dysuria and haematuria

Question 1

what is dysuria?

Answer 1

discomfort, burning, sensation of pain during micturition
- Patients may complain of urethral discomfort not associated with micturition

Question 2

what is external dysuria?

Answer 2

urine irritating inflamed genital organs

Question 3

what is internal dysuria?

Answer 3

pain felt in urethra

Question 4

who is most likely to be affected by dysuria?

Answer 4

women
then men over 40

Question 5

what is the pathophysiology of dysuria?

Answer 5

generally a result of irritation of urethra/ bladder.
- Inflammation of bladder causes difficulties in initiating urination and burning sensation
- Irritation of bladder causes bladder contraction  painful and frequent urination
- Although dysuria is typically caused by urethral/ bladder inflammation,

Question 6

what can cause pneumaturia or passing debris in urine?

Answer 6

urinary fistula

Question 7

what is pneumaturia?

Answer 7

mixture of gas in urine

Question 8

what is an uncomplicated UTI?

Answer 8

non complicated patient group
typical bacteria is within lower urinary tract

Question 9

what bacteria are common within UTIs

Answer 9

E.coli, staph. Epidermis, proteus mirabilis, S,aureus

Question 10

what can cause a UTI?

Answer 10

urethritis - STI
epididymo-orchititis
balanitis
prostatis

Question 11

what is epididymo-orchitis?

Answer 11

Bacterial orchitis might be associated with epididymitis — an inflammation of the coiled tube (epididymis) at the back of the testicle that stores and carries sperm. In that case, it’s called epididymo-orchitis. Orchitis causes pain and can affect fertility

Question 12

what is balanitis?

Answer 12

inflammation of the head of penis

Question 13

what can be non infectious causes of dysuria?

Answer 13

obstruction
trauma
malignancies
drug related
local irritants

Question 14

what obstructions can cause dysuria?

Answer 14

BPH, stones, strictures, stenosis

Question 15

what trauma can cause dysuria?

Answer 15

honeymoon cystitis, catherization, abuse, intense exercise

Question 16

what inflammatory conditions can cause dysuria?

Answer 16

interstitial cystitis, atrophic vaginitis, spondyloarthropathies non – infectious prostatitis, ketamine bladder

Question 17

what is spondyloarthropathies?

Answer 17

inflammation of the spine

Question 18

what drugs can cause dysuria?

Answer 18

dopamine, cantharidin, ticarcillin, penicillin-G, cyclophosphamide

Question 19

what local irritants can cause dysuria?

Answer 19

soap, creams, lubricants

Question 20

what are RF for dysuria?

Answer 20

sexual activities, drug history, travel history, recurrent UTIs, smoking, history of exposure to chemicals, using topical agents

Question 20

what can more serious or upper UTIs progress to?

Answer 20

pyelonephritis
sepsis - urosepsis

Question 21

what are RF for more serious dysuria?

Answer 21

bladder outlet obstruction
bladder/ urethral diverticulum
renal cysts
neurogenic bladder eg MS
immunocompromised - diabetes
spinal cord injuries
previous drug resistant UTIs

Question 22

what examinations should be done within dysuria?

Answer 22

vital signs, abdo exam, examination of genitalia (swabs, STI referral), PR/ prostate examination)

Question 23

what on a urine dipstick indicates UTI?

Answer 23

nitrites and leukocytes

Question 24

what can cause haematuria?

Answer 24

infection, trauma, cancer, coagulopathies, inflame disease, AI conditions, congetial or malformations, medications eg rifampicin, foods

Question 25

what is gross haematuria?

Answer 25

visible - red urine

Question 26

what is initial haematuria?

Answer 26

visible blood/ blood stained urine seen at start of urine only

Question 27

what is terminal haematuria?

Answer 27

visible blood/ blood stained urine seen at end of urine

Question 28

what is total haematuria?

Answer 28

blood stained urine throughout entire duration of urine flow with no ability to readily differentiate between urine and blood

Question 29

what pathology within the kidneys can result in haematuria?

