Urology Flashcards
What is the diagnosis of an acutely painful testis until proven otherwise?
A torsion.
Normally occurs in 10-20 yr old men.
Difficult to distinguish from epidiymo-orchitis, but there will be no fever, or leukocytosis (DO NOT WAIT FOR BLOODS TO GET BACK)
What is the mechanism for testicular torsion?
The testi twists on the spermatic cord - no blood supply and a build up of venous blood causing irrevesible ischemia after 6hrs
What are the different types of renal calculi?
Calcium oxalate (75%) - stones covered in sharp projections and cause bleeding. occur in alkaline urine.
Calcium magnesium ammonium phosphate (15%) - often associated with UTI. Grow very quickly and can cause stag horn calculi.
Urate (5%) - occur in acid urine.
Cystine (2%) Usually multiple, occur with renal tubular defects.
What is the classic pain associated with renal colic?
Loin - groin
What are the predisposing factors for renal calculi?
- Food - tea, chocolate, rhubarb, strawberries (increased oxalate levels)
- dehydration - job, summer,
- drugs - loop diuretics, antacids, acetazolamide, steriods, theophylline, aspirin, thiazides, allopurinol, vit c and d
- recurrent UTIs (in magniesium phosphate calciuli)
- Metabolic abnormalities - hypercalcuria/aemia (hyper PTH, neoplasia, sarcoidosis, Addison’s, Cushing’s, lithium,) hyperuricosuria, hyperoxaluria, cystinuria, renal tubular acidosis
- rental tract abnormalities - pelviureteric junction obstruction, hydronephrosis, calyceal diverticulum, horeshoe kidney, ureterocele, vesicoureteric reflux, uretheral stricture
- foreign bodies - stents, catheters
- family history
What is the analgesia best used in renal colic?
PR diclofenac
What are the indications for admission for renal calciuli?
Infection + stone Obstruction Uncontrolled analgesia AKI Anuria
How long on average does it take for a renal stone to pass?
Multiple size in mm by 4
>7mm unlikely to pass on its own
What % of kidney stones are seen on xray?
90%
90% have haematuria
What are the causes of a high PSA?
BPH, prostatitis, UTI, urinary retention, instrumentation, biopsy, TURP, prostate cancer
How can lower urinary tract symptoms be devided?
Obstructive: weakness of stream, hesitancy, terminal dribbling, interittency, feeling of an incomplete bladder emptying
Irritative: urgency, frequency, nocturia, incontinence
Which area of the prostate increased in BPH?
The inner (transitional) lobes
What is the management of BPH causing outflow obstruction?
Self help: avoid caffeine and alcohol, relax when voiding, void twice in a row, control urgency by using distraction techniques, increase time between voiding to retrain bladder.
Transurethral rescetion of prostate (TURP) - <30g)
Drugs - alpha blockers: decrease smooth muscle tone, 5alpha reductase inhibitors: decreases testosterone conversion to dihydrotestosterone, helps reduce size of prostate
What are the causes of chronic urinary retention?
Large prostate, pelvic malignancy, rectal surgery, DM, CNS disease,
What are the causes of acute urinary retention?
large prostate, urethral stricture, anticholingerics, alcohol, constipation, post op, infection, neurological, carcinoma
What volumes of urine can be in the bladder in acute and chronic retention?
600mL in acute
1500mL in chronic - can be painless
What are the risks of a TURP?
Haematuria/ haemorrhage Haemtospermia Hypothermia Urethral trauma/ stricture Infection Erectile dysfunction Incontinence Clot retention retrograde ejaculation Post TURP syndrome: low Na and low temp
When reliving a patient of their acute retention what points need to be considered?
Hyperkalaemia
Metabolic acidosis
Post obstructive diuresis - need to match input/output
Sodium and bicarbonate loosing nephropathy - the kidney is injured by the retention, need to replace in for out. hold any nephrotoxic drugs
Infection
What can cause urinary tract obstruction?
Outside the wall - pelviureter compression:
Tumours, diverituclitis, AAA, retroperitoneal fibrosis, accidental ligation of the ureter, retrocaval ureter, prostatic obstruction, phimosis
Within the wall:
Pelviuretic neuromuscular dysfunction, ureteric stricture, ureterovesical stricture, congential mega ureter, congenital bladder neck obstruction, neuropathic bladder, urethral stricture, congenital urethral valves, pinhole meatus
What are the clinical features of the different levels of urinary obstruction?
Acute upper tract:
Loin to groin pain. may be superimposed infection +/- loin tenderness or an enlarged kidney
Chronic upper tract:
Flank pain, renal failure, superimposed infection. Polyuria may occur due to impaired urinary concentration
Acute lower tract:
Acute retention, severe suprapubic pain, distended bladder
Chronic lower tract:
urinary frequency, hesitencey, poor stream, terminal dribbling, overflow incontinence, distended bladder ++
How do you differentiate between scrotal lumps?
Cannot get above it - inguinalscrotal hernia
Separate and cystic - epididymal cyst (>40yrs, painless, no treatment unless large)
Separate and solid - varicocele (dilated vein of pampiniform plexus, most common on L side. no treatment unless causing infertility)
Testicular and cystic - hydrocele ( collect of fluid in tunica vaginalis, if primary associated with a patent processus vaginalis but can be assocatied with trauma, infection, tumour)
Testicular and solid - tumour or orchitis (v painful)
What are the causes of orchitis?
Chlamydia, Ecoil, mumps, gonorrhoea, TB
Where is the growth felt in prostate cancer?
Peripherally
What is the difference between phimosis and paraphimosis?
Phimosis is when thee foreskin cannot be retracted and it occuldes the meatus.
Paraphimosis is then the foreskin has been retracted but cannot be replaced. This prevents venous return and can cause oedema ad ischemia to the glans penis
