
3 natural areas of stone impaction
Stones will form in kidney and once reach bladder they can be passed.
Less than 5mm can pass. 5-10mm will get stuck in natural narrowings
- PUJ
- ureter crosses iliac vessels
- As ureter opens into bladder
Renal colic management
- First line is NSAIDs then second is opiates
- In pregnant women, don’t do CT but do US and MRI if needed.
Treatment:
- If non septic and no symptoms can manage conservatively
- Tamulosin-alpha blocker can help passage of small ureteric stone (less than 1cm). Alpha receptors are found in distal ureter so relaxes these when blocked improving chance of these stones coming out.
- ESWL-shock wave treatment
Conservative
ESWL
Bottom take x ray pics and once determined location of stone we can shoot shockwaves at stone and these bits can pass.
Usually for stones 1cm
No anaesthetic, done on outpatient
GA needed
Designed for much bigger stones
Haematuria-blood in the urine
- Cancer until proven otherwise but could be due to infection, trauma, urological procedure.
- Clot retention or can they pass urine?
Management
- Encourage them to drink to flush out blood
- May have to admit if they have clot retention ie clots block bladder. So have to drain bladder using 3 way catheter and use third channel to flush bladder out and drain it.
If still worried about cancer do 2 tests:
- On left can see tumour involving the left kidney
- Also in haematuria clinics do cystoscopy under local anaesthetic and can see bladder cancer here
- CT contrast-looks for cancer
- CT non contrast-looks for kidney stones
Background of bladder cancer
Transitional cell carcinoma is the most common
Management
- TNM classification
- Starts on inner lining and progresses into bladder wall
- Muscle layer determines what treatment. Superficial if not invading muscle and anything reaching muscle=muscle invading bladder cancer.
- T1 can be managed by TURBT-go with camera and shave inside and then continue flexible cystoscopy surveillance. May need to give intravesical chemo or immunotherapy to maintain. Immunotherapy is injecting BCG into bladder producing immune response there which basically fights the superficial bladder cancer
- If invades bladder muscle we have to do Radial cystectomy-remove bladder (and prostate in men) and divert urine using ileal conduit urinary diversion and also offer radiotherapy
BPH and LUTS
Pushes urethra and narrows it causing urinary symptoms.
LUTS:
Bladder has 2 roles: storage of urine and passing of urine. Think Fundhips or for this FUN SHIPS
Definitions
To be able to use terminology BPH you need histology. Better to say BPE for enlargement unless you have histology results.
BPH is prevalent more in elderly men
Assessment:
Smooth-BPE
Craggy-cancer
Frequency volume chart-bladder diary to monitor fluid intake and output. Cut down on caffeine as this irritates the bladder and so this may be causing their issues.
Urine in bladder may cause back pressure on the kidneys
Management
Cut down bladder irritants like caffeine
Most common medications are the first 2-tamsulosin and finasteride (blocks conversion of testosterone to dihydrotestosterone which is more active form and by blocking this you can shrink prostate)
Anticholingeric and beta 3 agonists are mainly for bladder storage issues. Doesn’t effect prostate
PDE5-in smaller doses can help with urinary trouble secondary to BPE eg viagra
Rezum-steam into prostate to shrink it down
PAE-beads in vessels supplying prostate to shrink it
TURP
Go up urethra and core apple from inside to allow it to pass
Urinary retention
Percuss bladder and will be dull not resonant as it should be.
Put probe on tummy and it will give reading of how much urine in bladder
If catheter doesn’t go in, may need to use suprapubic catheter and if this fails may need to do it guided with a camera.
Management
What catheter?
