Urology - Haematuria, Infection and Incontinance Flashcards
when are kidney stones most common
aged 20-50
once yoube had a stone what are the chances of having another stone in the next 5 years
50%
what is the most common cause of stones
calcium oxulate
who is more likely to have a kidney stone male or female
men
testosterone increases oxalate production
what foods help inhibit stone formation
citrate (lemons, oranges etc)
how much water should be drunk daily to stop stones
2 for women
2.5L for men
what colour should the urine be
clear or pale yellow
what diet is worst for stones
high animal protein and high salt
what are other types of less common stones
uric acid stones - gout
calcium phosphate
infection stones - soft branching stones
cystine - inherited form - cystine urea
what is an issue for uric acid stones
cant see on x ray
why do kidney stones form
get saturation of salt and waste production - precipitates out (crystals)
how do you increase the amount of salt a volume can take
add heat
more alkaline - dissolves more calcium oxulate, uric acid and cystine
what are specific risk factors for stones
overactive parathyroid gland - hyperparathyroidism - releases calcium form body (bone) - increase in excreted calcium
what symptoms do you get with kidney stone
loin to groin pain - loin cholic only if in the kidney
in/visible haematuria
nausea vomiting
recurrent UTI
sepsis
why do you get loin to groin pain
ureter innervated by the same dermatomes
what is a stone emergency
infection behind stone
infected obstruction
complete blockage (swollen) and sepsis risk
- needs draining (nephrostomy tube)
what are the 3 ways to view stones and which is best and where can they see stones
USS – in kidney, bladder NOT ureter ureter is deeper and near bone
Xray – 80-90% stones can be seen
CT – BEST – all stones visible – see size, placement and density
what is the best pain killer for stones
diclophenec anti-inflammatories (IV or rectal)
or IV paracetamol
do all kidney stones need to be removed
no 2/3 of people can have stones in a kidney and it stays and doesnt grow
what are treatments for kidney stones
Lithotripsy - sound waves crack stone into smaller pieces
operation - ureteroscpe - then laser
what do you do for large stones?
PCNL
staghorn stones - likely to be infection struvite stones
how do you prevent further chance of stones
Investigations
Serum calcium and urate - hyperparathyroidism
Lifestyle
Fluids - 2-3L add lemon or lime
Occupational adjustment
Diet
Animal proteins - reduce
Salt - reduce
Oxalate rich foods - chocolate, nuts etc
Calcium - recommended intake
what are the 4 types of epithelium
Cuboid epithelium
Columnar epithelium
Transitional cell epithelium
Squamous epithelium
what parts of the renal system are made up of transitional epithelium
urinary tract lining
renal pelvis
ureter
bladder
urethra - up to fossa navicularis
what can cause haematuria
Cancer
- Bladder
- Kidney
- Ureter
- Urethra
- Prostate
Stones
Infection
- Lower UTI
- Pyelonephritis
Others - trauma, anticoagulants
what do you want to know in a history
Onset and duration
Associated symptoms
causes
Risk factors
Occupation
Family history
Fitness
what are some risk factors associated with bladder cancer
Age - 60-70
Sex - male
**Smoking - MAIN ONE
Occupational exposure
Drugs
- Cyclophosphamide, Phenacetin
Chronic irritation
- Stones
- Catheter
- Schistosomiasis
Pelvic radiotherapy
what are some occupations associated with TCC
Rubber manufacture
Dye manufacture
Fine chemicals
Retort houses of gas works
Rope and textile manufacture
Hairdressers
Leather workers
Plumbers
Painters
Drivers- Diesel exhaust
what is the examination
Abdomen
External genetalia
DRE- digital rectal examination
Urine diptick
MSU - mid stream urine - to stop contamination
Cytology
how do you diagnose TCC
