Urology Flashcards
Common causes of haematuria
- Tmours
- Renal calculi
- BPH
- Trauma
- Coagulopathy
- congenital or acquired abnormalities (Polycystic renal disease, urethral stricture)
____% of macroscopic haematuria is caused by urological cancer.
A single episode of microscopic haematuria has a risk of approximately ___% of being associated with malignancy.
What implications does this have for malignancy screening?
20% of macroscopic haematuria is caused by urological cancer.
A single episode of microscopic haematuria has a risk of approximately 4% of being associated with malignancy.
Therefore all patients with haematuria should be screened for malignancy, especially maxcroscopic
If someone has haematuria, what do we want to know from the hx?
- painfull or painless
- ?fever
- ?weightloss or anorexia
- Is the blood
- initial urethra or prostate
- terminal bladder base or prostate
- mixed anywhere
- Trauma
- Voiding symptoms
- Previous renal tract hx
- smoking
Investigations of someone with haematuria
- FBC, U&E’s, LFT, CRP
- MSU
- USS or CT IVU and a flexible cystoscopy is required
- ?PSA
What are the common pathogenic causes of a UTI
- E.coli
- Staphylococci
- Enterococci
- Proteus mirabilis
How can protease mirabilis cause stones
it is a urease producing orgnaism, and alkalinises the urine, precipitating phosphates from the urine to cause stones
What are the three major routes that urinary tract infection takes?
- ascending infection; from urethra, commonest
- haematogenous spread: TB and some perinephric abscesses
- Direct extension fistulas from colon or vagina
What mechanisms do bacteria use to infect the bladder?
- Vagina and periurethra normally colonised by lactobaccilus, these get replaced with recurring infections
- Type-1 fimbrae allow bacterial adherence to the bladder uro-epithelium
- P-fimbrae bind their P-blood group antigens on the epithelial surface and are associated with renal infection
- Bacteria release endotoxinss causing a decrease in ureteric perstalsis allowing for bacteria to ascend
What things can increase your host susceptibility for UTI’s
Children who express P1 antigens are at a greater risk of pyelonephritis, whilst those expressing ABO and Le B antigens are less susceptible
A high epithelial count on MSU can indicate?
An inadequate MS sample
Can a diagnosis of UTI can be made with lower bacterial counts if a single pathogenic organism is cultured
yes
Pyuria without organisms suggests what?
Possible renal calculi or renal tuberculosis
Investigation for renal TB?
Requires at least 3 early morning urines (EMU) for acid-fast culture
What are common contaminents of a MSU that don’t actually indicate infection?
Lacto bacilli, streptococci, diptheroids, gardenerella, mycoplasma
acute bacterial cystitis: Treatment
- A 3-day course of:
- Trimethoprim
- Nitrofratoin
- Amoxicillin Clavulanate
- Norfloxacin
Acute pyelonephritis: Treatment
- A 7-day dose of oral antibiotics +/- fluid replacement and admission:
- Gentamicin: for patients with normal kidney function
- Amoxicillin clavulanate (augmentin) or ceftriaxone
- Ciprofloxacin: well absorbed and in non-vomiting patients can be given orally
What things can you do to relieve symptoms of a UTI, and what do you need to be careful of…
High fluid intake and alkalinisation of urine
Mixtures of sodium bicarbonate and citrate can relieve dysuria
****alkaline urine decreases the efficacy of nitrofuratoin
Suitable regiemes of prophylactic antibiotics for recurrent UTI’s?
- Low dose antibiotic last thing at night OR
- Post-coital miturationa dn low dose antibiotic
Agent’s
- trimethoprim 100mg for 6-12 weeks
- nitrofuratoin 50mg for 6-12 weeks
How does epididymitis present and what is it usually caused by?
Common cause of scrotal pain (espeically in their 20’s) that comes on rapidly. Associate with dysuria, fever and sometimes urethral discharge.
Often caused by STI’s
- Neisseria gonorrhoea or Chlaymydia
- Coliform (in elderly)
What can be a non-infective cause of epididimytis?
Heavy lifting can cause urinary reflux into the vas and cause a chemical epididymitis
On examination of a patient with epididymitis, what would you classically see?
Tenderness localised to the epididymis which is enlargedm while the testes are normal/non-tender.
** in more advanced cases both the testis and epididymis may be enlarged/tender and the scrotal skin erythematous and indurated.
Congenital causes of obstructive nephropathy?
- Congenital obstruction of posterior urethral valves
- Spina bifida (s2,3,4 damage → poor detrusor function of bladder)
- Strictures or reflux of vesicoureteral or pelvicouteric junction
What are the stages of compensation and decompensation the bladder undergoes in response to obstruction or stasis distally?
“the stages of compensation”
Compensation
- Bladder musculature hypertrophies: Up to 2x, in order to balance increasing resistance
- Initially bladder emptying is still possible
- Trabeculation occures
- Pressure continues to increase (upto 2-4x the normal 30cms water)
- Diverticula occur as mucosa is pushed between the superficial muscle bundles
Decompensation
- Detrusor muscle may decompensate
- incomplete emptying
- Residual urine forms post-voidally
- Painful urinary rentention OR chronic urinary retention result
What is trabeculation of the bladder
When as a compensatory response the bladder wall becomes hypertrophied with individual muscle bundles standing out, becoming taut and giving a coarsely interwoven appearance to the mucosal surface.
What type of urinary calculi are common and can they be seen on xray (radiopaque)
90% are radiopaque and most contain calcium
(10% gallstones can be seen on xray)