Answer 29

pyelonephritis, kidney stones, post- infectious glomerulonephritis (ask about recent colds)

Question 30

what pathology within the ureter can result in haematuria?

Answer 30

infection

Question 31

what pathology within the bladder can result in haematuria?

Answer 31

bladder cancer, trauma

Question 32

what pathology within the urethra can result in haematuria?

Answer 32

cystitis (UTI), instrumentation of urinary tract

Question 33

can endometriosis result in haematuria?

Answer 33

yes

Question 34

what pathology within the prostate can result in haematuria?

Answer 34

BPH, prostate cancer

Question 35

what pathology within the vagina/ labia can result in haematuria?

Answer 35

menstruation, trauma (sexual activity, exercise, contusion)

Question 36

what is microscopic haematuria?

Answer 36

RBC only visible on microscope - most common

Question 37

what can cause miscroscopic haematuria - go through all organs)?

Answer 37

- Kidneys: pyelonephritis, nephrolithiasis, trauma - Ureter: infection, trauma - Bladder: trauma (sexual activity, exercise, contusion) - Urethra: cystitis - Endometrium: endometriosis - Prostate: acute prostatitis, BPH - Vagina/ labia: menstruation, trauma (sexual activity, exercise, contusion)

Question 38

what is haemoglobinuria?

Answer 38

presence of free hemoglobulin in urine (haemolytic anaemia)

Question 39

who is haemoglobinuria most common in?

Answer 39

ultra runners

Question 40

what investigations are needed within haematuria?

Answer 40

abdo exam DRE MSC dipstick resp exam cardiac exam fundoscopy bloods US of kidney and bladder CTKUB cystoscopy urodynamic tests

Question 41

what is cystoscopy?

Answer 41

camera passed down urethra of penis, past prostate and into bladder. water can be poured down side of channels to fill and flush bladder - Light on side of camera can see inside and devices can be passed down to take specimens and remove tissue

Question 42

what is beeturia?

Answer 42

urine can turn red after eating beetroot - pseudo

Question 43

what are RF for urinary tract malignancies?

Answer 43

- Age >40yrs - Male - Smoking history - Prior exposure to carcinogens – occupation - Previous pelvic radiation - Irritative urinary tract symptoms including urgency, frequency/ dysuria - History of urological pathology and treatment - Cyclophosphamide: - Analgesia misuse - Schistosomiasis:

Question 44

what is cyclophosphamide?

Answer 44

type of chemo

Question 45

what is schiosomiasis?

Answer 45

known as bilharzia - can be caused by parasitic worms

Question 46

O/E what would indicate urinary malignancies?

Answer 46

normal or renal mass that may be palpable, evidence of anaemia as well paraneoplastic syndromes (rare disorder that occurs when immune system has a reaction to cancerous tumour known as neoplasm)

Question 47

what referral is needed for Dysuria with unexplained non visible, 60+

Answer 47

2 week

Question 48

what referral is needed in Haematuria (visible and unexplained) without UTI or that persists after successful treatments, 45+?

Answer 48

2wk

Question 49

what referral is needed with Haematuria (non – visible and unexplained) with dysuria or raised WCC, 60+

Answer 49

2week

Question 50

what referral is needed WCC with unexplained non -visible haematuria, 60+?

Answer 50

2 week

Question 51

what referral is needed with UTI – unexplained, recurrent or persistent. 60+

Answer 51

non-urgent referral

Question 52

why would you need to refer to a nephrologist?

Answer 52

- Macroscopic haematuria: cystoscopy and imaging to exclude post renal cause - Significant proteinuria >2+ - Abnormal eGFR <60 - Severe hypertension of imaging findings suggestive or primary renal disease

Question 53

where does renal cell carcinoma arise from?

Answer 53

malignancy arising from renal parenchyma/ cortex

Question 54

what are RF for renal cell carcinomas?

Answer 54

smoking is most common link - Obesity and hypertension - Renal transplantation and ESRD - Age - Majority of cases are sporadic, but there has been some genetic links between