urology

Question 1

Mx of overactive bladder

Answer 1

conservative

• reassure and treat UTI
• dietary advice - avoid caffeine, spicy, citrus fruit, carbonated drinks
• BAUS bladder training exercises

medical

• anticholinergics - oxybutin, tolterodine, solifenacin - SE: dry mouth and eye
• B agonist - betmiga - relax bladder = reduced freq

surgery

• intravesicle botox injection
• SNS, neuromodulation, bladder augmentation, urinary diversion/conduit

Question 2

summarise urinary retention

Answer 2

suddenly unable to pass urine - if pressure build up severely = pressure on kidney = obstructive nephropathy and renal failure - check UE and FBC, consider US

pain

catheterise - measure residual - know how acute: 600-800ml = acute. 3-4L = chronic and chance of detrouser functioning in future reduced

DRE - check for ca

culture - UTI common cause

Question 3

cause of urinary retention and walking problems

Answer 3

cord compression - prostate mets

check neurology

refer for decompression immediately

Question 4

what do you prescribe for urinary retention

Answer 4

AB

laxatives - if cause is constipation

A blocker if renal function normal and plan to remove catheter

if renal failure - dont remove catheter

admit and monitor urine output and replace fluids if obstructive nephropathy suspected

Question 5

Mx of low pressure urinary retention

Answer 5

normal UE, Cr, no hydronephrosis

consider a blocker and trial w/o catheter

Question 6

Mx of high pressure urinary retention

Answer 6

high UE and CR

bilateral hydronephrosis

measure UO, BP and body weight

<10% need fluid replacement

never trial without catheter

surgery or long term catheter to unblock the prostate to stop them going into renal failure

Question 7

causes of detrouser overactivity

Answer 7

secondary to BPH, UTI, age related, sensitive to foodgps – caffeine/acidic things eg citrus, usually idiopathic

Question 8

causes of haematuria

Answer 8

infection - UTI

cancer

medical - nephritic syndrome

trauma

kidney stones - rub against the urothelium = microscopic haematuria

Question 9

approach to haematuria

Answer 9

resusitate including transfusion

3 way catheter

need to wash out the clots to completeness otherwise they carry on bleeding (clots splint open the BV) - saline and water

Hx Ex

bloods including clotting and G&S; KUB

MSU if infection signs (dysuria and temp) - AB

Question 10

RF for bladder cancer

Answer 10

smoking

Question 11

criteria for admission with haematuria

Answer 11

frank haematuria with clots

drop in Hb

social circumstances

Question 12

haematuria clinic

Answer 12

2 week wait

If just passing blood in urine and Hb and renal func fine

Question 13

haematuria Ix

Answer 13

FBC, clotting, UE

MSU MC&S

urine cytology

CT urogram (contrast enhanced urogram to check for abnormality in kidney parenchyma)/KUB US

flexible cystoscopy - have to wait until bleeding stops

• treat cause*
• follow up*

Question 14

Answer 14

Renal cell ca from cortext of the kidney

Iff transitional it would be from the pelvis

Question 15

Answer 15

bladder cancer - looks like seaweed

Question 16

presentation of ureteric colic

Answer 16

loin pain

soft abdo

microscopic haematuria

Question 17

causes of ureteric colic

Answer 17

stones

TCC

blood clot

RPF

?BPH/CaP

Question 18

ddx for ureteric colic

Answer 18

AAA

testicular torsion

perforated PU

appendicitis

ruptured ectopic

MI

diverticulitis

prostatitis

Question 19

Mx of ureteric colic

Answer 19

analgesia - morphine +- anti-emetic. Diclofenac if creatinine normal

if stoen <10mm, pain controlled, no sepsis - 2week trial of tamsulosin relaxes sm around distal part of the ureter – help improve spontaneous passage of small ureteric stones

follow up with KUB or IVU or CT KUB - 2weeks if significant obstruction or stones >5mm. otherwise 4weeks

high fluid intake

normal diet - dont cut out dairy

A and E if pain not controlled or pyrexia