The Urinary System and the Male Genital Tract Flashcards Preview

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Flashcards in The Urinary System and the Male Genital Tract Deck (38)
1

Urinary tract infections

Very common disorder of the urinary tract

Risk factors include:
Females>males
Sexual intercourse
Pregnancy
Diabetes
Urinary tract obstructions e.g. stones or catheters

2

Bacterial causes of UTIs

E.coli is the most common causative organism (>70% of community UTIs).

Other organisms include: Staphylococcus, Proteus and Klebsiella.

3

Cystitis

frequency
dysuria
urgency
haematuria and super pubic pain

4

dysuria

painful or difficult urination

5

pyelonephritis

high fever
rigors
vomiting
loin pain and tenderness

6

Prostatitis

flu-like symptoms
few urinary symptoms
swollen tender prostate on PR

7

Management of UTIs

Drink plenty of fluids.

Urinate often (double voiding).

Antibiotics (trimethoprim usually first line treatment in uncomplicated UTIs).

Imaging – US in non-resolving UTIs, children, men and pyelonephritis.

Severe cases may require hospital admission specially pyelonephritis and in the elderly

8

Function of Kidneys

Maintinance of water, electrolyte and acid-base homeostasis.
Excretion of many toxic metabolic waste products (urea and creatinine).
Hormonal function
Renin – help control blood pressure
Erythropoietin- stimulates production of RBCs in the bone marrow and helps in the production of vitamin D.
The functional unit is the nephron (consisting of a glomerulus and a renal tubule).
Filtration of most small molecules from the blood in the glomerulus.
Selective reabsorption in the renal tubule of most of the water and some molecules.
Maintenance of the acid-base balance.

9

Acute renal failure

A significant deterioration in renal function occurring over hours or days

There is a low urine volume (

10

Causes of Acute renal failure

Pre-renal
Hypoperfusion, sepsis
Renal
ATN damage to tubules due to ischaemia or nephrotoxins
Post-renal
Renal tract obstruction (eg stones, tumours)

11

Management of acute renal failure

Find and treat the cause

Treat exacerbating factors ( hypovolaemia, sepsis.. etc).

Stop nephrotoxic drugs ( NSAIDs, ACE-I, gentamycin and Vancomycin)

May need renal replacement therapy (haemofiltration/dialysis)

12

Chronic renal failure

Classified into 5 stages depending on the glomerular filtration rate (GFR)

GFR is the volume of fluid filtered from the glomerular capillaries into the Bowman’s capsule per unit time

Symptoms usually occur by stage 4

13

common causes of chronic renal failure

Glomerulonephritis
Diabetes
Renovascular disease
Hypertension
Polycystic disease

14

management of chronic renal failure

Managed under nephrology team. Treat reversible causes. Avoid exacerbating factors, avoid nephrotoxic drugs.
May progress to renal replacement therapy

15

Glomerulonephritis

A group of disorders where there is damage to the glomerular filtration apparatus. This may cause a leak of protein or blood into the urine.

Usually there is a deposition of immune complexes in one part of the nephron

16

Kidney stones

Crystal aggregates that form in the collecting ducts of the kidneys and can deposit anywhere in the renal tract.

Life time incidence 15%

Peak age 20-40 years.

Male: female = 3:1

17

Risk factors for kidney stones

Dehydration
Dietary factors ( increase chocolates, tea and rhubarb)
Drugs ( loop diuretics, antacids, corticosteroids, theophylline and aspirin)
Renal tract abnormalities
Recurrent UTIs
Metabolic abnormalities (hyperparathyroidism, hyperthyroidism and cancer)

18

symptoms kidney stones

Patient may be asymptomatic (found accidently on x-ray or blood on dipstick ).

Pain. Kidney stones causes loin pain. Ureteric stones case renal colic (from loin to groin). Bladder and urethral stones cause pain on micturition with interrupted flow. Patients often can’t lie still from the pain.

19

management of kidney stones

Imaging options: KUB-xray (80% of stones are visible). CT scan (99% of stones visible).

Prompt pain relief

Stones 5mm or causing obstruction may need intervention

20

renal cancer

Renal cell carcinoma

85% of all renal cancers.

Usually presents between the ages of 50 and 70 years.

2:1 male predominance .

Smoking an important risk factor along with obesity, hypertension, exposure to asbestos and certain hereditary conditions.

21

renal cancer presentation

50% incidental findings on abdominal imaging.

Haematuria.

Loin pain.

Abdominal mass.

Para neoplastic syndromes: e.g. polycythaemia, hypercalcaemia and hypertension.

22

treatment of renal cancer

Radical nephrectomy +/- chemotherapy

23

Transitional Cell Carcinoma presentation

Classically – painless haematuria
Frequency, urgency and dysuria can occur.

24

Transitional Cell Carcinoma tests

Urine for cytology
Cystoscopy and biopsy

25

Transitional Cell Carcinoma treatment

Depends on stage of disease and spread

Small lesions at early stage can be managed with diathermy on cystoscopy.

Later stages – radical cystectomy or palliative chemo/radiotherapy

26

Anatomy of Prostate

Prostate is a gland that is located at the base of the bladder and around the first part of the urethra.

In normal adults weighs around 20gm.

Helps in the secretion and maintenance of semen and spermatozoa.

27

Benign Prostatic Hyperplasia

Common
Hyperplasia: increase in the number of cells.
BPH: increase in number of cell resulting in the formation of nodules. Prostate weighs 60-100gm

28

Benign Prostatic hyperplasia symptoms

Usually those of lower urinary tract obstruction: increased frequency, hesitancy, nocturia, terminal dribbling.

Can lead to an increased risk of infection.

Enlarged prostate on PR

29

Benign Prostatic Hyperplasia treatment

If small and not symptomatic then conservative, reduce fluid intake (specially at night), reduce alcohol and caffeine, scheduled voiding.
Medical treatment: Alpha-blockers, reduces the smooth muscle tone in the prostate.
TURP (Transurethral Resection of the Prostate)

30

Prostate cancer risk factors

Age
Race (more common in black people and very uncommon in Asian people)
Family history
Hormone levels
Diet – increased risk with increased fat consumption

31

Prostate cancer symptoms

May be asymptomatic (has a slow course)

Nocturia, hesitancy, poor stream and terminal dribbling

Examination shows a hard irregular prostate

32

Prostate cancer diagnosis

Raised PSA (prostate specific antigen) but may be normal in 30% of cases
Biopsy

33

Prostate cancer treatment

Depends on stage of disease, age of patient and comorbidities

In elderly men with many comorbidities – watchful waiting may be an option

Local disease can be treated with radical prostatectomy

Hormonal therapy and radiotherapy for more advanced cases

34

Testicular torsion

Sudden onset of pain in 1 testis.

Pain in abdomen, nausea and vomiting.

Testis is hot, swollen and tender.

The testis may lie high and transversely.

Most common 11-30 years old.

35

Testicular torsion tests

Tests: USS with Doppler but may need exploratory surgery

36

Testicular torsion treatment

Treatment: Surgery, URGENT, if still viable bilateral fixation (orchidopexy) if abnormal then orchidectomy

37

Testicular tumours

Most common malignancy in males aged 15-44 years old.

Risk factors include: undescended testis, infant hernia and infertility.
Presentation: painless testicular lump often noted after trauma or infection
Germ cell tumours
Different categories
Most common is seminoma

38

Testicular tumours treatment

Treatment depends on type of tumour and stage

Usually involves an orchidectomy and a combination of radiotherapy and chemotherapy