Urology Flashcards
Define urinary tract infection
An infection aywhere in the urethra, bladder, ureters or kidney
Presentation of UTI in babies
Fever
Lethargy
Irritabilty
Vomiting
Poor feeding
Urinary frequency
Presentation of UTI in children
Fever
Abdo pain - suprapubic
Vomiting
Dysuria
Urinary frequency
Incontinence
Define acute pyelonephritis
Systemic signs of infection
Renal angle tenderness
Management of UTI
<3 months - IV abx
Trimethoprim
Nitro
Cefalexin
Amoxicillin
Investigations in recurrent UTI
US
DMSA scan
Micturating cystourethrogram - Vesico-Ureteric reflux 0
Define vululovaginitis
Inflammation and irritation of the vulva and vagina
Causes of vululovagnitis
Wet nappies
Chemicals or soaps
Tight clothing - traps moisture
Poor toilet hygiene
Constipation
Threadworms
Pressure on area - horse riding
Heavily chlorinated pools
Presentation of vulvulovaginitis
Soreness
Itching
Erythema around labia
Vaginal discharge
Dysuria
Constipation
Leukocytes but no nitirtes
Management of vulvulovaginitis
Supportive symptomatic management
Avoid washing
Avoid perfume
Good toilet hygiene
Keep dry
Emollients
Loose cotton clothing
Treat constipation
Avoid activities that exacerbate
Define nephrotic syndrome
Nephrotic syndrome occurs when the basement membrane of the glomerulus becomes highly permeable to protein allowing protein to leak from the blood into the urine.
Classic triad in nephrotic syndrome
Low serum albumin
High urine protein
Oedema
(deranged lipid profile with high cholesterol, high blood pressure, hyper coagulabilty)
Causes of nephrotic syndrome
Minimal change disease!!
Focal segmental glomerulosclerosis
Membranoproliferative glomerulonephritis
2ndry - henoch schonlein purpura, diabetes, infection
Management of nephrotic syndrome
High dose steroids
Low salt diet
Diuretics
Albumin infusions
Antibiotic prophylaxis
Complications of nephrotic syndrome
Hypovolaemia
Thrombosis
Infection
Acute or chronic renal failure
Relapse
Define nephritis
Inflammation within the nephrons of the kidney
Causes of nephritits
Post streptococcal glomerulonephritis
IgA nephropathy - Berger’s disease
Define post-streptococcal glomerulonephritis
Streptococcal antigens, antibodies and proteins get stuck in the glomeruli of the kidney and cause inflammation leading to acute kidney injury
Often 1-3 weeks post tonsillitis
Define IgA nephropathy
Related to henoch-schonlein purpura - IgA vasculitis.
IgA deposits in the nephrons cause inflammation leading to AKI
Define haemolytic uraemic syndrome
Occurs when there is a thromboss within small blood vessels - usually triggered by the shiga toxin
Classic triad in haemolytic uraemic syndrome
Haemolytic anaemia
Acute kidney injury
Thrombocytopenia
Presentation of haemolytic uraemic syndrome
Post gastroenteritis - usually bloody, 5 days ago
Reduced urine output
Haematuria
Abdominal pain
Lethargy
Confusion
Oedema
Hypertension
Bruising
Management of haemolytic uraemic syndrome
Medical emergency
Supportive management
Renal dialysis
Antihypertensives
Careful management
Blood transfusion
Define enuresis
Involuntary urination often nocturnal
Primary nocturnal - has never been dry at night
Secondary nocturnal - begins wetting bed when previously been dry for 6 months
Causes of primary nocturnal enuresis
FH!
Overactive bladder
Fluid intake
Failure to wake
Psychological distress
Secondary causes - constipation, UTI, learning disability
Causes of secondary nocturnal enuresis
UTI
Constipation
TIDM
Maltreatment
New psychosocial problems - school, home.
Pharmalogical management of enuresis
Desmopressin - reduces urine volume
Oxybutinin - anticholinergic
Imipramine - relaxes bladder?
Define polycystic kidney disease
Genetic condition leading to formation of fluid filled cysts in the kidney
Commonly autosomal dominant but recessive is found in neonates
Very poor prognosis - 1/3 die in neonatal period
Presentation of ARPKD
In utero
Cystic enlargement of the renal collecting duct
Oligohydramnios - pulmonary hypoplasia
Congenital liver fibdrosis
In life
Liver failure
Portal hypertension
Progressive renal failure
Hypertension
Chronic lung disease
Define Wilm’s tumour
A specific type of tumour affecting the kidney in children - typically under 5
Presentation of Wilm’s tumours
Abdominal pain
Mass in abomen
Haematuria
Lethargy
Fever
Hypertension
Weight loss
Investigations of Wilm’s tumour
Ultrasound
CT or MRI for staging
Biopsy for definitive diagnosis
Management of Wilm’s tumour
Surgical removal!
Adjuvant therapy to reduce size
Define posterior urethral valve
A pathology where there is tissue at the proximal end of the urethra that causes obstruction to the outflow of urine. Found in newborn boys. Creates back pressure causing hydronephrosis
Presentation of posterior urethral valve
Difficulty urinating
Weak stream
Chronic retention
Palpable bladder
Recurrent infections
Impaired kidney function
Bilateral hydronephrosis
Oligohydramnios - pulmonary hypoplasia
Presentation of posterior urethral valve
Difficulty urinating
Weak stream
Chronic retention
Palpable bladder
Recurrent infections
Impaired kidney function
Bilateral hydronephrosis
Oligohydramnios - pulmonary hypoplasiaI
Investigations in posterior urethral valve
Abdo ultrasound
Micturating cystourethrogram
Cystoscopy
Management of posterior urethral valve
Catheter for acute management
Ablation of extra tissue
Define undescended testes
Also known as cryptorchidism
Where testes do not escend from their point of development in the abdomen throgh the inguinal canal
Risk factors for undescended testes
FH
Low birth weight
Small for gestational age
Prematurity
Maternal smoking history
Management of undescended testes
Normally resolves in 3-6 months
Orchidopexy
Define hypospadias
Condition affecting males where the urethral meatus (opening) is abnormally displaced to the ventral side of the penis towards the scrotum.
Management of hypospadias
Do not circumcise
Surgery at 3-4 months
Define hydrocele
A collection of fluid within the tunica vaginalis
Clinical signs of hydrocele
Soft
Non-tender
Unilateral
Infront and below teste
Transilluminate with light
Management of hydroceles
US
Usually resolve
Surgical repair?
