Urology E77

Question 1

General Sx in urology?

Answer 1

Pain, Fever, weight loss, hypertension

Question 1

Where would you see fever w\ chills and where without chills?

Answer 1

With: UTI, obstruction of UUT
w\o: acute pyelonephritis, RCC

Question 2

What are some indirect urological sx?

Answer 2

Neuro: ED from diabetes, MS, parkinsons
GI: acute pyelonephritis or ureteral pain can abdominal pain

Question 3

Describe pain in urology?

Answer 3

Pain acute (renal colic) or chronic (chronic prostatitis) , The origin and location of pain (loin, suprapubic, scrotum, penile, perineum), pain is consistent, intermittent or recurrent, The severity and duration and irradiation and spread of the pain (descending irradiation)

Question 4

What is the most common type of kidney pain?

Answer 4

Renal or ureteric colic pain caused by migrating clots or stones

Question 5

What are LUT sx?

Answer 5

Storage, voiding and post voiding sx

Storage: oliguria. Pollakuria, nocturia, urgency w\wo incontinence

Voiding: hesitancy, straining, retention, weak or intermittent stream

Post voiding sx: feeling of incomplete voiding, dribbling

Question 6

What are the disturbances in urination?

Answer 6

Urinary incontininence (stress, urge, true, false)
urinary retention (complete, incomplete)
Dysuria (painful urination)

Question 7

What is true and false incontinence?

Answer 7

False: bladder never fully empties, pt urinates in small amounts all the time

True: active -> detrusor muscle overcomes normal sphincter contraction
Passive: impaired sphincters

Question 8

What is complete and incomplete urinary retention?

Answer 8

Complete: no urination possible
Incomplete: some possible w/ a lot of residual in bladder

Question 9

What are quantative changes in urine?

Answer 9

Polyuria: >3L per 24hrs
Oliguria: <500ml per 24hrs
Anuria: little to no urine, <100ml per 23hrs

Question 10

Reasons for anuria?

Answer 10

Pre-renal (shock)
Renal (nephrosclerosis)
Postrenal (stone\cancer)

Question 11

Qualitative changes in urine?

Answer 11

Haematuria: RBC in urine

Pyuria: WBC\pus in urine (urosepsis, urethritis, pyelonephritis)

Proteinuria: protein in urine

Chyluria: lymph in urine (milky white colour due to obstruction of lymph vessels)

Spermaturia: sperm in urine (retrograde ejaculation, side effect of alpha 1 blockers)

Pneumaturia: air in urine (fistula between intestine and UT, vesicovaginal fistula)

Question 12

Classification of haematuria?

Answer 12

Class 1: micro or macroscopic
Class 2: real or pseudo-haematuria (connected w coagulation of blood
Class 3: according to time of presentation
A) Initial haematuria: disorder of urethra (trauma, urethritis)
B) Terminal Haematuria: due to bladder problems (cancer, trauma, cystitis), BPH, Prostate Ca

Question 13

Emergency anuria tx?

Answer 13

Nephrostomy

Question 14

Genito-sexual sx?

Answer 14

Hematospermia
Priapism
proteinuria
Scrotal mass (cancer, cyst in epididymis, hernia)
Scrotal pain (infection, torsion, varicocele)
Erectile Dysfunction
Gynecomastia

Question 15

Disorders in ejaculation?

Answer 15

Retrograde ejaculation: spermaturia (due to drugs for BPH tx, surgery of bladder neck, transurethral resection of prostate, diabetes, MS

Absence of ejaculation (stenosis of prostate)

Premature ejaculation: ejaculation <1min
Delayed Ejaculation: >10 min

Question 16

What is haematospermia?

Answer 16

Blood in ejaculate
In pt >50 sign of prostate Ca
Pt <50 sign of STD

Question 17

What is priapism?

Answer 17

Painful erection lasting more than 4hrs

Question 18

Brief overview of erectile dysfunction

Answer 18

Inability to achieve and maintain erection
Types: organic, psychogenic, mixed
Causes: Beta blockers, decreased testosterone, increased oestrogen, CVD, chronic prostatitis, penile carcinoma, stress

Tx:
1st line: phosphodiesterase 5 inhibitors (Viagra)
2nd line: vacuum or intracavernous injections
3rd line: penile prosthesis
Other options: TRT, Psychotherapy

Question 19

What is gynecomastia?

Answer 19

Enlargement of breasts in men
Causes: decreased testosterone or increased oestrogen due to
Hormone producing testicular tumours, Kleinfelters, medication

Question 20

What is the mechanism of normal urination?

Answer 20

The pontine micturition center (brain) also causes inhibition of Onuf’s nucleus (sacral region of spinal cord), resulting in relaxation of the external urinary sphincter. When the external urinary sphincter and When enough pressure is sensed by the walls of the bladder, the detrusor muscle contracts, the bladder neck and opening to the urethra relax , urine is released.