FY1 Urology

Question 1

Bladder washouts

a) Indication
b) Procedure

Answer 1

a) - Clot retention
- Passing clots/darker urine - risk of clot retention

b) - Ensure anticoagulants/antiplatelets suspended if safe to do so
- Catheterised (ideally 16Fr 2-way or 22Fr 3-way)
- 2 large pots of sterile water
- 50 ml bladder syringe
- If in retention, aspirate volume first (do not want to aggravate by instilling further fluid into full bladder)
- 50mls instillations/aspirations
- Dispose of blood + clots in one pot
- Once running without clots/dark blood, do a further 1L washouts (clot + 1L rule)
- If at high risk of further clots - set up bladder irrigation (always 2 bottles)

Question 2

Stones

a) Management if <7mm
b) Management if >7mm
c) Management if infected-obstructed stone
d) Urine dip

Answer 2

a) - Pass spontaneously +/- tamsulosin or CCB
- Advice - hydration, dietary (eat calcium with oxalate - so binds in intestine rather than urine)
- Consider thiazide if hypercalciuric, consider stopping furosemide if safe
- Usually pass within 1-3 weeks
- 1st time formers - catch stone for analysis

b) - ESWL
- URS - better for lower ureteric stones, removal of small stones, laser fragmentation of larger stones
- PCNL
- Open/keyhole surgery and stone removal

c) - Sepsis 6 + ureteric stent
- Later stone and stent removal - e.g. 4 weeks later

d) - Blood
- Leuk + nitrites - worry about infection
- pH above 7 suggests urea-splitting organisms such as Proteus spp. whilst a pH below 5 suggests uric acid stones