Urology E77 Flashcards
General Sx in urology?
Pain, Fever, weight loss, hypertension
Where would you see fever w\ chills and where without chills?
With: UTI, obstruction of UUT
w\o: acute pyelonephritis, RCC
What are some indirect urological sx?
Neuro: ED from diabetes, MS, parkinsons
GI: acute pyelonephritis or ureteral pain can abdominal pain
Describe pain in urology?
Pain acute (renal colic) or chronic (chronic prostatitis) , The origin and location of pain (loin, suprapubic, scrotum, penile, perineum), pain is consistent, intermittent or recurrent, The severity and duration and irradiation and spread of the pain (descending irradiation)
What is the most common type of kidney pain?
Renal or ureteric colic pain caused by migrating clots or stones
What are LUT sx?
Storage, voiding and post voiding sx
Storage: oliguria. Pollakuria, nocturia, urgency w\wo incontinence
Voiding: hesitancy, straining, retention, weak or intermittent stream
Post voiding sx: feeling of incomplete voiding, dribbling
What are the disturbances in urination?
Urinary incontininence (stress, urge, true, false)
urinary retention (complete, incomplete)
Dysuria (painful urination)
What is true and false incontinence?
False: bladder never fully empties, pt urinates in small amounts all the time
True: active -> detrusor muscle overcomes normal sphincter contraction
Passive: impaired sphincters
What is complete and incomplete urinary retention?
Complete: no urination possible
Incomplete: some possible w/ a lot of residual in bladder
What are quantative changes in urine?
Polyuria: >3L per 24hrs
Oliguria: <500ml per 24hrs
Anuria: little to no urine, <100ml per 23hrs
Reasons for anuria?
Pre-renal (shock)
Renal (nephrosclerosis)
Postrenal (stone\cancer)
Qualitative changes in urine?
Haematuria: RBC in urine
Pyuria: WBC\pus in urine (urosepsis, urethritis, pyelonephritis)
Proteinuria: protein in urine
Chyluria: lymph in urine (milky white colour due to obstruction of lymph vessels)
Spermaturia: sperm in urine (retrograde ejaculation, side effect of alpha 1 blockers)
Pneumaturia: air in urine (fistula between intestine and UT, vesicovaginal fistula)
Classification of haematuria?
Class 1: micro or macroscopic
Class 2: real or pseudo-haematuria (connected w coagulation of blood
Class 3: according to time of presentation
A) Initial haematuria: disorder of urethra (trauma, urethritis)
B) Terminal Haematuria: due to bladder problems (cancer, trauma, cystitis), BPH, Prostate Ca
Emergency anuria tx?
Nephrostomy
Genito-sexual sx?
Hematospermia
Priapism
proteinuria
Scrotal mass (cancer, cyst in epididymis, hernia)
Scrotal pain (infection, torsion, varicocele)
Erectile Dysfunction
Gynecomastia
Disorders in ejaculation?
Retrograde ejaculation: spermaturia (due to drugs for BPH tx, surgery of bladder neck, transurethral resection of prostate, diabetes, MS
Absence of ejaculation (stenosis of prostate)
Premature ejaculation: ejaculation <1min
Delayed Ejaculation: >10 min
What is haematospermia?
Blood in ejaculate
In pt >50 sign of prostate Ca
Pt <50 sign of STD
What is priapism?
Painful erection lasting more than 4hrs
Brief overview of erectile dysfunction
Inability to achieve and maintain erection
Types: organic, psychogenic, mixed
Causes: Beta blockers, decreased testosterone, increased oestrogen, CVD, chronic prostatitis, penile carcinoma, stress
Tx:
1st line: phosphodiesterase 5 inhibitors (Viagra)
2nd line: vacuum or intracavernous injections
3rd line: penile prosthesis
Other options: TRT, Psychotherapy
What is gynecomastia?
Enlargement of breasts in men
Causes: decreased testosterone or increased oestrogen due to
Hormone producing testicular tumours, Kleinfelters, medication
What is the mechanism of normal urination?
The pontine micturition center (brain) also causes inhibition of Onuf’s nucleus (sacral region of spinal cord), resulting in relaxation of the external urinary sphincter. When the external urinary sphincter and When enough pressure is sensed by the walls of the bladder, the detrusor muscle contracts, the bladder neck and opening to the urethra relax , urine is released.
