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urology final boss COPY > investigations in urology ( lab, instruements, biopsy,) > Flashcards

investigations in urology ( lab, instruements, biopsy,) Flashcards

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1
Q

Gross anatomy of male urethra

A
  • 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.
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2
Q

female urethra

A

Female urethra is 2-4 cm long.

Is wider than the male urethra

diameter of male urethra is about 7mm,

whereas female is 9mm

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3
Q

Instrumental Investigations = DIAGNOSTIC ONLY

A

Anterograde - normal route of urine i.e

kidneys –> ureter –> urinary bladder –> urethra

Retrograde - opposite to the normal route of urine

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4
Q

Anterograde examinations

NATE

A
  • 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
  • Antegrade Pyelouretography = administration of contrast medium through nephrostomy tube to outline the collecting system
  • Tissue Biopsy - sample histological examinations
  • Exudates - urethral/ vaginal discharge
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5
Q

indiations of Antergrade Pyelouretography

A

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

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6
Q

indications for Nephroscopy

A

to check for residual stones in the collecting system after an open operation

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7
Q

Retrograde investigations to male urethra

A

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
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8
Q

indications of Urethroscopy

A

stone in urethra,

foreign body,

very rarely urethral tumour

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9
Q

define the diameter of the urethra which intrument is used

A

Calibration of the urethra

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10
Q

Retrograde examination of Urinary bladder

A

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

Cystoscopy

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11
Q

Indications of Catheretisation of the Urinary Bladder

A
  1. Ddx between anuria and retention of urine in patients with obesity
  2. Obtain Urine sample for labs/ culture
  3. urodynamic investigation of LUT
  4. For Imaging with contrast ( Cystography & MCU)
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12
Q

Idications for Retrograde Cystography

A

TRAUMA to UB

VUR

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13
Q

Indications of Micturating Cystography

A

VUR active or passive

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14
Q

4 Indications of Cystoscopy

A
  1. HAEMATURIA - mg of renal bladder
  2. Staging Cystoscopy – Colorectal / Cervical
  3. VesicoVaginal Fistulas
  4. Combined with Biopsy to determine Chronic Cystitis
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15
Q

Which disease is a stong contraindication for Cystoscopy

A

ACUTE CYSTITIS

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16
Q

Therapeutic use of Catheterisation of the Urinary Bladder

A

Drain Urinary Bladder during retention

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17
Q

Retrograde Instrumentation of the Ureters

A

Catheterisation of the ureter

  • Retrograde Ureto-Pyelogrphy

Ureterocystoscopy = endoscopic guidance

  • usually combined w/ Renoscopy + Pyelography = UretoRenoscopy
    • investigation of Ureter, Collecting system & calyx
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18
Q

Indications of Catheterisation of Ureter

A
  1. NB- Obtain sample for cytology for Urothelial ca
  2. define level of obstruction in the ureter
  3. Administration of contrast medium fhrough uretric catheter for Retrograde Ureto-Pyelogrphy
    • ​​X-ray differences between ureteric tumours and stone in ureter, esp radiolluscent stone.
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19
Q

x-ray ddx of stones and ca on RetrogradeUretero-Pyleography

A

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
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20
Q

Ureteroscopy Indications

A

Stones in the Ureter

Urothelial ca

Foreign body in the the Ureter

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21
Q

Retrograde Investigations of the Kidney

A

UreteroRenoscopy - Inspects ureter-> Renal Pelvis-> Renal Calyx

  • investigation of the Ureter and Renal collecting system
  • uses a Uretorenoscope
    • ​Indications
      1. ​​urothelial carcinoma
      2. stones in ureter
      3. foreign body in ureter
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22
Q

2 kinds of CONTRAINDICATIONS for Retrograde investigations

A

Absolute

Trauma to the urethra shown by urethrorrhagia

Relative

Acute Inflammation of

  1. urinary bladder - > acute cystitis
  2. prostate -> acute prostatitis
  3. urethra -> Acute urethritis
  4. epididymis -> Acute epididymitis
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23
Q

Biopsy in urology

Study These Flashcards
A
  1. Renal biopsy - Fine Needle Aspiration Biopsy
  2. Prostate biopsy - Needle biopsy under local anesthetic, transab or transrectal
  3. UB biopsy - Cystoscope under General anesthetic
  4. Testicular Biopsy - General anesthesia w/ zylocaine to inhib spermatogenesis . & fix w/ bovin solution
24
Q

