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dysuria and haematuria Flashcards

1
Q

what is dysuria?

A

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

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2
Q

what is external dysuria?

A

urine irritating inflamed genital organs

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3
Q

what is internal dysuria?

A

pain felt in urethra

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4
Q

who is most likely to be affected by dysuria?

A

women
then men over 40

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5
Q

what is the pathophysiology of dysuria?

A

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,

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6
Q

what can cause pneumaturia or passing debris in urine?

A

urinary fistula

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7
Q

what is pneumaturia?

A

mixture of gas in urine

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8
Q

what is an uncomplicated UTI?

A

non complicated patient group
typical bacteria is within lower urinary tract

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9
Q

what bacteria are common within UTIs

A

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

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10
Q

what can cause a UTI?

A

urethritis - STI
epididymo-orchititis
balanitis
prostatis

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11
Q

what is epididymo-orchitis?

A

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

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12
Q

what is balanitis?

A

inflammation of the head of penis

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13
Q

what can be non infectious causes of dysuria?

A

obstruction
trauma
malignancies
drug related
local irritants

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14
Q

what obstructions can cause dysuria?

A

BPH, stones, strictures, stenosis

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15
Q

what trauma can cause dysuria?

A

honeymoon cystitis, catherization, abuse, intense exercise

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16
Q

what inflammatory conditions can cause dysuria?

A

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

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17
Q

what is spondyloarthropathies?

A

inflammation of the spine

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18
Q

what drugs can cause dysuria?

A

dopamine, cantharidin, ticarcillin, penicillin-G, cyclophosphamide

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19
Q

what local irritants can cause dysuria?

A

soap, creams, lubricants

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20
Q

what are RF for dysuria?

A

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

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20
Q

what can more serious or upper UTIs progress to?

A

pyelonephritis
sepsis - urosepsis

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21
Q

what are RF for more serious dysuria?

A

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

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22
Q

what examinations should be done within dysuria?

A

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

23
Q

what on a urine dipstick indicates UTI?

A

nitrites and leukocytes

24
Q

what can cause haematuria?

A

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

25
Q

what is gross haematuria?

A

visible - red urine

26
Q

what is initial haematuria?

A

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

27
Q

what is terminal haematuria?

A

visible blood/ blood stained urine seen at end of urine

28
Q

what is total haematuria?

A

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

29
Q

what pathology within the kidneys can result in haematuria?

A

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

30
Q

what pathology within the ureter can result in haematuria?

A

infection

31
Q

what pathology within the bladder can result in haematuria?

A

bladder cancer, trauma

32
Q

what pathology within the urethra can result in haematuria?

A

cystitis (UTI), instrumentation of urinary tract

33
Q

can endometriosis result in haematuria?

A

yes

34
Q

what pathology within the prostate can result in haematuria?

A

BPH, prostate cancer

35
Q

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

A

menstruation, trauma (sexual activity, exercise, contusion)

36
Q

what is microscopic haematuria?

A

RBC only visible on microscope - most common

37
Q

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

A
  • 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)
38
Q

what is haemoglobinuria?

A

presence of free hemoglobulin in urine (haemolytic anaemia)

39
Q

who is haemoglobinuria most common in?

A

ultra runners

40
Q

what investigations are needed within haematuria?

A

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

41
Q

what is cystoscopy?

A

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

42
Q

what is beeturia?

A

urine can turn red after eating beetroot - pseudo

43
Q

what are RF for
urinary tract malignancies?

A
  • 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:
44
Q

what is cyclophosphamide?

A

type of chemo

45
Q

what is schiosomiasis?

A

known as bilharzia - can be caused by parasitic worms

46
Q

O/E what would indicate urinary malignancies?

A

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)

47
Q

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

A

2 week

48
Q

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

A

2wk

49
Q

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

A

2week

50
Q

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

A

2 week

51
Q

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

A

non-urgent referral

52
Q

why would you need to refer to a nephrologist?

A
  • 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
53
Q

where does renal cell carcinoma arise from?

A

malignancy arising from renal parenchyma/ cortex

54
Q

what are RF for renal cell carcinomas?

A

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

55
Q
A

GU (3 decks)

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