Urology Flashcards
What is obstructive uropathy?
Blockage preventing urine flow through the ureters, bladder and urethra. Leads to kidney damage = post renal AKI.
What is hydronephrosis?
Swelling of the renal pelvis and calyces of kidney due to backpressure up the ureters. Causes renal angle pain and mass in kidney area.
USS, CT or IV urogram (X ray with IV contract collecting int he urinary tract)
How does urinary tract obstruction present?
LOWER eg bladder/urethra: Difficulty or inability to pass urine (e.g., poor flow, difficulty initiating urination or terminal dribbling)
Urinary retention, with an increasingly full bladder
Impaired renal function on blood tests (i.e. raised creatinine)
UPPER (ureters): flank pain, reduced urine output, vomiting.
What investigations would you do in obstructive uropathy?
USS KUB
What is the renal angle and what does tenderness there suggest?
aka costovertebral angle. 12th rib + vertebral column at the back, lower part of the kidneys.
Give 4 causes of upper urinary tract obstruction.
Kidney stones
Tumours pressing on the ureters
Ureter strictures (due to scar tissue narrowing the tube)
Retroperitoneal fibrosis (the development of scar tissue in the retroperitoneal space)
Bladder cancer (blocking the ureteral openings to the bladder)
Ureterocele (ballooning of the most distal portion of the ureter – this is usually congenital)
Give 4 causes of lower urinary tract obstruction.
Benign prostatic hyperplasia (benign enlarged prostate)
Prostate cancer
Bladder cancer (blocking the neck of the bladder)
Urethral strictures (due to scar tissue)
Neurogenic bladder
What is neurogenic bladder? Give 3 causes and complications.
Abnormal function of the nerves innervating the bladder and urethra causing overactivity or underactivity in the detrusor muscle of the bladder and the sphincter muscles of the urethra.
Causes are: Multiple sclerosis Diabetes Stroke Parkinson’s disease Brain or spinal cord injury Spina bifida
Complications are:
Urge incontinence
Increased bladder pressure
Obstructive uropathy
How do you manage obstructive uropathy?
Remove/bypass obstruction:
Upper –> Nephrostomy = thin tube inserted cutaneously into kidney –> ureter, to drain urine.
Lower –> catheter - urethral or suprapubic (cutaneous, above pubic bone)
Give 4 complications of obstructive uropathy.
Pain
Acute kidney injury (post-renal)
Chronic kidney disease
Infection (from bacteria tracking up urinary tract into areas of stagnated urine)
Hydronephrosis (swelling of the renal pelvis and calyces in the kidney)
Urinary retention and bladder distention
Overflow incontinence of urine
What is the management of hydronephrosis?
Idiopathic - PUJ narrowing. Treat with pyeloplasty
Percutaneous nephrostomy - tube through skin and kidney into ureter under radiological guidance
Anterograde ureteric stent - through kidney into ureter under radiological guidance
Consent a patient for a urinary catheter.
What is it - tube inserted into urethra to bladder.
Why - indications include:
Urinary retention due to a lower urinary tract obstruction (e.g., enlarged prostate)
Neurogenic bladder (e.g., intermittent self-catheterisation in multiple sclerosis)
Surgery (during and after)
Output monitoring in acutely unwell patients (e.g., sepsis or intensive care)
Bladder irrigation (e.g., to wash out blood clots in the bladder)
Delivery of medications (e.g., chemotherapy to treat bladder cancer)
Post void bladder scan - >500mls.
Who: a nurse or doctor
When: short or long term, TWOC - remove catheter, monitor UO, use bladder scan to ensure minimal urine left in bladder.
Where: inserted through urethra sits in bladder.
How would you counsel a patient about starting tamsulosin?
Action - reduces prostate size to allow urine to flow out from bladder through urethra.
PO daily tablet
SEs - postural hypotension.
How do you manage catheter-associated UTIs?
Take sample using aseptic technique from catheter/port (not from the bag) Asymptomatic bacteriuria not treated
Symptomatic - 7 days abx, change catheter.
What is BPH?
Benign prostatic hyperplasia of stromal epithelial cells of prostate. Presents with LUTS
What are LUTS? Give 5 examples.
Lower Urinary Tract Symptoms:
Hesitancy – difficult starting and maintaining the flow of urine
Weak flow
Urgency – a sudden pressing urge to pass urine
Frequency – needing to pass urine often, usually with small amounts
Intermittency – flow that starts, stops and varies in rate
Straining to pass urine
Terminal dribbling – dribbling after finishing urination
Incomplete emptying – not being able to fully empty the bladder, with chronic retention
Nocturia – having to wake to pass urine multiple times at night
IPSS = international prostate symptom score used to assess severity of LUTS.
What investigations would you do for LUTS?
Digital rectal examination (prostate exam) to assess the size, shape and characteristics of the prostate
Abdominal examination to assess for a palpable bladder and other abnormalities
Urinary frequency volume chart, recording 3 days of fluid intake and output
Urine dipstick to assess for infection, haematuria (e.g., due to bladder cancer) and other pathology
Prostate-specific antigen (PSA) for prostate cancer
What is PSA? What causes raised PSA?
Prostate specific antigen. 75% false positive for prostate ca 15% false negative. Causes of raised PSA: BPH, prostatitis, UTI, cycling, prostate stimulation/ejaculation.
How can you distinguish between benign and cancerous prostate on PR?
Firm/hard, craggy, irregular, loss of central sulcus.
Benign: smooth, symmetrical, soft, central sulcus
How is BPH managed?
Symptom dependent
Alpha blockers eg tamsulosin relax smooth muscle, rapid improvement in symptoms
5-alpha reductase inhibitors eg finasteride
TURP= transurethral resection of prostate
TEVAP=transurethral electrovaporisation of the prostate
HoLEP - Holmium laser enucleation of the prostate
Open prostatectomy via abdominal or perineal incision.
