Urolithiasis
A state marked by or tending to the formation of urinary claculi
Nephrolithiasis
kidney stone
Ureterolithiasis
stone in ureter
Most common kidney stone crystals
Calcium oxalate- (indicate acidic urine environment)
Marathon runners may have this condition-
crystalluria
Patient that has recurrence of calcium oxalate kidney stones. What 4 things do you tell them it might have been caused by and tx?
- Low fluid intake. Stay hydrated! 2. Hypercalciuria. Too much calcium being excreted- increase calcium intake and use thiazide diuretics. 3. Hyperoxaluria- Increase calcium intake and avoid foods high in oxalate. 4. Hypocitraturia- Get potassium citrate supplementation, and increase intake of high citrate foods (lemon juice)
Foods high in oxalate
rhubarb, spinach, beets, chocolate
Risk factors for uric acid stones
Hyperuricosuria from Gout or Tumor lysis sundrome
Tx of uric acid stones
Make urine alkaline, increase intake of high citrate foods, increased fluid intake, dec meat, cranberries, and animal protein intake, allopurinol
Why is allopurinol given as tx in some cases of nephrolithiasis?
decreases amount of uric acid in blood- helpful in tx of uric acid stones
struvite stones aka
magnesium ammonium phosphate stones
risk factors for struvite stones
STAGHORN calculi, recurrent UTI’s with urease-splitting Klebsiella and Proteus species
Risk factors for cystine stones
LARGE, BRANCHED calculi in childhood or adolescense
What foods to avoid if have very alkaline urine causing kidney stones?
high citrus foods. avoid lemon juice, oranges, etc.
What foods to avoid if you have very acidic urine causing kidney stones?
decrease meat, cranberries
tx of struvite stones
chronic abx therapy and stone removal
tx of cystine stones
make urine alkaline, penicillamine, captopril
shapes of calcium oxalate crystals
dumbbell shaped or needle-shaped- monohydrate. envelope shaped- dihydrate.
Shape and color of uric acid crystals
rhombic plates or rosettes, yellow or reddish brown
Magnesium ammonium phosphate, or struvite cystals shape
“coffin lid”
Shape of cystine crystals
hexagonal
Cystine crystals are pathognomonic for..
cystinuria
Patient complaint of sudden onset of unilateral flank pain, N/V, and urinary frequency and urgency. Hematuria sometimes as well. Dx?
Nephrolithiasis. If increased urinary frequency and urgency, may be uretolithiasis
Nephrolithiasis Dx options
- Lab tests- serum creatinine, serum electrolytes, serum calcium, serum phosphate, serum uric acid. 2. UA– gross and microscopic hematuria, urine sediment. 3. Serum PTH levels. 4. Stone analysis (strain urine). 4. 3 24-hour urine collections
Gold standard to determine stone composition
Stone analysis (strain urine)
When are three 24-hour urine collections indicated?
If positive family hx of nephrolithiasis, recurrent nephrolithiasis, chronic medical conditions favoring stone formation. To determine urine volume, pH, creatinine, sodium, calcium, uric acid, oxalate, citrate.
Stones in imaging studies are usually RADIOPAQUE, exception=
uric acid stones
What imaging study is gold standard for diagnosis of kidney stones?
Non-contrast helical abdominal CT
Best prevention of nephrolithiasis
intake of more than 2 L of fluid/day, decrease dietary sodium and protein intake, increase calcium 800-1200 mg/day
May be causal association between nephrolithiasis and…
progression to CKD/ESRD
4 types of urinary incontinence associated with lower UT dysfunction
stress, urge, mixed, overflow
Overactive bladder syndrome
type of urge urinary incontinence with urgency, frequency, and nocturia without incontinence
UI most common in men and women
stress in women, urge in men
When emptying bladder, what contracts and what relaxes?
contraction of detrusor smooth muscle, relaxation of smooth internal and striated external sphincter muscles
Causes of UI in person
Trauma, UTI, meds (diuretics), DM, neurogenic, surgical, prostate disease (men), BPH, prostate cancer
What UI has increased post-void residual volume?
Overflow urinary incontinence
PE of UI patient
cardio, abdominal, GU, neurologic
Lab tests in UI
UA, renal function, prostate specific antigen
What are components of dx in UI?
history, and PE, lab tests (UA, renal function, PSA), PVR, urodynamic tests
PVR =
more than 200-300 ml in ultrasound or cath
normal male sexual function depends on interactions between these systems
hormonal, psychological, neurogenic, and vascular
Causes of erectile dysfunction
Endocrine abnormality, psychogenic, meds, vascular disease, neurogenic, decreased libido
Meds that may cause ED
antihypertensives, antidepressants (SSRI’s), antiandrogens, and narcotics/NSAIDS
ED Diagnosis (PE)
usually not very helpful. can do cardio exam to check for risk factors, GU- secondary sexual characteristics like hypogonadism, neuropathy
ED diagnosis- labs to get
FBG, BUN, creatinine, fasting lipid profile, serum total testosterone, serum PRL, thyroid, FSH, LH
ED tx
treat underlying cause. Testosterone replacement if hypogonadism. PDE-5 inhibitors, PGE E1 (alprostadil) therapies, vacuum erection devices, penile implants
when are prostaglandin E1 therapies contraindicated?
intraurethral alprostadil contraindicated in men with hx of priapism. Intrapenile alprostadil contraindicated in men with hx of priapism or severe coagulopathy
PDE-5 inhibitors contraindicated in men on…
nitrate therpay or with hx of ischemic optic neuropathy
balanitis
inflammation of the glans penis or glans clitoridis
balanoposthitis
inflammation of the glans penis and overlying prepuce
Hydrocele
collection of fluid between the parietal and visceral layers of the tunica vaginalis
varicocele
a collection of dilated and tortuous veins in the pampiniform plexus surrounding the spermatic cord in the scrotum
Fluid around testis in communicating hydrocele
peritoneal fluid
fluid in non-communicating hydrocele
from the mesothelial lining of the tunica vaginalis
What occurs d/t failure of processus vaginalis to close during development?
communicating hydrocele
what type of hydrocele is not reducible and does not increase in size with crying or straining?
Non-communicating hydrocele
spermatic cord resembling “bag of worms”
varicocele
varicocele occurs more commonly on what side?
L