Urology Tutorial Flashcards
List causes of haematuria
Nephritidies Cancer stones Infection (UTI, pyelonephritis) Trauma Endometriosis Coagulopathies AV malformations
What is the one of the biggest urological emergencies that can occur in haematuria?
Clot retention - where a clot forms and blocks somewhere along the urinary tract and pt goes into acute retention
What is a typical history of clot retention?
Patient has pinkish urine for a few days, which got darker and there were clumps in it
Suddenly unable to pee and in a lot of pain
When might you admit someone for haematuria?
Clot retention
Suspected Hb drop
How do you manage haematuria?
ABCDE, resus Transfuse if req. Insert 3 way foley catheter + do multiple flushes with sterile saline to rid of clots If still bleeding - bladder USS Massive clots may req. surgical removal
If haematuria settles after ABCDE and resus, what might you do?
Trial voiding without catheter, outpatient USS KUB and flexible cystoscopy to look for main causes of haematuria
What investigations might you do for suspected stones?
CTKUB
Bloods - FBC, UE, coag
Urine dip +/- MSU
What is a staghorn calculus?
Calcification of 2+ calyces
What is the difference between CTKUB and CT abdomen?
CTKUB doesn’t involve contrast as contrast and stones both appear white so wouldn’t be able to see stones with normal CT abdomen
What is the gold standard test for diagnosing stones?
CT KUB
The ureters run in front of what muscle?
Psoas major
What might be a sign that a renal stone is causing significant blockage?
Hydronephrosis
What is the management of kidney stones?
Analgesia
?admission
When might you admit someone with renal stones?
Need opiates/IV analgesia
Deranged UE
Infection
What makes renal stones an emergency?
If there is an infection on top of the kidney being obstructed
How do you manage infections + stones?
ABCDE + resus
Sepsis 6
Drain kidney - nephrostomy/stent
What are options for definitive stone management?
Conservative management, e.g. analgesia or medical therapy ESWL Flexible/rigid ureteroscopy PCNL Nephrectomy
What does ESWL stand for?
External shock wave lithrotripsy
When is ESWL CI?
In pregnancy
If stones are not radio opague
What does PCNL stand for?
Percutaneous nephrolithotomy
What does PCNL involve?
Camera inserted straight into kidney and instrument vibrates very quickly and breaks up bits of stones and picks them up
Needed for bigger stones, e.g. staghorn calculi
When might you do a nephrectomy for stones?
If you check split renal function and affected kidney is only contributing e.g. 2% to total kidney function
What are the categories of causes of urinary retention?
Obstructive Drugs Inflammatory Neurogenic Post-op
What are obstructive causes of urinary retention?
BPE Urethral stricture Constipation Clot retention Pelvic mass
What drugs can cause urinary retention?
Alcohol
Diuretics
Spinal/epidural
Opioids
What inflammatory processes can cause urinary retention?
UTI
Prostatitis
What are neurogenic causes of urinary retention?
Spinal cord injury CES MS PD Pelvic trauma Pelvic surgery
How should you assess a pt in urinary retention?
Screen for sx of CES!!
Screen for red flags, e.g. wt loss, bone pain, haematuria (spinal mets?)
Ex - abdo, DRE, neuro
What investigation might you do for someone in urinary retention?
UE - USS KUB if abnormal
Bladder scan
How do you manage acute urinary retention?
Catheterise
What is determines as low risk urinary retention?
<1000ml
UE normal
Uncomplicated
How do you manage low risk urinary retention?
Discharge, treat cause (e.g. alpha blocker, laxatives, abx) then trial wo catheter
What is deemed high risk urinary retention?
> 1000ml
Abnormal UE
Complicated, e.g. UTI
How is high risk urinary retention managed?
Admit, hourly UO, IV fluids if >200ml/h 2hrs
Why do you want to give fluids to someone who is in urinary retention and passing >200ml/h 2hrs?
They are at risk of post-obstructive diaresis (where they go beyond the normal fluid balance + become v. dehydrated)
What is the normal capacity of the bladder?
500-600ml
