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Surgery II > Urology: Urinary Tract Infections > Flashcards

Urology: Urinary Tract Infections Flashcards

1
Q

how can you divide sites of obstruction?

A

lower and upper urinary tract

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2
Q

what does an obstruction in the lower urinary tract cause?

A

urinary retention

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3
Q

what does an obstruction in the upper urinary tract cause?

A

hydronephrosis

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4
Q

requirements of bladder filling and urine storage

A
  • accommodation of increasing volumes of urine
  • low detrusor pressure
  • appropriate sensation
  • bladder outlet closed at rest and remains that way at higher intra-abdominal pressures
  • absence of involuntary bladder contractions
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5
Q

requirments of bladder emptying and voiding

A
  • coordinated contraction of the bladder
  • smooth musculature of adequate magnitude and duration
  • concomitant lowering of resistance at the level of the smooth and striated sphincter
  • absence of anatomical obstruction
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6
Q

what are anatomical problems which can cause problems at the outflow tract

A
  • prostatic obstruction
  • bladder neck contracture
  • urethral stricture
  • urethral compression, fibrosis
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7
Q

causes of lower urinary tract obstruction in men

A
  • BPH
  • urethral strictures
  • prostatic CA/abscesses
  • stones
  • bladder tumours/cloth retention
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8
Q

causes of lower urinary tract obstruction in women

A
  • pelvic prolapse
  • pelvic masses
  • urethral stricture
  • urethral diverticulum
  • Fowler’s syndrome
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9
Q

what is Fowler’s Syndrome?

A

urinary retention associated with dysfunctional electromyographic activity in the absence of neurological problems; associated with polycystic ovary syndrome

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10
Q

cause of lower urinary tract obstruction found in both sexes

A

functional obstruction - when the sphincter fails to relax

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11
Q

what happens if urinary retention is left untreated?

A

can lead to kidney damage or urosepsis

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12
Q

characteristics of acute urinary retention

A
  • suprapubic pain

- sudden inability to void

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13
Q

causes of AUR

A
  • bladder neck obstruction
  • urethral causes
  • gynaecological causes
  • neurological causes
  • drugs
  • psychogenic
  • post-operative urinary retention
  • anorectal causes
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14
Q

causes of bladder neck obstruction

A
  • BPH, prostate CA, acute prostatitis, prostatic abscess

- bladder tumour, clot obstruction, bladder stones, bladder neck sclerosis

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15
Q

urethral causes of AUR

A
  • urethral stricture
  • urethral tumours
  • urethral stones
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16
Q

neurological causes of AUR

A
  • spinal cord lesions in acute phase
  • metastatic spinal cord compression
  • demyelinating spinal cord diseases
  • peripheral neuropathies
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17
Q

pharmacological causes of AUR

A
  • a-adrenergics
  • B-blockers
  • anticholinergic
  • antidepressants and neuroleptics
  • opioids
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18
Q

anorectal causes of AUR

A
  • fecal impaction
  • rectal tumour
  • pain from anorectal surgery
  • perirectal abscess
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19
Q

gynaecological causes of AUR

A
  • ovarian or uterine tumours
  • high-degree pelvic organ prolapses
  • post-partum urine retention
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20
Q

what is a AUR of unknown cause called?

A

spontaneous

triggered (if the underlying cause is identified)

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21
Q

management of AUR

A
  • history and physical examination (incl DRE)
  • bladder catheterisation
  • check bloods (creatinine and electrolyte) and urine (urinalysis and culture)
  • alpha blocker and attempting TWOC after a variable period of bladder rest
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22
Q

when should consider admitting the patient

A
  • gross haematuria
  • urosepsis
  • acute renal injury
  • drained urine volume >1L
  • significant post-obstructive polyuria
  • unusual symptoms (severe abdominal pain, neurological)
  • inability to manage with an indwelling catheter
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23
Q

what is TWOC?

A

trial without catheter

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24
Q

risk for TWOC failure?

A
  • older than 70yo
  • prostate size larger than 50g
  • severe LUTS
  • drained volume at catheterisation >1L
  • spontaneous AUR vs precipitated
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25
Q

signs and symptoms of chronic urinary retention

A
  • painless urinary retention
  • voiding LUTS
  • suprapubic discomfort
  • recurrent UTIs
  • rarely pure storage symptoms
  • renal failure
  • overflow incontinence
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26
Q

2 main types of CUR

A

high-pressure and low-pressure

27
Q

what is high-pressure CUR

A

obstruction with the presence of detrusor muscle activity

28
Q

what is low-pressure CUR

A

detrusor failure with low intravesical pressure

29
Q

signs of high-pressure CUR

A
  • new-onset hydronephrosis

- high creatinine over baseline

30
Q

what does high pressure in the detrusor mean?

A

upper urinary tract damage - AKI/CKD

31
Q

what is post-obstructive diuresis?

A

polyuric state after the relief of a urinary tract obstruction, despite reaching homeostasis

32
Q

risk factors for post obstructive diuresis

A
  • bladder outflow obstruction
  • bilateral ureteric obstruction
  • unilateral ureteric obstruction in a solitary kidney
33
Q

what happens if POD is left untreated?

A
  • severe dehydration
  • hyponatremia
  • shock
  • central pontine myelosis
  • electrolyte imbalances
  • death
34
Q

how can you diagnose POD?

A
  • urine output after catheterisation
  • exceeds 200ml/hr for 2 consecutive hours
  • > 3L/1 day
35
Q

what is the difference between physiological and pathological POD?

