Urology Flashcards
How might the position of patient differ in someone with renal colic versus abdominal pain?
renal colic- cannot find comfortable position therefore rolling around
abdo pain- staying still in one position
List two sites of stone impaction
PUJ
Pelvic brim
VUJ
How can struvite stone present?
recurrent UTIs
malaise
weakness
loss of appetite
List three differential diagnoses for renal colic
Acute abdo- gallstones, pancreatitis, AAA
Pyelonephritis
Bacterial cystitis
Gynae
Referred pain- orchitis
Chest- lobar pneumoni, rib fractures
Which imaging do you do for renal colic? (the most sensitive investigation)
Non-contrast CT KUB
What does radio-opaque mean?
presence of calcium within the stone
List one radioopaque stone
ca phosphate
ca oxalate
List one radiolucent stone= transparent
uric acid
(struvite stone= infection, cystine are relatively radiolucent)
Which co-infection is indinavir stones associated with?
HIV
What is the treatment for renal stones?
Analgesia- NSAIDs, opiates
Alpha blockers
Stent or percutaneous nephrostomy tube
surgery
List two indications for intervention to remove stone?
pain unresponsive for analgesia
related fever
renal function impairment
obstruction unrelieved >4 weeks
What is the first intervention for kidney stone?
shock wave therapy- ESWL
If ESWL fails, what is the next option?
PCNL- percutaneous nephrolithonomy
What is one indication for ESWL?
pregnancy
pacemaker
distal obstruction
uncorrected coagulopathy
Name one indication for PCNL
staghorn calculi
stone >2cm
multiple stones
Which surgical treatment for kidney stones is safe in pregnant women?
ureterenoscopy
Which treatment is safe for coagulopathies?
ureterenoscopy
List three surgical treatments for stones
cystoscopy
open surgery
ureterenoscopy
nephrectomy!!
List two complications of urinary retention
infection, AKI, haematuria
List two complications of chronic urinary retention
hydronephrosis
CKD
bladder detrusor hypertrophy
List three risk factors for acute urinary retention
BPH
Constipation
Cancer- prostate, pelvic
Infection- cystitis
Trauma
Medications
List one medication that can lead to urinary retention
antimuscarinics (decreased bladder sensation and detrusor contractility)
sympathomimetics
opioids (decreased bladder sensation)
Signs of acute urinary retention when palpating and percussing bladder?
dull to percussion
enlarged palpable bladder
List two aspects of examination in acute urinary retention
abdo exam- suprpubic tenderness and palpate/percuss bladder
PR exam
vaginal exam
neuro exam- neuro impairment
List three investigations for acute urinary retention
bladder USS
urinary catheterisation
urinalysis
U+Es
FBC- infection, haematuria
What is the treatment for acute urinary retention?
urethral catheterisation
suprapubic catheter
treat underlying cause
Red flags for malignancy with haematuria
old age
male
cigarette smoking
chemical exposure- benzenes
history of pelvic radiation
List two differentials for glomerular haematuria
IgA nephropathy- Berger’s disease
Thin glomerular basement disease
hereditary nephritis- Alport syndrome
List two causes for non-glomerular haematuria
urinary obstruction
transitional cell carcinoma
pyelonephritis
renal cell cancer
UTI
BPH
Strenuous exercise
List two causes for pseudo haematuria
food- beetroot, blackberries
menses
drug related
Painless haematuria. What MUST you rule out
transitional cell carcinoma
List three differentials for the acute scrotum
testicular torsion
acute epididymitis
acute orchitis
abscess
hernia
hydrocele