Investigation over age 50
Upper tracts
Ultrasound
IVU
CT scan
Bladder, urethra
Cystoscopy
MSU
Cytology
90% sensitive in high grade TCC
False negative 40-70%
how does bladder cancer present
Haematuria
LUTS
Storage symptoms
Recurrent UTI
Others
Pneumaturia
Pain
Lower lib swelling
Bone pain, anorexia, weight loss
Anuria
how common is bladder TCC
4TH Commonest Ca
2nd commonest urological cancer
13000 new cases in UK/ year
5000 deaths
Majority have curable disease
what is bladder caner staging
what is treatment and staging of bladder cancer
TURBT - transurethral resection of bladder tumour
MRI/ CT pelvis and abdomen
Chest x ray
Bone scan
how is bladder cancer staged
how is the cancer classed
Number
Single
Multifocal
Appearance
Papillary 70% - Ta
Solid 10% - T2
Flat 10%
Mixed 10%
what is urinary diversion and what are the procedures
Ileal conduit -
Orthotopic Neobladder
Ileal
Ileo colic
Colonic
Continent pouch
Ureterosigmoidostomy
what is the survivability of different stages of bladder cancer
pain followed by haematureia
cancer
haematuria followed by pain
stone
what is staging of TCC
how des TCC spread
Usually papillary
Direct extension to
Renal vein
Vena cava
Lymphatic spread to
Para aortic
Para caval
Pelvic
Blood spread to
Liver
Lung
bones
what is treatment of TCC
Curative
Nephro-ureterectomy - remove ureter as it will likely develop cancer
Uretero-renoscopic laser ablation
Palliative
Systemic chemotherapy
Palliative surgery
Arterial embolisation
what is 5 year survivability of TCC
5 year survival
Organ confined 60-100%
Locally advanced 20-50%
Node positive 15%
Pulmonary bone metastasis 10%
Why is kidney cancer increasing
More searching radiography
We are living longer
What are common risk factors for cancer
Obesity and smoking
What is the most common type of kidney cancer
Clear cell (75-80%)
what is the 2nd most common type of kidney cancer
Papillary (type 1 and 2) (10-15%)
What is the 3rd most common renal cancer
Chromophobe (young females)
what are the rarest types of renal cancer
Medullary - sickle cell - very aggressive
Collecting duct
What are other types of renal cancers
Urothelial - urothelium cancer - common
Sarcomas
Wilms - kids - surgery and chemo
Benign and inflammatory lesions
- oncocytomas surgery at 6-7cm
- angiomyelolipoma - blood, fat and muscle - 4cm can spontaneously rupture - females in pregnancy - progesterone
-
What are the 4 Bosnian classification of renal cysts
- Benign simple cyst
- Minimally complex cyst
2F - 2 follow in up - monitor for 5 years can become cancer (thick wall) - Indeterminate cyst mass - surgery maybe
- Clearly malignant - surgery
Which cancers are associated with con Hipple-Lindau
Clear cell RCC
Retinal angiomas
Pheochromocytosis - adrenal gland
Hemangioblastomas of the central nervous system
Why can you get a cough with renal cancer
Mass hits the bottom of the diaphragm and causes irritation
What is Stauffers syndrome
paraneoplastic presentation due to hepatomegaly
what endocrine does the kidney produce
1,25-
dihydroxycholecalciferol, renin, erythropoietin, and various prostaglandins
What is poly cystic kidneys
Autosomal dominant- resulting I’m multiple cysts in the kidneys
How does PCK present
Pain, size (abdomen distended), haematuria (they pop), asymptomatic, hypertension,
Effect of ketamine on kidneys
Very dangerous - destroys kidneys - no major surgery
Diversion of urine methods
Nephrostomy
Ilial conduit - use a bit of the ilium and similar to stoma
Neobladder - continence system (retains urine - may need to self catheterise)
TURBT — when is it used
All bladder tumours - to have tissue to determine the staging of the bladder cancer
How do you determine the stage of bladder cancer
MRI
CT
TURBT - tissue to see the layers
What is urethral syndrome
Symptoms of a UTI without the UTI
