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Final Surgery Imp Questions > Urosurgery > Flashcards

Urosurgery Flashcards

1
Q

Ttt of urinary bladder injury

A

🌷 Intraperitoneal rupture bladder+ complicated extraperitoneal rupture bladder
Immediate exploration and repair
🌷Uncomplicated Extraperitoneal rupture bladder
Large bore 22 french catheter for 2wks +prophylactic abs
Cystography b4 removal
Repair if there is associated injury requires repair

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2
Q

Ttt of urethral injury

A

🌹Ant urethra dt falling astride
🌹Post. Urethra dt fracture pelvis
🪷Standard initial management suprapubic cystostomy+tube insertion either open or subcutaneous
Definitive management
🌿Ant urethra after 3wks *short stricture endoscopic viu
*Long stricture anastomotic urethroplaty
🌿Post urethra anastomotic urethroplaty

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3
Q

Causes of strile pyuria

A

Tb
Cancer
Stones
Fungi
Interstitial nephritis
AGN

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4
Q

Risk factors of complicated UTI

A

Female sex
Old age
DM
Immunosuppression
Malnutrition
Pregnancy
History of stones
Functional or structural abnormalities
Instrumentation

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5
Q

Complications of acute pyelonephritis

A

Chronic pyelonephritis
CRF if affects both kidneys
Pyonephrosis
Septicemia up to septic shock
Perinephric abcess

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6
Q

Ttt of acute pyelonephritis

A

🌻non complicated
Ciprofloxacin 500mg bid
Smx trimethoprim septrin bid
For 10-14 day
★Analgesics+antipyretics
★Adequate hydration
🌻complicated
Iv penicillin+ gentamycin for 14-21 days then oral till 1 month
Urgent drainage of obstructed kidney by percutaneous nephrostomy or jj stent
★Iv fluids
★Analgesics antipyretics
Ttt of stones PCNL
🌿re do culture to ensure that relapse doesn’t occur

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7
Q

Ttt of pyonephrosis

A

It is a surgical emergency nephrostomy plus abs coverage
📌If functioning kidney
Urgent drainage by percutaneous nephrostomy or dj tube then ttt of the cause
📌Non functioning kidney
🌿If non functioning kidney+ normal other kidney
Nephrostomy till septicemia subsides then nephrectomy
🌿If non functioning kidney+ non functioning other kidney
Nephrostomy plus ttt as CRF

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8
Q

Causes of perinephric abcess

A

Most common rupture of renal abcess or extension of pyelonephritis
Hematogenous from infected septic focus :tonsillitis, osteomyelitis
Infection of perinephric hematoma

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9
Q

Causes of perinephric abcess

A

Most common rupture of renal abcess or extension of pyelonephritis
Hematogenous from infected septic focus :tonsillitis, osteomyelitis
Infection of perinephric hematoma

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10
Q

Ttt of perinephric abcess

A

Under abs coverage urgent open drainage through lumbar incision èout waiting for fluctuation
In severe cases nephrectomy may be indicated if kidney function is poor

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11
Q

Causes of chronic cystitis
Mention ttt
And ttt of acute cystitis

A

🌹CIID
Infectious
Bacteria or virus adenovirus
Drugs cyclophosphamide
Interstitial cystitis pyuria + suprapubic pain without obvious cause
Colovesical fistula
Chronic irritation TB, stones, Long term catheter radiotherapy
🌹Ttt ==>ttt of the cause
Interstitial cystitis cystoscopy+bladder distension effective temporarily
📌Smx trimethoprim septrin bid for 3-5 days
Ciprofloxacin 500mg bid for 3-5 days
For 1st infection

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12
Q

NIH CATEGORIES of prostatitis

A

Class:1 acute prostatitis
Class:2 chronic bacterial prostu
Class:3 chronic non bacterial prostatitis
Chrinic pelvic pain syndrome
Class:4 asymptomatic inflammatoryProstatitis

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13
Q

Ttt of acute and chronic prostatitis

A

Acute: iv penicillin+gentamycin oral then oral for 4wks
Abcess transurethral drainage
Chronic: oral smx -tmp for 4-12 wks +smooth muscle relaxant , a blocker

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14
Q

Ttt of acute and chronic prostatitis

A

Acute: iv penicillin+gentamycin oral then oral for 4wks
Abcess transurethral drainage
Chronic: oral smx -tmp for 4-12 wks +smooth muscle relaxant , a blocker

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15
Q

Causes of hematuria

A

📌General
Blood diseases
HTN
Anticoagulants
📌Urological
Congenital Polycystic kidney
Traumatic kidney or UB urethral
Inflammatory cystitis prostatitis pyelonephritis TB bilharziasis
Neoplastic hypernephroma UB cancer prostate
cancer
Iatrogenic open or endoscopic urologic surgery
Stones
BPH
📌Nephrological
APN
IGA nephropathy berger disease

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16
Q

Ttt of uut &lut obstruction

A

First urgent management is to relieve obstruction then manage post operative diuresis
★In LLT==>urethral catheter or suprapubic cystostomy
★In UUT ==>JJ tube or percutaneous nephrostomy s
Then ttt the cause (tumor-stone)
And before the surgery u should predict the prognosis

17
Q

Causes of urinary tract obstruction

A

🌿BOO
★Functional
Atonic bladder - anticholinergic
★mechanical
BPH-stricture -puv-uretrocele-bladder neck contracture -stone
🌿Ureteral obstruction
★intrinsic
Stricture -stone - tumor - trauma - puj dt adynamic segment
★extrinsic
Tumor trauma puj dt crossing of bv - retroperitoneal fibrosis - retrocaval ureter

18
Q

Causes and Ttt of post obstruction diuresis

A

🌻Causes
★Physiological urea induced diuresis
★Pathological kidney inability to concentrate the urine
★Iatrogenic glucose infusion
🌻Ttt
★Monitor uop and input
Cvp fluid balance -charts
Electrolytes
★Iv fluids replacement on hourly basis to replace fluids and electrolytes deficiency
Till stabilization of UOP serum creat electrolytes

19
Q

Ttt of ED

A

🌷First line
Sex therapy
Pde5 inhibitors
Vaccum assisted device
🌷Second line
Intracacarnosal alprostadil
Trans urethral alprostadil
🌷Third line
Penile prosthesis
Vascular surgery

20
Q

Causes of urine retention
Ttt

A

BOO Stricture BPH ureterocere PUV stone
Clot retention
Infection and drugs
Post operative retention
In pelvic surgery dt reflex pain
UB over distension from anesthesia
Ttt
Relieve obstruction
Investigation to detect the cause
BPH ==>TURB
Management of clot retention
Wide bore triple way catheter to evacuate clot and irrigate the bladder

21
Q

Causes and Ttt of overflow incontinence

A

Neurogenic
Sacral or SC injury
Ttt ……. intermittent clean catheterisation

Non neurogenic
BPH…….TURB
urethral Stricture……VIU , anastomotic urethroplaty
DSD………intraurethral sphincterotmy

22
Q

Causes and Ttt of urge incontinence

A

Neurogenic
suprasacral SC injury
Ttt ==> drugs anticholinergic
Surgery, UB augmentation
Non neurogenic
Irritative symptoms of BPH , Cystitis
Ttt of the cause

23
Q

Causes and Ttt of stress incontinence

A

In male dt aging or after TURP
In female weakness of pelvic floor muscle dt repeated vaginal delivery
Ttt
Pelvic muscle exercise
Mild injection of bulking agent
Moderate urethral sling
Severe. Artificial sphincter

Final Surgery Imp Questions (4 decks)

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