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Urology > 1.6 Stenosis and fistulas in the urinary tract > Flashcards

1.6 Stenosis and fistulas in the urinary tract Flashcards

1
Q

causes of stenosis in UT

A

TICI

o Trauma
o Infection (UTI)
o Congenital anomaly (UPJ obstruction: ureteral strictures , uretheral strictures)
o Iatrogenic (scarring from previous surgery,radiotherapy, stones, tumor)

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2
Q

symptoms of stenosis of UT

A

o Difficulty voiding, difficulty emptying the bladder
o Dysuria
o Drippling
o Urinary incontinence
o UTI
o Weak urine stream
o Decreased ejaculation force
o Symptomless in some cases

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3
Q

treatment of UT stenosis

A

o Dilatation
o Urethrotomy
o Anastomotic repair for short posterior urethral strictures
o Open surgical reconstruction
o Catherization

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4
Q

fistulas in the urinary tract

A

An abnormal opening between the urinary tract and another nearby organ, such as the
colon or the vagina, or the outside.

  • The connection allows for the passage or leakage of urine, feces or other matter to pass where it shouldn´t
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5
Q

fistulas of UT are more common in which gender

A

More common in women
but not very common in developed countries (due to adequate healthcare during childbirth

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6
Q

etiology of fistulas in UT

A

o Any damage to the tissue of the urinary tract, pelvic region or vagina can create optimal conditions for fistula formation

  • Injury/accident
  • Surgery (hysterectomy, C-section)
  • Malignancies in pelvic region
  • Radiation treatment
  • IBD or diverticulitis
  • Problems from episiotomy incision for childbirth (deep tears, infection)= is a incision in the tissue between the vaginal opening and the anus during childbirth
  • Infections (less often)
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7
Q

Symptoms of fistula in UT

A
  • Frequent UTI
  • usually painless
  • fluid/urine/feces leaking from vagina,
  • foul-smelling gas or discharge,
  • passing gas from urethra while urinating, frequent UTIs,
  • irritation in vulva,
  • abdominal pain
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8
Q

diagnosis of fistulas in UT

A

Patient history, urine sample, CBC ( infection?)
* Excretory urogram : contrast dye injected to urinary tract, X-ray to examine the bladder
* CT urogram/urography: dye into vein: evaluate vagina and lower urinary tract
* Dye test : bladder filled with a dye and patient coughs or bears down: look for bladder leakage by checking dye in vagina
* Cystoscope
* Cystogram : bladder fills with contrast dye to evaluate for location of urinary leakage
* Retrograde pyelogram : similar to excretory urogram, but specifically for leakage between vagina and ureter
* Fistulogram: X-ray
* Flexible sigmoidoscopy
* MRI

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9
Q

treatment of fistulas in UT

A

Conservative if small,
urinary catheter,
surgical repair

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10
Q

Ureteral stricture def

A

narrowing of ureter

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11
Q

Ureteral stricture etiology

A

CUSUT

  • Congenital (eg. UPJ obstruction)
  • UTIs
  • Scarring from previous surgery,
  • Urinary stones,
  • Tumor
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12
Q

Ureteral stricture symptoms

A
  • flank pain,
  • feeling of fullness,
  • hematuria,
  • nausea,
  • UTIs,
  • pain worsen with increased fluid/alcohol
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13
Q

pain worsen with increased fluid/alcohol is a symptoms of what

A

ureteral stricture

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14
Q

Ureteral stricture diagnostics

A
  • US,
  • CT,
  • MRI,
  • renal nuclear medicine scan,
  • retrograde ureteroscopy
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15
Q

Ureteral stricture complication

A
  • hydronephrosis,
  • kidney infections,
  • kidney stones
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16
Q

Ureteropelvic junction obstruction (UPJ) definition

A

the point of blockage is where the ureter meets the collecting system of the kidney

17
Q

Ureteropelvic junction obstruction (UPJ) etiology

A
  • most often congenital,
  • abnormal blood supply,
  • scar tissue,
  • infections,
  • earlier treatment for a blockage,
  • kidney stones
18
Q

Ureteropelvic junction obstruction (UPJ) symptoms

A
  • abdominal mass
  • back/flank pain
  • vomiting
  • hematuria
  • UTIs
  • kidney infection
19
Q

Ureteropelvic junction obstruction (UPJ) diagnostics

A
  • CT,
  • US,
  • urine/blood test,
  • nuclear scans,
  • X-rays of kidney/bladder/ureter,
  • voiding cystourethrogram (X-ray of bladder while emptying)
20
Q

Urethral stricture def

A

narrowing of urethra due to scarring

21
Q

Urethral stricture epidemiology gender

A

male > female

22
Q

Urethral stricture etiology

A
  • 45% urethral manipulation (eg.
    *catheterization,
    *prostatectomy,
    *prostate brachytherapy,
    *correction of hypospadias)
  • 30% unknown
  • 20% bacterial infections
23
Q

Urethral stricture symptoms

A
  • Feeling as bladder isn’t empty after urinating
  • Frequent UTI
  • increased urinary frequency, urinary urgency
  • loss of bladder control
  • dysuria
  • edema of penis and surrounding structures,
24
Q

Urethral stricture diagnostics

A
  • Urethroscopy,
  • urethrography (contrast dye into urethra and observe where the
    dye progresses using a fluoroscopic X-ray device),
  • MRI, CT, US
25
Q

Urethral stricture treatment

A
  • if no significant symptoms : observation
  • Urinary retention : suprapubic catheter
  • Dilation of stricture with catheters with balloons (stent for several weeks)
  • Urethrotomy = cut stricture with laser or scalpel with urethroscopic guidance
  • Open surgical removal
26
Q

Urethral stricture complication

A
  • often reoccur,
  • kidney infections and damage,
  • stone formation,
  • bladder enlargement and dysfunction
27
Q

Urethrotomy =

A

cut stricture with laser or scalpel with urethroscopic guidance

28
Q

types of Urinary fistula

A
  • Vesicovaginal:
    *between vagina and bladder. Most frequent type in women.
    *Occurs most often because of a previous hysterectomy. Difficult labor can also cause it.
  • Ureterovaginal: between ureter and vagina; most occur due to prior
    hysterectomy or pelvic surgery
  • Enterovesical: between bladder and bowel: another of the most common urinary fistulas
  • Vesicouterine: between bladder and uterus
  • Urethrovaginal: between urethra and vagina
  • Colovesical: between colon and bladder
  • Rectovaginal: between vagina and rectum
29
Q

are urinary fistulas painful?

A

no usually painless

30
Q

Excretory urogram

A

: contrast dye injected to urinary tract, X-ray to examine the bladder

31
Q
  • Dye test :
A

bladder filled with a dye and patient coughs or bears down: look for bladder leakage by checking dye in vagina

32
Q

Retrograde pyelogram what is it specific for

A

: similar to excretory urogram(contrast dye injected to urinary tract, X-ray to examine the bladder)

but specifically for leakage between vagina and ureter

33
Q
  • Fistulogram
A

x ray

34
Q

CT urogram

A

dye into vein: evaluate vagina and lower urinary tract

35
Q

Cystogram

A

bladder fills with contrast dye to evaluate for location of urinary leakage

36
Q

Treatment of urinary fistulas

A

most require surgical repair
* Conservative: simple fistula can heal on their own.
*urinary catheter to bypass fistula;
*incase of ureterovaginal fistula we’ll place a stent in the ureter which will help correct the flow from the kidneys to the bladder

  • Surgery: Type and location of fistula will determine the type of surgery (vaginal vs. abdominal approach; open vs. laparoscopic)

Urology (30 decks)

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