A
  • physiological: stops after 24hrs

- pathological: last longer than 48hrs; made worse with excessive IV fluid replacement

36
Q

main causes of upper urinary tract obstruction

A
  • renal causes
  • ureteric causes
  • lower urinary tract problems
37
Q

what are the main things that can cause UUTO?

A
  • congenital
  • neoplastic
  • inflammatory
  • metabolic
  • miscellaneous
38
Q

what are the miscellaneous causes of UUTO?

A
  • sloughed papillae
  • trauma
  • renal artery aneurysm
  • retroperitoneal fibrosis
  • aortic aneurysm
  • radiation therapy
  • pregnancy
39
Q

how can things from the LUT cause UUTO?

A

these problems put back pressure into the UUT

40
Q

what two things are involved in the pathophysiology of UUO

A

ureteric pressure and renal blood flow

41
Q

what are the phases of unilateral ureter obstruction

A 
Phase 1 (up to 1.5h post obstruction): ↑ureteric pressure, ↑RBF rises (afferent arteriole dilatation).
Phase 2 (from 1.5 to 5h post obstruction): ureteric pressure continues ↑, RBF (efferent arteriole vasoconstriction).
Phase 3 (beyond 5h): ureteric pressure falls, RBF continues to fall (afferent arteriole vasoconstriction).
42
Q

what are the phases of bilateral ureter obstruction?

A 
Acute BUO or obst. of solitary kidney
Phase 1 (up to 1.5hr): ureteric pressure rises, RBF rises (afferent arteriole dilatation).
Phase 2 (from 1.5-5hr): ureteric pressure continues to rise, RBF is significantly lower than that during unilateral ureteric obstruction.
Phase 3 (>5h): ureteric pressure remains elevated (in contrast to UUO). By 24 hours RBF has declined to the same level for both unilateral and bilateral ureteric obstruction.
43
Q

how do electrolyte balances change in UUO

A
  • dec urine flow
  • inc Na absorption
  • dec Na excretion
  • dec water loss from obstructed kidney
44
Q

how are electrolyte reabsorption/elimination affected by BUO

A
  • marked natriuresis due to the excessive amount of Na retained
  • inc K retention
  • solute diuresis from the accumulation of urea in extracellular fluid
  • all due to inc release of natriuretic peptides
45
Q

pathological changes in urinary obstruction

A
  • tubulointerstitial fibrosis
  • inflammatory cell infiltration
  • apoptotic renal tubular cell death
  • kidney function loss
46
Q

clinical pressure of AUR

A
  • flank pain on diuresis

- radiates to the ipsilateral testicle/labia and lower abdomen

47
Q

clinical presentation on CUR

A
  • painless/asymptomatic
  • obstruction of the bladder outlet
  • anuria
  • new-onset HTN
  • renal failure
  • recurrent UTIs
48
Q

how can you diagnose these conditions

A
  • imaging
49
Q

investigations for urinary obstruction

A
  • urinalysis
  • assessment of renal function
  • US
  • CTKUB
  • CTIVP
  • DTPA
  • MR Urography
  • antegrade and retrograde pyelography
50
Q

what is the Whitaker’s test

A

an image-guided procedure which measures the pressure in the kidney or bladder to determine whether there is the presence of obstruction

51
Q

what is hydronephrosis?

A
  • dilatation of renal pelvis and calyces
52
Q

what can cause a false positive result for hydronephrosis

A
  • extrarenal pelvis
  • parapelvic cysts
  • vesicoureteric reflux
  • high urine flow
53
Q

what can cause a false negative result for hydronephrosis

A
  • intrarenal collecting system
  • dehydration
  • dilated calyces mistaken for renal cortical cysts
54
Q

what are simple kidney cysts?

A
  • clear fluid filled masses
  • increasing incidence with age
  • can present with dull pain, acute pain due to intra-cyst bleeding, infection, obstruction
55
Q

what are complex cysts?

A
  • ones that contain blood, pus or are calcified
  • have septation, irregular margins
  • malignant potential
  • appear on US and CT with contrast
56
Q

how can you classify kidney cysts lesion?

A

Bosniak classification

57
Q

what are medullary sponge kidney

A
  • dilatation of distal collecting ducts
  • mainly asymptomatic, symptoms of renal colic and pyelonephritis
  • normal renal function
58
Q

what re calycael diverticula?

A

outpouching from the pelvo-calceal system

- stasis and stone formation in the diverticulum

59
Q

what is Autosomal dominant polycystic kidney disease?

A
  • autosomal dominant

- multiple expanding renal parenchymal cysts

60
Q

associated disorders to ADPKD

A
  • circle of willis berry aneurysms
  • cysts of liver, pancreas and spleen
  • renal adenomas but no risk of malignancy
  • cardiac valve abnormalities; aortic aneurysms
  • diverticular disease
61
Q

clinical presentations of ADPKD

A
  • abdominal masses
  • flank pain
  • macroscopic haematuria
  • UTI
  • hypertension
  • positive family history
  • renal failure
62
Q

what is acquired renal cystic disease?

A
  • cystic degenerative disease of the kidney

- associated with CRF and ESRF

63
Q

clinical manifestations of ARCD

A
  • pain

- haematuria

64
Q

which 2 syndromes predispose to malignancy?

A
  • Von Hippel-Lindau syndrome

- Tuberous sclerosis

Surgery II (19 decks)

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