indications of Renal Biopsy

Study These Flashcards
A

diagnosis of

  1. Nephrosis
  2. Chronic GlomeruloNephritis
  3. Lupus
  4. Colllagen disorders
  5. Malignancies
    1. Cytological exam of ; Urothelial and parenchymal tumors
    2. Staging and prognosis
25
Contraindications of Renal Biopsy
**Solitary** Kidney Hydroephrosis **Haemorrhagic** diseases
26
Indications of Prostatic biopsy
Pca diagnosis * type * staging - local/ advanced * Grading - gleason * rx option - according to IPSS - TURP, Open
27
Indication of biopsy to the Urinary Bladder
suspicion of Uriniary Bladder tumors using a **Resectoscope**
28
Non Invasive Imaging investigation in urology
US X-ray IVU
29
US in urology
30
X-ray in Urology
31
IVU in urology
32
Lab s in Urology
Urine specimens BLood iinvesitgations Genitourinary Secretions
33
5 Routine Urine tests
1. Diureses 2. Ph 3. Culture 4. Sedimentation of urine 5. Colour
34
pH of urine what is normal causes of changed pH
35
Culture of urine, what does it show amd why is it used
36
which values are important Sedimentation
37
Diuresis of Urine normal diuresis / 24 hrs Polyuria
38
Colour of Urine
39
Microbiological tests for Urine -which diseases is it done what is _contamination_ what is _clincally significant infection_
indicated in UTI's upper & lower **morning mid stream** urine sample as 1st stream contains normal bac * _significant infection_ = over 10^5 CU * _contaminatino_ = less than 10,000
40
what is Cytology of urine indications examples biomarkers for Pca
Procedure to I/D cancer cells in urine used for 1. Pca- **_PCA3 ag_** in urine after prostatic massage 2. Bladder cancer
41
what is better PCA3 ag in urine or prostatic biopsy
transrectal Biopsy of prostate is def dg
42
What is a spermogram
tests semen after 25days w/o sex, masturbation and ejaculation material is given to labs w/in **30mins**
43
examples of _blood tests_ in urology Renal Func test parameters why is clotting status required? indication of genetic investigations indications of hormonal tests NB which 2 tumor biomarkers are important
PSA = blood PCA3 ag urine = early detection
44
PRostatic secretions ## Footnote main indications method loc of acute and chronic gonococci
**_Direct microscopy_** of prostate after a _Prostatic Massage_ indicated for **STI'S** * Neiserria * Gonorrhea * acute = **_Intra_**cellular location of gonococci * chronic = **_Extra_**cellular location of gonococci
45
rand cells according to **who inflammatory parameters of ejaculate**
Who inflamm parameters of ejaculate = **rand cells = increased inflamm** 1. **spermatogenic**- matture and immature over 5x106ml 2. **non spermatogenic** - leukocytes over 1x106ml
46
**_Ejaculate_** laboratory investigatino in urology
culture via **direct microscopy** pH- _alkaline_ - infection = **STI** method of collection * requires **3-5 days** abstinence * must complete all ejaculation of contents as hte 1st expeled porstion is the most mobile Who inflamm parameters of ejaculate = **rand cells = increased inflamm** 1. **spermatogenic**- matture and immature over 5x106ml 2. **non spermatogenic** - leukocytes over 1x106ml
47
Terms related to SPERM ANALYSIS what are the 2 main parameters of ejaculate
----------------------------Quantitative parameters of ejaculate ------------------------- * sperm **Volume** * sperm **Concentration** ----------------------------Qualitative parameters of ejaculate ------------------------ * Total sperm **Mobility** * spem **Morphology** * **Therapeutic Sperm Cryopreservation**
48
analysis of sperm ejaculatory Volume
* normal 2-6 ml * Hypovolemia below 2 ml 1. incomplete ejaculation 2. d/2 **ejac duct obstruction** * hypervolemia above 6
49
analysis of ejaculateory sperm concentration
50
analysis of ejaculatory sperm motility what's necrospermia
Total sperm motility should be over 50% * **Asthenospermia** = reduced motility below 50% * **Necrospermia** = complete abscence of motility
51
evaluation of ejaculatory sperm morphology
normal sperm morphology has over 14% sperm w/ normal shape **Teratospermia** = less than **14%** of sperm in ejaculate is w/ normal shape
52
what is OAT syndrome
OligoAsthenoSpermia etio= spermeogenetic * testicular dysgenesis * malposition - cryptochordism, retractile, ectopy * varicocele transport anomalies * orchitis - * epididymitis - occlusion * Prostatitis - occlusion dg = sperm analysis = **spermogram** **​** hormone lvls & karyotyping Rx ment of underlying cause
53
Characteristics of ejaculate specimen
**color** - white is normal. Red means chronic prostatitis amount 2-6 ml is normal sperm count 40mil - 120mil per ejaculate is normal
54
how many sperm should be alive with good form for pregnancy
around 50%
55
what is surgical sperm retrieval used for how is it retrieved from the vas deferens = MVSA how is it retrieved from epididymis how is it retrieved from testis
surgical sperm retrieval is used to acheive pregnancy during **obstructive azoospermia** vas _deferens_ = MVSA * **M**icrosurgical **V**asdeferens **S**perm **A**spiration _epididymis_ = MESA & PESA * **Microsurgical** **E**pididymal **S**perm **A**spiration * **Percutaneaous****E**pididymal**S**perm**A**spiration _testis_ = TEFNA & TSE 1. Testicular Fine Needle Aspiration 2. Testicular Sperm Excision

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