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Year 3 Surgery > Urology > Flashcards

Urology Flashcards

1
Q

What are some causes of haematuria?

A

Infection
Malignancy
Renal calculi
Trauma

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2
Q

What should be asked about in a history for haematuria?

A

Associated sx - suprapubic pain, fever, flank pain
Smoking
Drug history
Occupational history - industrial carcinogens
Travel history - schistosomiasis

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3
Q

What are the initial investigations for haematuria?

A

Urine dip
Bloods - FBC, U&Es, clotting, PSA
Deranged renal function => urine protein levels

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4
Q

When should someone be referred for haematuria?

A

> 45yrs with visible haematuria no evidence of UTI, or visible which persists after tx for UTI
60yrs non-visible haematuria w/ dysuria/raised WCC
Nephrological cause, falling GFR, CKD, proteinuria, <40yrs with HTN

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5
Q

What are renal stones typically comprised of?

A

Calcium oxalate/phosphate
Struvite - typically staghorn calculi
Cysteine
Urate

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6
Q

Where are renal stones likely to be located?

A

Narrow points

Pelviureteric junction, crossing the pelvic brim, vesicoureteric junction

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7
Q

How do renal stones present?

A 
Sudden onset loin to groin pain 
Colicky due to peristalsis 
Nausea and vomiting 
Haematuria 
Signs of infection
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8
Q

What initial investigations are done for ureteric colic?

A

Urine dip - blood, signs of infection

Bloods - FBC, CRP, U&E, urate and calcium levels (stone composition)

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9
Q

What imaging is done for ureteric colic?

A

Non-contrast CT KUB - identify stone, assess for alternative pathology
USS - assess for hydronephrosis

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10
Q

What is the initial management for ureteric colic?

A

Fluid resuscitation
Analgesia - opiate/NSAIDs PR
IV abx if signs of infection
Should pass spontaneously if <5mm

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11
Q

When should someone with renal stones be admitted?

A

Stone >5mm
Uncontrolled pain
Evidence of infection
Post-obstructive AKI

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12
Q

What is the management for ureteric stones => obstructive uropathy/significant infection?

A

Stent insertion via cystoscopy

Nephrostomy

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13
Q

What is the definitive treatment for ureteric/renal stones?

A

Extracorpeal shock wave lithotripsy - for small stones, stone broken up by shock waves
Percutaneous nephrolithotomy - renal stones only, fragmented via lithotripsy
Flexible uretero-renoscopy - laser lithotripsy => fragments then removed

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14
Q

What are complications of ureteric/renal stones?

A

Infection
AKI
Recurrence => scarring and loss of kidney function

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15
Q

What advice should be given for specific stones?

A

Calcium - check PTH levels
Urate - avoid red meat, may need allopurinol
Cystine - genetic testing, homocystinuria

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16
Q

What are different types of incontinence?

A 
Stress
Urge 
Mixed 
Overflow 
Continuous
17
Q

What is stress incontinence?

A

Leakage of urine when intra-abdominal pressure exceeds urethral pressure
Due to weakness of the pelvic floor muscles

18
Q

What are risk factors for stress incontinence?

A

Post-partum damage to pelvic floor muscles and urethral sphincter
Constipation, obesity, post-menopausal

19
Q

What is urge incontinence?

A

Detrusor hyperactivity => overactive bladder

Uninhibited bladder contraction => rise in intravesicular pressure => leakage of urine

20
Q

What are causes of urge incontinence?

A

Neurogenic eg stroke
Infection, malignancy, idiopathic
Drugs eg cholinesterase inhibitors (used to treat Alzheimer’s; donepezil, rivastigmine)

21
Q

What is overflow incontinence?

A

Progressive stretching of bladder wall => loss of bladder sensation
Loss of ability to identify the need to urinate => build up of pressure and dribbling of urine

22
Q

What causes overflow incontinence?

A

Chronic urinary retention

Prostatic hyperplasia, spinal cord injury

23
Q

What initial investigations should be done for incontinence?

A

Urine dipstick - infection, haematuria

Post-void bladder scan

24
Q

How are urodynamics used to assess incontinence?

A

Measure intra-vesicular and intra-abdominal pressure, allows measurement of detrusor muscle pressure => suggests urge incontinence

25
Q

What do outflow urodynamics assess?

A

Measures detrusor muscle activity against urine flow rate

High intra-vesicular pressure with poor urine flow => overflow

26
Q

What lifestyle advice should be given for incontinence?

A

Weight loss, reduce caffeine intake, smoking cessation

27
Q

How can stress incontinence be managed?

A

Pelvic floor muscle training

If not responsive/unsuitable for surgery => duloxetine can be trialled => stronger urethral contractions

28
Q

How can urge incontinence be managed?

A

Bladder training for at least 6 weeks

Anti-muscarinic drugs eg oxybutinin/tolterodine

29
Q

What are causes of acute urinary retention?

A

BPH, prostate ca, urethral strictures
Constipation
Neuro causes - peripheral neuropathy, MS, Parkinson’s
Drugs - anti-muscarinics, spinal/epidural anaesthesia

30
Q

How does acute retention present?

A

Inability to pass urine, suprapubic pain
Signs of infection
Recent change to meds
Palpable bladder, may have an enlarged prostate

31
Q

What investigations are done in acute retention?

A

Post void bladder scan - shows volume of retained urine
Bloods - FBC, CRP, U&Es
Need to send off CSU
USS to look for hydronephrosis

32
Q

How is acute retention managed?

A

Catheter, measure amount drained
Treat underlying cause
BPH - tamsulosin
Signs of infection - abx

33
Q

What are complications of acute retention?

A

AKI, hydronephrosis
High pressure urinary retention
Post-obstructive diuresis

34
Q

What is high pressure urinary retention?

A

High intra-vesicular pressure overcomes the anti-reflux mechanism of bladder
Urine backs up into ureters => hydronephrosis/hydorureter
Deranged renal function

35
Q

What is post-obstructive diuresis?

A

Kidneys over-diurese post catheterisation due to loss of medullary conc
Leads to worsening AKI
If producing >200ml/hr should have ~1/2 of their urine output replaced

Year 3 Surgery (6 decks)

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