Urology Flashcards
Urinary Tract Obstruction
Interference with flow of urine at any site along the urinary tract
* Can be anatomical or functional
3
Most common causes of urinary tract obstructions
Renal calculi
Prostate enlargement
Urethral strictures
7
Complications of urinary obstruction
Hydronephrosis
Hydroureter
UTI & cystitis
Residual urine volumes
Low bladder wall compliance
Vesicouretral reflux (backflow)
Pain
What are renal calculi & aetiology
Massess of crystals, protein and other substances that form within the urinary sustem
Low water intake, dehydration, high salt/sugar intake, little exercise, obesity, gout, altered pH
Pathophysiology of renal calculi
Supersaturation of urine, causing crystalisation of salts and proteins (unable to dissolve) forming a solid precipitate
Can cause obstruction & pain
3
Types of stones
Calcium oxalate & phosphate
Struvite stones
Uric acid stones
Manifestations of renal calculi
Renal colic
Haematuria
Diagnosis of renal calculi
Stone/urine analysis
IV pyelogram or US
Abdominal CT
Treatment of renal calculi
High fluid intake
Decrease intake of stone forming substance
Stone removal
Aetiology of prostate enlargement
Prostatitis
Benign prostatic hyperplasia
Prostate neoplasia
Pathophysiology of prostate enlargement
Partial obstruction of urethra causes detrusor muscle to increase force of contraction
If blockage continues, afferent nerves in the bladder walls are adversely affected = urgency & increased detrusor contractions
Collagen deposition in SM of detrusor causes an inability to stretch and contract
Manifestations of prostatic enlargement
Increased frequency
Nocturia
Poor & intermittent force of stream
Urgency
Incomplete emptying
UTI and Causes
UTI is an infection of any part of the urinary system
Causes: retrograde bacterial movement, often faecal (E. Coli)
Natural prevention of UTI
- Bacteria washed out by urine during micturition
- Low pH & high osmolality of urea & epithelial lining secretions = bactericidal
- Ureterovesical junction (closes during bladder contraction to prevent reflux)
- Long urethra & prostatic secretions in men (antibacterial)
Pathophysiology of UTI
- Normal flora from bowel, vagina or perineum entering urinary tract
- Irritation of epithelium, causing pain, inflammation and infection
- Vasodilation & hyperaemia (swelling, inflammation, hematuria)
- Increased permeability (oedema)
- Fullness, small voids, urgency, frequency (oedema on stretch receptors)
- Cell immune response (+leukocytes)
Risk factors of UTI
- Young women, shorter urethral length, sexual intercourse, pregnancy, past hx
- IDC, urinary retention/stasis, obstructions, dehydration, incontinence
- Compromised immune system (DM, CKD), antibiotic use
Types of UTI
Asymptomatic bacteriuria
Cystitis
Pyelonephritis
Catheter-associated
Upper UTI
Lower UTI
Manifestations of UTI & in elderly
Urine frequency, urge & oliguria
Feeling of fullness
Dysuria
Cloudy, red urine
Pain, fever, chills, N/V (Upper UTI)
Elderly: abdominal discomfort, cognitive impairment/delirium
Diagnostic studies for UTI
- Hx & physical examination
- Dipstick urinalysis (+nitrites, leukocytes, RBC)
- Urine culture and sensitivity (for confirmation & antibiotic sensitivity)
- Imaging (CT urography, ultrasonography)
Treatment of UTI
Medication therapy (cefalexin, amoxicillin + clauvulanic acid)
Adjuvant therapy (urine alkaliniser, cranberry juice)
Increased fluid intake
Good hygiene, postcoidal voiding
Probiotic yoghurt with lactobacillus to restore commensal flora
Follow up care for UTI
Repeat urine examination for bacteriuria (required for pregnant women)
* If recurrent uncomplicated cystitis occurs 2x in 6 months or 3x in 12 months = US & specialist
