Week 7 - Urinary System And The Male Genital Tract Flashcards
What is bacteruria?
Bacteria in the urine
May be asymptomatic or symptomatic
What is a urinary tract infection?
The presence of pure growth of >10^5 organisms in fresh urine
What is a UTI in the urethra called?
Urethritis
What is a UTI in the bladder called and what are the symptoms?
Cystitis
Symptoms: frequency, dysuria, urgency, haematuria, suprapubic pain
What is a UTI in the prostate called and what are the symptoms?
Prostatitis
Symptoms: flu-like symptoms, few urinary symptoms, swollen tender prostate on PR
What is a UTI in the kidney called and what are the symptoms?
Pyelonephritis
Symptoms: high fever, rigours, vomiting, loin pain, tenderness
What organism is the most common cause of UTI’s (>70%)?
E.coli
What organisms may cause UTI’s?
E.coli
Staphylococcus, proteus, klebsiella
How do you manage UTI’s?
- plenty of fluids
- urinate often - double void
- antibiotics (trimethoprim usually first line treatment in uncomplicated UTI’s)
- imaging (US in non resolving UTI’s, children, men and pyelonephritis)
- severe cases - hospital admission (pyelonephritis and elderly)
What does the hormone renin do?
Help to control BP
What does the hormone erythropoietin do?
- stimulates production of RBC’s in the bone marrow
- helps vitamin D production
What toxic metabolic waste products do the kidneys excrete?
Urea
Creatinine
What are the 2 types of renal failure?
Acute
Chronic
What is acute renal failure?
- a significant deterioration in renal function occurring over hours/days
- low urine volume (
What can cause acute renal failure?
Pre-renal (80% causes) - hypoperfusion (shock), sepsis
Renal - ATN damage to tubules due to ischaemia or nephrotoxins
Post-renal - renal tract obstruction (e.g. stones, tumours)
How is acute renal failure managed?
- find and treat cause
- treat exacerbating factors (hypovolaemia,sepsis)
- stop nephrotoxic drugs (NSAIDs, ACE-I’s, gentamycin, vancomycin)
- may need renal replacement therapy (haemofiltration/ dialysis)
What is chronic renal failure?
- classified in to 5 stages - depending on glomerular filtration rate (GFR) - vol of fluid filtered from the glomerular capillaries into the Bowman’s capsule per unit time
- symptoms usually occur by stage 4
What are the common causes of chronic renal failure?
Glomerulonephritis, diabetes, Reno-vascular disease, hypertension, polycystic disease
What is glomerulonephritis?
- a group of disorders where there is damage to the glomerular filtration apparatus
- may cause a leak of protein or blood into the urine
- usually there is a deposition of immune complexes in one part of the nephron
What are renal stones?
-crystal aggregates that form in the collecting ducts of kidneys and can deposit anywhere in the renal tract
- life time incidence - 15%
- peak age - 20-40 yrs
- male:female - 3:1
What are the risk factors for renal stones?
- Dehydration, dietary factors
- drugs (loop diuretics, antacids, corticosteroids, theophylline and aspirin)
- renal tract abnormalities
- recurrent UTIs
- metabolic abnormalities (hyperparathyroidism, hyperthyroidism, cancer)
how may kidney stones be detected?
-may be asymptomatic but might be detected on and X-ray or blood on a dipstick
- pain - cause loin pain
- ureteric stones cause renal colic (from loin to groin)
- bladder and urethral stones cause pain on micturition with interrupted flow
- often can’t lie still from the pain
How are renal stones managed?
- imaging options - KUB- X-ray or CT scan
- pain relief
- stones 5mm and causing obstruction - intervention
What is renal cell carcinoma?
- 85% of all renal cancers
- usually presents between the ages of 50-70
- 2:1 male predominance
-risk factors: smoking, obesity, hypertension, asbestos exposure, certain hereditary conditions
What is the presentation of renal cell carcinoma?
- 50% incidental findings on abnormal imaging
- haematuria
- loin pain
- abdominal mass
- para neoplastic syndromes (consequence of cancer in the body) e.g. polycythaemia, hypercalcaemia, hypertension
What is used to treat renal cell carcinoma?
-radical nephrectomy
+-
-chemo
What is the most common benign condition in the bladder?
Cystitis
What are the most common malignant condition in the bladder?
Transitional cell carcinomas
What is the presentation of transitional cell carcinoma?
- classically - painless haematuria
- frequency, urgency and dysuria can occur
What are the tests that can be conducted to test for transitional cell carcinoma?
- urine for cytology
- cytoscopy and biopsy done via urethra
How can transitional cell carcinoma be treated?
- depends on stage (1-3) and spread
- small lesions at early stage can be managed with diathermy on cytoscopy
- later stages - radical cystectomy or palliative chemo/radiotherapy
What does the prostate gland do?
Helps in secretion and maintenance of semen and spermatozoa
Usually weighs around 20gm
What is benign prostatic hyperplasia?
- common
- increase in the number of cells resulting in the formation of nodules - prostate weights 60-100gm
What is hyperplasia?
Increase in the number of cells
What are the signs and symptoms of benign prostatic hyperplasia?
- usually those of lower urinary tract obstruction (increased frequency, hesitancy, nocturia, terminal dribbling)
- can lead to increased risk of infection
- enlarged prostate on PR
How may benign prostatic hyperplasia be treated?
- if small and asymptomatic then conservative, reduce fluid intake (esp. at night), reduce alcohol and caffeine, scheduled voiding
- medical treatment - alpha-blockers - reduces smooth muscle tone in the prostate
- TURP - transurethral resection of the prostate
What are the risk factors of prostate cancer?
- age
- race (more common in black people and very uncommon in Asian people)
- family history
- hormone levels (inc. in prostate specific antigen (PSA) level)
- diet - increased risk with fat consumption
What are the signs and symptoms of prostate cancer?
- may be asymptomatic (has a slow course)
- nocturia, hesitancy, poor stream and terminal dribbling
- examination shows hard, irregular prostate
How is a diagnosis confirmed for prostate cancer?
- raised PSA (prostate specific antigen) but may be normal in 30% of cases
- biopsy
How is prostate cancer treated?
- depends on stage, age of patient and comorbidities
- local disease can be treated with radical prostatectomy
- hormonal therapy and radiotherapy for more advanced cases
What is testicular torsion?
Twisted spermatic cord
What are the symptoms of testicular torsion?
- sudden onset of pain in 1 testis
- pain in abdomen, N+V
- testis = hot, swollen and tender
- testis may lie high and transversely
- most common in 11-30 yrs
What tests are conducted to test for testicular torsion?
- USS with Doppler
- may need exploratory surgery
How is testicular torsion treated?
URGENT
- surgery
- if still viable, bilateral fixation (orchidopexy)
- if abnormal then orchidectomy
When are malignant testicular tumours most common?
15-44 years
What are the risk factors for getting testicular tumours?
- undescended testes
- infant hernia
- infertility
What is the presentation of testicular tumours?
Painless testicular lump often noted after trauma or infection
What is the most common germ cell tumour?
- different categories
- most common = seminoma
How are germ cell tumours treated?
- depends on type of tumour and stage
- usually involves an orchidectomy and a combination of radiotherapy and chemo
What is a germ cell?
A germ cell is any biological cell that gives rise to the gametes of an organism that reproduces sexually
What are the risk factors of UTI’s?
- females>males
- sexual intercourse
- pregnancy
- diabetes
- urinary tract obstructions - stones or catheters
