investigations in urology ( lab, instruements, biopsy,) Flashcards
(39 cards)
Gross anatomy of male urethra
- male urethral length is between 20-25 cm long
- The shape of the male urethra
- penis is flaccid is the shape of an S
- penis is erect the urethra takes the shape of U
From anatomical point of view, the male urethra is divided in to two anatomical parts:
Posterior urethra:
- Prostethic urethra from bladder neck to prostatic apex. Longest part of urethra is about 2-4cm.
- Membranous urethra is located from prostatic apex to urological diaphragm. Average of 1-2cm long.
Anterior urethra:
- Bulbous urethra; widest part of male urethra
- Penile urethra; length cannot be guessed but average is 16cm
- Before external meatus in glans penis is fossa naviculars.
female urethra
Female urethra is 2-4 cm long.
Is wider than the male urethra
diameter of male urethra is about 7mm,
whereas female is 9mm
Instrumental Investigations = DIAGNOSTIC ONLY
Anterograde - normal route of urine i.e
kidneys –> ureter –> urinary bladder –> urethra
Retrograde - opposite to the normal route of urine
Anterograde examinations
NATE
-
Nephroscopy = inspection of the collecting system of the kidney via nephrostomy tube.
- Can be done through previous channel after renal surrgery / or new channel via X-RAY
- Percutaneous Nephrostomy - placement of a small, flexible (catheter) through your skin(flank/ back) into your kidney
- Can be done through previous channel after renal surrgery / or new channel via X-RAY
- Antegrade Pyelouretography = administration of contrast medium through nephrostomy tube to outline the collecting system
- Tissue Biopsy - sample histological examinations
- Exudates - urethral/ vaginal discharge
indiations of Antergrade Pyelouretography
defines the level of ligature of the ureter an degree of obstruction
if retrograde is contraindicated = Urethral trauma
if retrograde is difficult d/2 urethral changes = Tumor, Stenosis, Compression
indications for Nephroscopy
to check for residual stones in the collecting system after an open operation
Retrograde investigations to male urethra
Urethroscopy
- urethroscopy is the initial step of urethrocystoscopy.
- indications may be; stone in urethra, foreign body, very rarely urethral tumour
Drilling = placement of catheter in the UB that stops along the urethra
Calibration to urethra = to define the diameter of the urethra
- May be performed by soft catheters (bouges), or hard metalic dilators
- With these instruments we may find the anatomical part of the structure of the urethra
indications of Urethroscopy
stone in urethra,
foreign body,
very rarely urethral tumour
define the diameter of the urethra which intrument is used
Calibration of the urethra
Retrograde examination of Urinary bladder
Catheterisation of UB = catheter in UB
- Main sign that catheter is in UB is leakage of urine
- can be replaced by US
-
Retrogradecystography
- active / passive
- Micturating Cysto-Urethrogram (MCU) / VUR= imaging bladder and urethra on flouroscopy while passing urine using contrast
-
Retrogradecystography
Cystoscopy
Indications of Catheretisation of the Urinary Bladder
- Ddx between anuria and retention of urine in patients with obesity
- Obtain Urine sample for labs/ culture
- urodynamic investigation of LUT
- For Imaging with contrast ( Cystography & MCU)
Idications for Retrograde Cystography
TRAUMA to UB
VUR
Indications of Micturating Cystography
VUR active or passive
4 Indications of Cystoscopy
- HAEMATURIA - mg of renal bladder
- Staging Cystoscopy – Colorectal / Cervical
- VesicoVaginal Fistulas
- Combined with Biopsy to determine Chronic Cystitis
Which disease is a stong contraindication for Cystoscopy
ACUTE CYSTITIS
Therapeutic use of Catheterisation of the Urinary Bladder
Drain Urinary Bladder during retention
Retrograde Instrumentation of the Ureters
Catheterisation of the ureter
- Retrograde Ureto-Pyelogrphy
Ureterocystoscopy = endoscopic guidance
- usually combined w/ Renoscopy + Pyelography = UretoRenoscopy
- investigation of Ureter, Collecting system & calyx
Indications of Catheterisation of Ureter
- NB- Obtain sample for cytology for Urothelial ca
- define level of obstruction in the ureter
- Administration of contrast medium fhrough uretric catheter for Retrograde Ureto-Pyelogrphy
- X-ray differences between ureteric tumours and stone in ureter, esp radiolluscent stone.
x-ray ddx of stones and ca on RetrogradeUretero-Pyleography
tumor = Marked, irregular, filling defect, connected to the wall
stone = Regular, filling defect, NOT connected to wall
- Urothelial Carcinoma/ Transitional Cell Carcinoma of Pelivs, Ureter & Valyces
Ureteroscopy Indications
Stones in the Ureter
Urothelial ca
Foreign body in the the Ureter
Retrograde Investigations of the Kidney
UreteroRenoscopy - Inspects ureter-> Renal Pelvis-> Renal Calyx
- investigation of the Ureter and Renal collecting system
- uses a Uretorenoscope
-
Indications
- urothelial carcinoma
- stones in ureter
- foreign body in ureter
-
Indications
2 kinds of CONTRAINDICATIONS for Retrograde investigations
Absolute
Trauma to the urethra shown by urethrorrhagia
Relative
Acute Inflammation of
- urinary bladder - > acute cystitis
- prostate -> acute prostatitis
- urethra -> Acute urethritis
- epididymis -> Acute epididymitis
Biopsy in urology
- Renal biopsy - Fine Needle Aspiration Biopsy
- Prostate biopsy - Needle biopsy under local anesthetic, transab or transrectal
- UB biopsy - Cystoscope under General anesthetic
- Testicular Biopsy - General anesthesia w/ zylocaine to inhib spermatogenesis . & fix w/ bovin solution
indications of Renal Biopsy
diagnosis of
- Nephrosis
- Chronic GlomeruloNephritis
- Lupus
- Colllagen disorders
- Malignancies
- Cytological exam of ; Urothelial and parenchymal tumors
- Staging and prognosis
