Flashcards in The Urinary System and the Male Genital Tract Deck (38)
Urinary tract infections
Very common disorder of the urinary tract
Risk factors include:
Urinary tract obstructions e.g. stones or catheters
Bacterial causes of UTIs
E.coli is the most common causative organism (>70% of community UTIs).
Other organisms include: Staphylococcus, Proteus and Klebsiella.
haematuria and super pubic pain
painful or difficult urination
loin pain and tenderness
few urinary symptoms
swollen tender prostate on PR
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
Function of Kidneys
Maintinance of water, electrolyte and acid-base homeostasis.
Excretion of many toxic metabolic waste products (urea and creatinine).
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.
Acute renal failure
A significant deterioration in renal function occurring over hours or days
There is a low urine volume (
Causes of Acute renal failure
ATN damage to tubules due to ischaemia or nephrotoxins
Renal tract obstruction (eg stones, tumours)
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)
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
common causes of chronic renal failure
management of chronic renal failure
Managed under nephrology team. Treat reversible causes. Avoid exacerbating factors, avoid nephrotoxic drugs.
May progress to renal replacement therapy
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
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
Risk factors for kidney stones
Dietary factors ( increase chocolates, tea and rhubarb)
Drugs ( loop diuretics, antacids, corticosteroids, theophylline and aspirin)
Renal tract abnormalities
Metabolic abnormalities (hyperparathyroidism, hyperthyroidism and cancer)
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.
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
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.
renal cancer presentation
50% incidental findings on abdominal imaging.
Para neoplastic syndromes: e.g. polycythaemia, hypercalcaemia and hypertension.
treatment of renal cancer
Radical nephrectomy +/- chemotherapy
Transitional Cell Carcinoma presentation
Classically – painless haematuria
Frequency, urgency and dysuria can occur.
Transitional Cell Carcinoma tests
Urine for cytology
Cystoscopy and biopsy
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
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.
Benign Prostatic Hyperplasia
Hyperplasia: increase in the number of cells.
BPH: increase in number of cell resulting in the formation of nodules. Prostate weighs 60-100gm
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
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)
Prostate cancer risk factors
Race (more common in black people and very uncommon in Asian people)
Diet – increased risk with increased fat consumption
Prostate cancer symptoms
May be asymptomatic (has a slow course)
Nocturia, hesitancy, poor stream and terminal dribbling
Examination shows a hard irregular prostate
Prostate cancer diagnosis
Raised PSA (prostate specific antigen) but may be normal in 30% of cases
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
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.
Testicular torsion tests
Tests: USS with Doppler but may need exploratory surgery
Testicular torsion treatment
Treatment: Surgery, URGENT, if still viable bilateral fixation (orchidopexy) if abnormal then orchidectomy
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
Most common is seminoma