introduction to urological practive Flashcards
(22 cards)
what is the urothelium?
the lining of the urinary system from the calynx to teh external meatus
it is impervious to urine
3-5 layers thick
outline the micturition cycle?
good diagrams in notes
- bladder filling
- detrusor muscles relaxed
- urethral sphincter tone and pelvic floor tone prevent leaking - first sensation to void
- detrusor muscles relaxed
- urethral sphincter and pelvic floor contracts - normal desire to void
- detrusor muscle contracts
- urethral sphincter relaxes (voluntary control)
- pelvic floor relaxes
micturition occurs
back to step 1
what are the 7 steps to taking a history in urology?
- history
- physical exam
- basic investigations
- specialist investigations
- imaging
- endoscopy
- biopsy
what are the lower urinary tract symptoms?
remember with the pneumonic FUNWISE
Frequency Urgency Nocturia Weak stream Intermittency Sensation of incomplete emptying E
can be split into storage, voiding and post voiding symptoms which can help to determine the cause
what are the irritative/ storage LUTS?
- frequency (day and night)
- urgency
- incontinence (urge, stress, overflow, anatomical)
what are the obstructive/ voiding LUTS?
- hesitency
- poor stream
- terminal dribbling
- post micturition dribbling
How do you assess someone that presents with LUTS?
examination (abdo)
- suprapubic tenderness
- palpable bladder
- consistency
- shape
- abnormalities
- genital examination
- digital rectal examination
essential investigations
- history of symptoms
- MSU
- U&Es
- PSA in males
- bladder scan
- frequency / volume chart
optional investigations
- assess flow rate
- plain X-ray KUB
- USS/ CT renal tract
- urodynamics - catheter into the bladder and pressure is applied to the bladder and to the abdomen separately so difference is measured.
- cystoscopy
what are the causes of voiding dysfunction?
- UTI
- Overactive bladder
- Bladder outlet obstruction
- Bladder cancer
- Prostate cancer or benign prostate hyperplasia
- Gynaecological problems
- Bladder stones
- Fistulas eg. between bladder and vagina
how are LUTS managed?
Conservative
Medical
- Alpha blocker or 5alpha reductase inhibitors - BPH
- Anticholinergic - overactive bladder
Surgical
- Urolift
- rezum/steam therapy
- TURP/ green light laser prostatectomy
- Holmium laser enucleation of prostate
- Open or robotic prostatectomy
how is urinary incontinence managed?
Conseravtive
Urethral catheter for overflow incontinence
Anti Cholinergic or adrenergic agonists for urge incontinence
Surgical for significant stress incontinence
Plugs, bulking agents, tapes, mesh, artificial urinary sphincters
Correction of anatomical cause
what are the 2 types of haematuria?
visible
non-visisble (can be asymptomatic or symptomatic)
what investigations do you do for haematuria?
- FBC/ U&Es
- MSU
- Urine cytology
- Blood PSA in men
- Imaging: USS, IVU, Retrograde pyelogram, MRI, Isotope scanning, CT urogram (the new standard), Endoscopy, Flexible/ rigid cystoscopy, ureteroscopy
- Biopsy - rare
how are bladder cancers classified?
diagram in notes
what is the treatment for bladder cancer?
Low risk - TURBT mitomycin C X1
Medium risk - mitomycin C X6
High risk - BCG therapy, radical cystectomy
Muscle invasive - radical cystectomy or radiotherapy
what are the common renal cancers?
renal cell tumour - cancer of the renal parenchyma (this is more common)
TCC - cancer of the collecting system (renal pelvis)
other rare types
how is renal cancer treated?
Need to do renal function tests and look at any other kidney disease to see if the patient really needs their kidney.
Need to look for any signs of advanced disease and any metastasis
Treatment
- Chemotherapy and radiotherapy are not very efficient for renal therapy because they function by stopping cell proliferation but nephrons will not regenerate.
- surgery
what is prostate specific antigen?
This is a protease enzyme which is secreted in the seminal fluid and a small amount gets into the bloodstream during cell division (bound tightly to plasma proteins)
what are the causes of raised PSA?
BPH
prostastasis
prostate cancer
what are the symptoms of prostate cancer?
- may be asymptomatic
- LUTS
- backache
- symptoms of metastasis
- symptoms of local progression - invasion of bladder and ureter causing blockage and back pressure
how is prostate cancer diagnosed?
- measure PSA
- TRUS biopsy from peripheral zone
- TURP
how is prostate cancer staged?
- DRE
- bone scan
- CT/MRI - endorsed by NICE to be done before a biopsy to see if there is anything more serious going on
how is prostate cancer managed?
nice diagram in notes
if localised or locally advanced then monitor, radical prostectomy, DXT, 2nd therapy hormone treatment
if metastasized, hormonal manipulation, treat metastasis, palliative care