* If recurrent in postmenopause = check for pelvic organ prolapse and vaginal atrophy (mimic symtoms)
* If in elderly = screen for DM
Asymptomatic bacteriuria
Bacteria present in urine (>105 CFU/mL) without No signs & symptoms
Usually in elderly
No treatment except pregnancy or urological patients
Acute cycstitis, aetiology & risk factors
Most common UTI
Inflammation of the bladder that occurs due to bacterial retrograde movement into the bladder, usually E.coli
Risks: women, sexually active, pregnancy, elderly, antibiotics that disrupt flora, DM, IDC, incomplete voiding, neurogenic bladder, obstruction
Types of acute cystitis
Uncomplicated: symptomatic infection in individual with structurally and functionally normal UT
Complicated: symptomatic in men OR abnormality (obstruction, CKD, DM, immunosuppression, catheter)
Pathophysiology of acute cystitis
Bacterial irritation of the bladder epithelium causing infection & inflammatory response (vasodilation, hypereamia, permeability = redness, swelling, oedema of mucosal lining of bladder, hematuria)
Oedema stimulates stretch receptors, causing a feeling of fullness and urgency on small urine volumes
Manifestations of acute cystitis
- Dysuria (mucosal inflammation)
- Urgency & frequncy, bladder fullness (oedema)
- Flank pain (referred inflammatory pain)
- Hematuria
- Cloudy urine (leukocytes)
- Odour (bacteria)
Diagnosis and Treatment
Urinalysis & urine culture
Tx: antibiotics, repeat cultures, prevention (pass urine after sex, wipe away from vagina)
Acute pyelonephritis
(summary)
Aetiology, PP, M, Types
Infection of the renal pelvis and interstitium with positive urine culture
A: by stones, vesicoureteral reflux or pregancy (E. coli, proteus, pseudomonas)
PP: WBC infilration, inflammation, renal oedema, purulent urine, involvement of blood stream
M:
* Mild: low grade fever, no N/V, pain (oral tx)
* Severe: systemic symptoms (fever, N/V, severe pain, injury (IV tx, admission)
Chronic pyelonephritis
Recurrent kidney infections, usually occurs with other renal pathology
PP: inflammation causes tubule destruction, atrophy, scarring and kidney disease, pain, HTN
Dx: IVPyelography, US
Glomerular disorders, causes and most common type
Any condition affecting the glomerulus
C: immune response, toxins, drugs, vascular disorders, systemic diseases, metabolic disorders
Most common: glomerulonephritis
Glomerulonephritis & aetiology
Inflammation of the glomerulus
A: caused most commonly by immunological abnormalities, also drugs, vascular/systemic diseases (DM, lupus), viral
Most common cause of end stage kidney disease
Acute glomerulonephritis
Usually following streptococcus infection
Deposition of antigen-antibody complexes on basement membrane, triggering Cā and antibody mediated damage to epithelium of glomerulus
Acute glomerulonephritis manifestations
Hematuria, proteinuria, low GFR, oliguria, HTN, oedema
Most recover without permanent damage
Chronic glomerulonephritis
Several glomerular diseases that progressively lead to end stage kidney disease due to sclerosis and interstitial injury
Strong presence of hematuria and proteinuria
Nephrotic syndrome
Glomerular injury resulting in excretion of > 3.5g protein in urine/day
Oliguria & causes
Low urine output less than 30mls/hr
Caused by HoTN, dehydration, blood volume loss, UTI, obstruction
Enuresis & types
Involuntary passage or urine (diurnal or nocturnal)
Primary: continence never established
Secondary: aquired due to a number of factors
* UTI, neurological, structural abnormalities, DM/DI, CKD, sleep distubances/REM, stress
Diuretics & types
Treat HTN and fluid volume excess by modifying kidney function (inducing diuresis and NaCl excretion through reabsorption inhibition)
Loop, thiazide, K-sparing
Loop diuretics
