Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Renal > Urology > Flashcards

Urology Flashcards

1
Q

3 common regions for renal stones to get deposited

A

1) Pelviureteric junction (coming out of renal pelvis)
2) Pelvic brim
3) Vesicoureteric junction (going into bladder)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Incidence and peak age, sex of renal stones

A

Lifetime incidence up to 15%
Peak age 20-40
M:F = 3:1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Types of stones

A

Calcium oxalate -75%
Magnesium ammonium phosphate (struvite/triple phosphate) - 15%
Also urate and more

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

6 x presentation features of renal stones

A

1) Renal Colic
2) UTI (increased risk if voiding impaired)
3) Haematuria
4) Proteinuria
5) Sterile pyuria
6) Anuria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Renal colic features

A

Excruciating ureteric spasms - loin to groin pain
Nausea and vomiting
Often cannot lie still

Renal obstruction - felt in loin
Mid-ureter - like appendicitis or diverticulitis
Lower ureter - bladder irritability and pain in scrotum, penile tip or labia
In bladder or urethra - pelvic pain and dysuria, Strangury (desire but inability to void)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Examination of kidney stones

A

No tenderness usually

May be renal angle tenderness, esp. on percussion if there is retroperitoneal inflammation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Urine dip in kidney stones

A

Usually +ve for blood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Imaging of stones

A

Spiral non-contrast CT is the best (helps exclude ruptured AAA which presents similarly)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Initial management of stones

A

Analgesia - diclofenac or opioids
IV fluids - help pass stone
Antibiotics eg. cefuroxime or gentamicin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Management of stones

A

Most past spontaneously - increase fluid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Management of stones >5mm/pain not resolving

A

Medical expulsive therapy - nifedipine or alpha-blocker (tamsulosin)
This promotes expulsion and reduces analgesia requirements

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

If still not passing

A

Extracorpeal shockwave lithotripsy - shatters stone - SE: renal injury and may cause DM
Ureteroscopy using basket (if pregnant)
Percutaneous nephrolithotomy - keyhole surgery to remove stones when large, multiple or complex (intracorporeal lithotripsy or stone fragmentation)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Prevention of stones

A

Drink plenty
Normal Ca2+ dietary intake- low stimualtes oxalate excretion
Low salt diet

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Prevention of calcium stones

A

Thiazide diuretic used to decrease calcium excretion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What increases oxalate levels? (therefore avoid if oxalate stones)

A 
Chocolate
Tea
Rhubarb
Strawberries 
Nuts 
Spinach
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Causes of urinary tract obstruction

A

1) Luminal - stones, sloughed papilla, blood clots, tumour (renal, ureteric or bladder)
2) Mural - stricture, neuromuscular dysfunction
3) Extra mural - Abdominal/pelvic mass or tumour, retroperitoneal fibrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Features of acute upper tract obstruction

A

Loin pain radiating to groin
May be superimposed infection which can cause loin tenderness
Or enlarged kidney

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Features of chronic upper tract obstruction

A

Flank pain
Renal failure
Superimposed infection
Polyuria due to impaired urinary concentration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Features of acute lower tract obstruction

A

Acute urinary retention
Suprapubic pain
Distended palpable bladder - dull to percuss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Features of chronic lower tract obstruction

A 
Urinary frequency, hesitancy
Poor stream, terminal dribbling 
Overflow incontinence 
Distended palpable bladder
PR may feel large prostate
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Imaging of UT obstruction

A

USS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Treatment of UUT obstruction

A

Nephrostomy or ureteric stent
A-blockers (tamsulosin) to reduce stent-related pain from spasm
Pyeloplasty - widen PUJ - if idiopathic PUJ obstruction

23
Q

Treatment of LUT obstruction

A

Catheter insertion - urethral or suprapubic
Treat underlying cause
NB: Large diuresis after relief of obstruction - can cause temporary salt-losing nephropathy

24
Q

What is urinary retention?

