Ward teaching week 5

Question 1

what is done for an expected UTI?

Answer 1

urinalysis and send urine sample for culture

start empirical antibiotics and then specific antibiotics once culture is back

Question 2

what can cause someone to be prone to UTIs?

Answer 2

incomplete bladder emptying (stagnant urine)

• can be a neurological problem (bladder cant contract)
• can be due to urethral stricture/stenosis

Question 3

how are patients prone to UTIs managed?

Answer 3

treat underlying cause if possible
cranberry juice can help make urine more acidic to kill bacteria
can give low dose prophylactic antibiotics in some people

Question 4

a stone in which part of the urinary tract can cause increased frequency and urgency?

Answer 4

distal ureter

Question 5

what is urodynamic testing?

Answer 5

tests bladder’s ability to store and release urine

tests pressure in rectum and bladder (abdominal pressure) and compared the two

Question 6

what is uroflowmetry?

Answer 6

measures of speed and volume of urine voiding and plots on a graph
usually a single smooth up and down curve
several up and down waves can indicate voiding problem (indicates that abdominal muscles are being used to help force urine out of bladder)

Question 7

how is acute urinary retention managed?

Answer 7

catheterization

always give an alpha blocker (terazosin, …zosin etc) for 2 days before removing catheter

Question 8

how is chronic urinary retention managed?

Answer 8

intermittent catheterization

Question 9

how is chronic urinary retention due to detrusor inactivity (neurological issue) managed?

Answer 9

parasympathomimetic (bethanacol chloride)
- increases detrusor contraction
intermittent catheter also used

Question 10

how is urinary retention due to BPH managed?

Answer 10

alpha blocker
5-alpha reductase inhibitor (finasteride) also used if patient at risk of progression (raised PSA, elderly etc)
intermittent catheter

Question 11

smoker with haematuria, urinary retention and hydronephrosis is most likely what diagnosis?

Answer 11

bladder cancer

Question 12

a bladder cancer at what site is most likely to cause a hydronephrosis?

Answer 12

trigone

at ureteric orifice or inside ureter

Question 13

how is a ureteric tumour diagnosed?

Answer 13

ureteroscopy

CT urogram

Question 14

how can diarrhoea cause kidney stones?

Answer 14

causes dehydration which increases risk of kidney stones

Question 15

which type of kidney stones cant be seen on KUB?

Answer 15

uricate (uric acid) stones

Question 16

1st line pain management for kidney stones?

Answer 16

diclofenac

Question 17

which kidney stones should be left to pass on their own?

Answer 17

4mm or less

in practice up to 1cm stones can be passed with assistance if not causing a problem (hydronephrosis etc)

Question 18

what is given to assist passing of large stones?

Answer 18

terazosin (alpha blocker)

Question 19

which stones are not left to pass on their own and must be treated with nephrostomy?

Answer 19

infection
declining kidney function (hydronephrosis etc)
patient cant handle the pain

Question 20

acidic/alkaline urine causes which types of stones?

Answer 20

acidic = uric acid
alkaline = calcium phosphate

Question 21

how long do you give for patient to pass the stones and how is this monitored?

Answer 21

3-4 weeks

check progress via KUB X ray or non-contrast CT if uric acid stones (cant be seen on KUB)