Frusemide (oral, IV)
Potent inhibitor of Na and Cl at ascending limb of loop of Henle, & convoluted tubules
* Better for oedema as this transporter absorbs more Na than others in the nephron
Adverse: electrolyte imbalance (hyponatraemia, hypokalaemia, hypermagnasemia) - serum levels must be monitored
Thiazide diuretics
Hydrochlorothiazide (oral)
Inhibit absorption of Na and Cl in the proximal segment of the distal convuluted tubule
* Excrete water, Na, Cl, K, Mg but decrease excretion of uric acid and Ca
* Less potent for oedema but first choice for HTN
K-sparing diuretics
Amilodide, spironolactone
Act on distal tubules and collecting ducts with reduced diuretic capacity BUT spare K excretion therefore are used in combination with other diuretics
Oxybutynin
& side effects
Oral
Urinary antispasmodic drug - enuresis & detrusor overactivity
Inhibit muscarinic action of acetylcholine on bladder SM
SE: palpitations, tachy, constipation, dizziness
Amoxicillin-Clavulanic acid (Augmentin Duo)
Oral penicilin antibiotic for UTI infections
Has bactericidal effect on sensitive organisms during active multiplication
SE: N, D, headache
Cephalexin
Oral cephalosporin antibiotic for genitourinary infections including acute prostatitis (streptococci, E. coli)
Work by inhibiting bacterial wall synthesis
SE: N
Chronic Kidney Disease & PP
Progressive loss of renal function due to systemic or renal disease, staged by level of GFR
PP: renal injury leads to loss of nephrons = increased glomerular permeability and filtration
* Proteinuria increases tubule injury, causing inflammation and scarring and increased angiotensin II
CKD Manifestations
Uraemia
High plasma creatinine
Oedema & HTN (electrolyte disturbances)
Hypocalcaemia, hyperlipidaemia, immune suppression, headache, impaired cognition, bad breath, easy bruising
Neurogenic bladder
Bladder dysfunction caused by neurological disorder
Can be overactive, flaccid, leakage
Acute Kidney Injury & types
Explain most common
Sudden decline in kidney function, indicated by low GFR, uremia and high plasma creatinine
* Prerenal: most common, from impaired blood flow causing cell injury (hypovolaemia, haemorrhage, HoTN, cardiac failure)
* Intrarenal
* Postrenal
Types of functional and structural abnormalities
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Hypospadias: urethral meatus located on ventral side of penis
Polycycstic kidneys: cyst formation causes cell proliferation, BM remodelling and oedema
Renal agenesis: absence of one of both kidneys
Vesicoureteral reflex: issue with junction
**Enuresis: **involuntary urine passage beyond bladder control age
Upper vs Lower UTI
Upper UTI affects renal parenchyma, pelvis and ureters, and causes systemic symptoms (pain, fever, chills)
Lower UTI has local but not systemic symptoms
Nursing Assessment of UTI
Health history
* Previous UTI, UT abnormalities, pregnancy, cancer, STI
* Antibiotics, antispasmodics, IDC/IMC, urinary hygiene
* S: N/V, anorexia, chills, frequency, urge, nocturia, back pain, dysuria, burning
Objective Data
* Fever, hematuria, odour, pyuria, tender on palpation, +(bacteria, RBC, leukocytes, nitrites), US/CT/IVP
Intervention
* Increase fluid intake, local heat to lower back
* Educate about medication course, SE, monitor own SS, persistant S or signs of recurrent infection
* Monitor for tx efficacy and delirium in elder
Health promotion
* At risk individuals, regular voiding & empty bladder completely, wipe front to back, adequate fluids, cranberry juice, post coidal void, temp dicontinue use of diaphragm
Prevention of CAUTI
- Avoid unecessary catheterisation & early removal
- Aseptic technique
- Wash hands before and after
- Routine perineal care
- Avoid incontinent episodes