A

Not emptying the bladder

Due to obstruction or decreased detrusor power

25
What happens in acute urinary retention?
Bladder usually tender and containing about 600ml of urine
26
Causes of acute UR
``` Prostatic obstruction - usual cause in men Urethral strictures Anticholinergics Psychological 'holding' Alcohol Constipation Post op - pain/inflammation or anaesthetics Infection Neurological - cauda equina syndrome Carcinoma ```
27
Examination in acute UR
Prostate - DRE Abdominal exam Perineal sensation - Cauda test
28
Tricks to aid voiding
``` Analgesia Privacy on wards Ambulation Standing Running taps or in a hot bath ```
29
If tricks fail
Catheterise Start alpha-blocker - tamsulosin after 2-3 days trial without catheter - continue tamsulosin
30
Prevention of acute UR
Finasteride - decreased prostate size | Tamsulosin
31
Presentation of chronic UR
More insidious and may be painless Bladder capacity can be >1.5L Overflow incontinence, acute on chronic retention, lower abdominal mass UTI Renal failure
32
Causes of chronic UR
Prostatic enlargement - common Pelvic malignancy DM CNS disease
33
Management of chronic UR
Only catheterise if pain, urinary infection or renal impairment Otherwise treat underlying cause
34
Prevalence of benign prostatic hyperplasia
Common - 24% aged 40-64 | 40% 65+
35
What happens in BPH
Benign nodular or diffuse proliferation of musculofibrous and glandular layers of the prostate Inner zone enlarges (unlike outer zone enlargement in prostate carcinoma)
36
Features of BPH
LUTS - nocturia, frequency, urgency, post-micturition dribbling, poor stream, overflow incontinence, haematuria and bladder stones - UTI
37
Tests in BPH
Rule out cancer - PSA and transrectal USS + biopsy
38
Lifestyle changes in BPH
Avoid caffeine and alcohol | Relax when voiding, void twice in a row, practise "holding on"
39
Medication what and when?
Mild disease and when waiting for surgery A-blockers - tamsulosin (doxazosin, terazosin) SE: ED, drowsiness, depression, dry mouth, hypotension, weight gain) 5alpha-reducatase inhibitors -eg. finasteride - prevent testosterone conversion to dihydrotestosterone - reduce prostate size - excreted in semen SE: impotence and decreased libido
40
Surgery in BPH
Transurethral resection of prostate - 14% become inpotent - beware of bleeding and TURP syndrome (absorption of washout causing hyponatraemia and fits) Transurethral incision of prostate - same benefit as TURP but less risk to sexual function and less destruction - best option for small glands Retropubic prostatectomy - open operation if prostate very large Transurethral laser-induced prostatectomy - may be as good as TURP
41
Warnings to patients having TURP
Haematuria - first 2 weeks, haematospermia, hypothermia, urethral stricture, post TURP syndrome, infection, ED, incontinence, retrograde ejaculation Avoid driving and sex for 2 weeks
42
Main cause of incontinence in men
Enlargement of prostate | Urge incontinence
43
2 types of incontinence in women
Stress incontinence - when raised intraabdominal pressure - eg. coughing, laughing - common in pregnancy and following birth Urge incontinence/overactive bladder syndrome - urge to urinate quickly followed by emptying of bladder
44
Things which precipitate urgency/leaking in urge incontinence
``` Coming Home Cold Sound of running water Coffee, tea, coke Obesity ```
45
Cause of urge incontinence
Detrusor overactivity (central inhibition decreased or peripheral sensitisation) or a bladder muscle problem
46
Management of stress incontinence
Pelvic floor muscle exercises - 8 contractions 3x day for 3 months Intravaginal electrical stimulation
47
Surgical management of stress incontinence
Tension-free vaginal tape - to stabilise mid-urethra | Urethral bulking
48
Medical management of stress incontinence if surgical not an option
Duloxetine (SNRI)
49
Management of urge incontinence
Look for spinal cord problems and for vaginitis Bladder training and weight loss = important Male = consider condom catheter
50
Medical management of urge incontinence
Antimuscarinics eg. tolterodine (solifenacin or oxybutynin) Topical oestrogen - raise bladders sensory threshold B3 adrenergic agonist - mirabegron - if antimuscarinics CI or unsuccessful
51
Management of urge incontinence if original medical treatment unsuccessful
BOTOX Percutaneous posterior tibial nerve stimulation - if BOTOX not wanted
52
What type of stones does Proteus cause
Magnesium ammonium phosphate (struvite) stones | - often form large calculi (staghorn)
53
What type of stones are associated with hyperparathyroidism
Calcium phosphate renal stones

Renal (9 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions