session 9 obstruction

Question 1

causes urinary obstruction

Answer 1

tumours of pelvis/ureter, strictures, calculus, blood clot, endometriosis, pregnancy

Question 2

why does pregnancy cause obstruction

Answer 2

high levels of progesterone relax muscle fibres in renal pelvis and ureters and cause a functional obstruction

Question 3

causes urinary retention

Answer 3

pelviureteric junction obstruction, pelvic masses, constipation, inflammation, tumours, neurogenic disorders

Question 4

examples of neurogenic disorders causing urinary retention

Answer 4

cogenital abnormalities, external pressure on cord or lumbar nerve roots, trauma to spinal cord

Question 5

acute urinary retention cause and presentation

Answer 5

painful inability to void, residual volume 300-1500ml. flare up BPH, strictures

Question 6

chronic urinary retention cause and presentation

Answer 6

painless, may still void, RV 300-4000ml. BPH, neurological condition

Question 7

how to manage acute urinary retention

Answer 7

catheterise and record residual volume, history, abdo genetalia and rectum exam, urine dip, U and E

Question 8

how to treat acute urinary retention

Answer 8

alpha blockers for BPH, catheter

Question 9

how to manage chronic urinary retention

Answer 9

catheterise and record residual volume, history, exam, urine dip, u and e

Question 10

what is high pressure chronic urinary retention

Answer 10

kidney swells due to build up or urine. has abnormal U+E and hydronephrosis.

Question 11

what can high pressure chronic urinary retention cause

Answer 11

permanent renal scarring. CKD, AKI

Question 12

what is low pressure chronic urinary retention

Answer 12

normal renal function with no hydronephrosis. bladder is compliant but won’t empty

Question 13

how to treat chronic urinary retention

Answer 13

long term catheterisation or intermittent self catheterisation

Question 14

what is post obstructive diuresis

Answer 14

over diuresis of kidneys following catheterisation of bladder to treat urine retention. worsens AKI as excess water and ions are lost causing hypovolaemia

Question 15

what is hydronephrosis

Answer 15

dilation of the renal pelvis and calyces due to obstruction at any point along urinary tract causing increased pressure and blockage.

Question 16

cause of unilateral hydronephrosis

Answer 16

upper tract blockage

Question 17

cause of bilateral hydronephrosis

Answer 17

lower tract blockage

Question 18

consequences of hydronephrosis on kidney

Answer 18

progressive atrophy, GFR declines and if bilateral renal failure occurs

Question 19

what does obstruction at pelviureteric junction cause

Answer 19

hydronephrosis

Question 20

what does obstruction at ureter cause

Answer 20

hydroureter then hydronephrosis

Question 21

what does obstruction at bladder neck cause

Answer 21

bladder distension with hypertrophy then hydrourteter then hydronephrosis

Question 22

what is acute ureteric obstruction

Answer 22

calculus blocks the ureter, causes renal colic. normally unilateral

Question 23

concequences acute ureteric obstruction

Answer 23

acute renal failure if bilateral, anuria/oliguria, pyonephrosis

Question 24

pyonephrosis

Answer 24

infected obstructed kidney. causes death from sepsis and loss of renal function

Question 25

what test tests for upper urinary tract obstruction

Answer 25

diuretic venography (MAG3)

Question 26

how to drain upper urinary tract

Answer 26

nephrostomy, JJ stent

Question 27

what is urolithiasis

Answer 27

urinary calculi.

Question 28

risk factors urolithiasis

Answer 28

male, dehydrated, caucasion

Question 29

3 most common places for urolithiasis

Answer 29

pelviureteric junction, pelvic brim, vesicoureteric junction

Question 30

5 types of urinary calculi

Answer 30

calcium oxalate, calcium phosphate/calcium oxalate, magnesium ammonium phosphate, uric acid, cysteine

Question 31

how do ureteric stones present

Answer 31

renal colic, sweaty, pale, restless, nausea, vomiting.

Question 32

how do bladder stones present

Answer 32

strangury. urge to pass something that will not pass. untreatable UTIs. hematureia and renal failure

Question 33

treatment urolithiasis

Answer 33

analgesia, fluid intake, ESWL, ureteroscopic destruction. PCNL, open surgery

Question 34

what is acute prostatitis

Answer 34

infection of prostate.

Question 35

causative organisms prostatitis

Answer 35

e coli, C. trachomatis, Neisseria gonorrhoea

Question 36

symptoms prostatitis

Answer 36

soft, tender, enlarged prostate. malaise, rigours, fever. cannot pass urine, dysuria, perineal tenderness

Question 37

what causes chronic prostatitis

Answer 37

inadequately treated infection.

Question 38

how to diagnose chronic prostatitis

Answer 38

histology shows neutrophils, plasma cells and lymphocytes. positive culture

Question 39

what is non bacterial prostatitis

Answer 39

enlargement of prostate due to C trachomatis affecting sexually active men

Question 40

what does histology show non bacterial prostatitis

Answer 40

fibrosis and chronic inflammation

Question 41

what is BPH

Answer 41

non-neoplastic enlargement of the prostate gland, leads to bladder outflow obstruction.

Question 42

symptoms BPH

Answer 42

difficulty starting urination, poor stream, dribbling post micturition, frequency and nocturia

Question 43

what does rectum feel like BPH

Answer 43

firm, smooth, rubbery

Question 44

what an untreated BPH cause

Answer 44

acute urinary retention, progressive bladder distension causing chronic painless retention and overflow incontenence, bilateral upper tract obstruction and renal impairment causing CKD.

Question 45

treatment BPH

Answer 45

a blockers to relax smooth muscle at bladder neck and in prostate. finasteride (5a-reductase inhibitor) to prevent conversion of testosterone to androgen dihydrotestosterone.