Urology- Fleck Flashcards by Madeline Wing

Called to ER to see a 42 yo female
Fever to 102, tachycardia, hypotension
Flank pain, UA with bacteria, increased WBC
Exam….flank tenderness to percussion

What next?
Imaging?

thinking infection; CT w/out contrast

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CT w/ and w/out contrast shows stones the best

CT w/out

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this type of imaging avoids radiation but gives us less information

renal US

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1 differential when you suspect infection in pt. w/ flank pain, fever, WBC’s

pyelonephritis

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Dx?

pyelonephritis on CT

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huge kidney stone seen (in renal pelvis area)

xanthogranulomatous pyelonephritis

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chronic pyelonephritis usually a/w what microbe and type of kidney stone

Proteus; struvite

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bear claw sign

XGP

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foamy macrophages

XGP

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renal abscess

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renal abscess w/ obstructing stone

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air is seen

emphysematous pyelonephritis

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air seen

emphysematous pyelonephritis

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ureterolithiasis

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how to treat pt?
Called to ER to see a 42 yo female
Fever to 102, tachycardia, hypotension
Flank pain, UA with bacteria, increased WBC
Exam….flank tenderness to percussion

identify pathogen
drain infection
Ab’s

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ureteral stents

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65 yo male w/ enlarged prostate

prostate abscess

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how to treat prostate abscess

drain infection
Ab’s

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24 year old female with history of “recurrent UTI”
All cultures negative, Labs normal
CC: Urgency, frequency, dysuria
UA normal without RBCs, WBCs or bacteria

Pain with a full bladder, relief with emptying

interstitial cystitis

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Inflammatory Bladder Condition
No Known Cause
No Perfect Treatment or Cure…Treatment Algorithm to follow
ALL cultures negative

interstitial cystitis

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pain and pressure in the pelvis; constantly peeing; Ab’s do not help

interstitial cystitis

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hemorrhaging seen

interstitial cystitis

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Cystoscopy under anesthesia with short-duration, low-pressure hydrodistension may be undertaken as a treatment option

for interstitial cystitis

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hemorrhaging in bladder

interstitial cystitis

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If ________are present, then fulguration (with electrocautery) and/or injection of triamcinolone should be performed

Hunner lesions

Hunner lesion/ulcers

this rarely requires cystectomy

ulcerative cystitis

post void dribbling dyspareunia dysuria

urethral diverticulum

most common cancer in urethral diverticulum

adenocarcinoma

most common urethral cancer

squamous

most common bladder cancer

transition epithelium (urothelium)

what imaging does the best when looking at pelvic fluid

MRI

urethral diverticulum

how to treat urethral diverticulum

surgery

67 year old man with intermittent painless gross hematuria and persistent microscopic hematuria Long smoking history UA with 50 RBC/HPF but no bacteria Normal Creatinine Normal physical

bladder cancer

#1 cause of bladder cancer

smoking (and aniline dye exposure)

standard hematuria evaluation

CT Urogram; cystoscopy

gross painless hematuria (more than 3 RBC's for microscopic field)

bladder cancer

drugs and myoglobinuria (secondary to rhabdomyolysis) can cause what

red urine

gross hematuria, what are your top 2 differentials

cancer stones

ADPKD

enhancement seen

RCC

treatment for RCC

remove mass

stage of cancer when confined to kidney

stage I and II

stage of cancer when it reaches Gerota's fascia

stage III

stage of cancer when it reaches renal vein/IVC

stage IV

renal cancer guidelines decide between 2 things

nephrectomy or ablation

papillary bladder tumor

#1 treatment to prevent recurrent bladder cancer

BCG (medicine injected into bladder)

transitional cell carcinoma of renal pelvis

“field” disease of all urothelial tissue…a urothelial cancer in the kidney is associated with increased incidence of cancer in the ureter, bladder and contralateral kidney

urothelial carcinoma

treatment for urothelial carcinoma

remove entire ureter/kidney/part of bladder

kidney stones

best thing to do to get kidney stone to pass

ESWL (shock wave)

alpha blocker used to help kidney stone pass

Flomax (Tamsulosin)

27 year old involved in MVA Multiple Pelvic Fractures Urology called to ER Blood at urethral meatus what are we worried about?

urethral disruption bladder rupture renal/ureteral trauma

what to use to evaluate urethra

retrograde urethrogram

what to use to evaluate the bladder

CT cystogram

what to use to evaluate the kidneys and ureters

CT urogram

what not to do if suspected urethral disruption

do not put a catheter in

what can get torn in men who have a "saddle" injury

membranous uretha

membranous urethral tear

to treat urethral disruption

suprapubic tube

2 types of bladder rupture

extraperitoneal and intraperitoneal

what test to order to view bladder rupture

CT Cystogram

what type of bladder rupture

intraperitoneal bladder rupture

type of bladder rupture

extraperitoneal

which bladder rupture heals on its own with catheter placed

extraperitoneal bladder rupture

what is the usual treatment for renal trauma

do nothing and let it heal on its own

overactivity or discoordination w/ high pressure voiding (potential renal damage)

supra sacral lesions

acontractile compliant bladder (less risk of renal damage)

sacral lesions

what type of injuries have high risk of kidney damage

spinal cord injuries

Up to 3 months after a traumatic spinal cord injury the bladder is atonic---manage with catheter

spinal shock

triad: elevated bp, bradycardia, sweating

autonomic dysreflexia

only occurs in SCI at or above T6

autonomic dysreflexia

manage spinal shock with what

w/ catheter

how to treat autonomic dysreflexia

drain the bladder

overactive bladder

poor compliance of bladder puts patients at risk for what

renal failure

sympathetic nerve causing relaxation of bladder promoting bladder filling

hypogastric n.

parasympathetic n. causes contraction of bladder promoting voiding

pelvic (splanchnic)

innervates external urethral sphincter providing voluntary control over voiding

pudendal n (somatic)

____ stimulation in bladder wall promotes relaxation

beta 3

Damage to _____ and _____ nerve can lead to Urinary retention

sacral and pelvic

anti-cholinergic medication used for overactive bladder (M3 antagonist)

Oxybutynin

this medication used for overactive bladder has lots of side effects

oxybutynin

beta-3 agonist used for overactive bladder (detrusor relaxation)

Mirabegron

M3 agonist used for atonic bladder

Bethanechol

SE to worry about with anticholinergics

memory loss

SE of mirabegron to be aware of

increase in bp

alpha blocker used for BPH and has SE of orthostatic hypotension

Tamsulosin

erectile dysfunction meds cause what to decrease in size

prostate gland

duplicated ureters

most common urinary congenital anomaly

duplicated ureter

congenital anomaly seen in Turner's and Trisomies

horseshoe kidney

pelvic kidney (pancake kidney)

what type of drug to use for kidney stone passage

alpha blockers (Tamsulosin)

best thing for kidney stone having trouble leaving the system

shock wave