Urology Conditions Flashcards
What is Dysuria?
Pain that arises from irritation of the urethra that is felt during micturition
What is Frequency?
Increased passage of urine during daytime
What is Nocturia?
Increased passage of urine at night
What is Urgency?
An uncontrollable desire to micturate that might be associated with incontinence
What is Acute Pyelonephritis?
An upper urinary tract infection
What are some predisposing factors of Acute Pyelonephritis?
Outflow Tract Obstruction (Stone) Vesicoureteric reflux Renal/Bladder Calculi Diabetes Mellitus Neurogenic Bladder Dysfunction
What are some clinical features of Acute Pyelonephritis?
Pyrexia Rigors Flank Pain Dysuria Malaise Anorexia Dipstick +ve MSU
What is Acute Cystitis?
Acute inflammation of the urinary bladder
What is the main cause of Acute Cystitis?
Lower Tract infection due to coliform bacteria, more common in females
What are some clinical features of Acute Cystitis?
Dysuria Frequency Urgency Suprapubic Pain Lower back Pain Incontinence Microscopic Haematuria
What is Urethritis?
Inflammation of the Urethra
What is the cause of Urethritis?
STIs
What are some clinical features of urethritis?
Dysuria
Meatal Pruritis
3-10 days after contact
Discharge
What is Acute Urinary Retention?
A new onset inability to pass urine which leads to pain and discomfort, with significant residual volumes
What are some causes of Acute Urinary Retention?
BPH UTI Constipation Severe Pain Anti-Muscarinics Spinal Anaesthesia Neurological
What are the clinical features of Acute Urinary Retention?
Suprapubic Pain
Inability to Micturate
Palpable Distended Bladder
What investigations should be ordered for Acute Urinary Retention?
Post-void bladder scan
FBC, CRP, U+E, MSU/CSU
USS - ?Hydronephrosis
What are the management options for acute urinary retention?
Immediate Catheterisation, then TWOC after 24/48h
Treatment of underlying cause
What is a possible complication of acute urinary retention?
Excess diuresis post-catheterisation giving AKI
What is Chronic Urinary Retention?
The painless inability of the patient to pass urine
What are some causes of Chronic Urinary Retention?
BPH - (Men) Urethral Strictures Prostate Ca Pelvic Prolapse/Masses - (Women) Neurological - MS/Parkinsons
What are some clinical features of Chronic Urinary Retention?
Painless urinary retention Weak stream Hesitancy Reduced Functional Capacity Overflow incontinence Palpable distended bladder
What are some appropriate investigations for Chronic Urinary Retention?
Post-void bladder scan
FBC, CRP, U+E
USS - ?Hydronephrosis
What are the management options for Chronic Urinary Retention?
Long Term Catheter
Intermittent Self-Catheterisation
Suprapubic Catheter
Correction of underlying cause
What are possible complications with Chronic Urinary Retention?
Recurrent UTIs
Bladder Calculi
CKD
What is Urinary Incontinence?
The involuntary leakage of urine
What are the subtypes of Urinary Incontinence?
Stress Urge Mixed Overflow Continuous
What is Stresss incontinence?
Leakage of urine when intra-abdominal pressure exceeds the urethral pressure
What are some causes of stress incontinence?
Post-partum
Constipation
Obesity
Pelvic Floor surgery
What is urge incontinence?
Overactive bladder leads to bladder contraction giving a rise in intravesical pressure and urine leakage
What are some causes of urge incontinence?
Neurogenic
Infection
Malignancy
Idiopathic
What is Mixed incontinence?
A mixture of Stress and Urge incontinence
What is Overflow incontinence?
A complication of chronic retention, leading to a reduced bladder sensation
Which conditions commonly give overflow incontinence?
BPH
Spinal cord injury
What is Continuous incontinence?
There is a continuous leakage of urine, usually due to a congenital malformation
What investigations should be performed for incontinence?
Post-void USS
Urodynamic assessment
Cystoscopy
What are some conservative management options of incontinence?
Pelvic Floor muscle training
Bladder training
Anti-muscarinics
What are some surgical options for incontinence?
Botox injections
Vaginal tape
Sacral nerve stimulators
What are Lower Urinary Tract Symptoms (LUTS)
A term used to describe an array of symptoms affecting the control and quality of micturition
What are some causes of LUTS in males?
BPH UTI Malignancy Detrusor Weakness Chronic Prostatitis Urethral stricture External compression Neurological disease
What are some causes of LUTS in females?
UTI Menopause Malignancy Detrusor weakness Urethral stricture External compression Neurological disease
How can LUTS be sub-divided?
Storage symptoms
Voiding symptoms
What are some storage symptoms?
Urgency
Frequency
Nocturia
Urinary incontinence
What are some voiding symptoms?
Hesitancy Intermittency Straining Terminal dribbling Incomplete emptying
What are some conservative management options for LUTS?
Regulate fluid intake
Urethral milking/double voiding
Pelvic floor exercises
Bladder training techniques
What are potential complications with LUTS?
Infection
Renal/Bladder Calculi
Renal failure
Bilateral Hydronephroses
What are the potential subtypes of bladder cancer?
Transitional Cell Carcinoma
Squamous Cell Carcinoma
Adenocarcinoma
Sarcoma
What are the 4 layers of the bladder wall, going inner - outer?
Transitional Epithelium (Urothelium)
Lamina Propria
Muscularis Propria
Fatty Connective Tissue
What are some risk factors for bladder cancer?
Smoking Age Exposure to aeromatic hydrocarbons Schistosomiasis Previous radiation to Pelvis
What are some clinical features of bladder cancer?
Painless haematuria Recurrent UTIs Frequency Urgency Feeling of incomplete voiding
What are some treatment options for bladder cancer?
TURBT
Adjuvant intravesical therapy
Radical Cystectomy
