Urinary Tract Disorders Flashcards
(47 cards)
What is the incidence of urinary tract stones?
15% of population has urinary tracts stones
What are the types of renal stones?
Alkaline urine:
1-Calcium oxalate
2-Calcium phosphate
3-Struvite
Acidic urine:
1-Urate stone
2-Xanthine stone
3-Cysteine stone
What is the most common type of stones?
Calcium oxalate
(If recurrent and multiple Ca oxalate stones: familial and hyperoxaluria)
What is the most radio-opaque stone?
Calcium phosphate
What is the stone that are related to proteus infection forming a staghorn stone?
Struvite
What are the characteristics of urate and xanthine stones?
-The most radiolucent
-Associated with cell death “chemotherapy”
What are the manifestations of urinary stones?
-Renal stones: hematuria mainly, loin pain
-Ureteric stones: hematuria, pain from loin to groin
-Urinary bladder stones: hematuria, cystitis, Supra-pubic pain
Hemorrhagic cystitis May occur with certain medications like…
Cyclophosphamides
Recurrent painful hematuria in a young female=….
Interstitial cystitis
What is the rate of passage of stones: according to stone size?
1mm—85%
2-4mm—75%
5–7mm—60%
The most specific diagnostic tool for stones is …
CT
What is the treatment of each case…?
1–<5mm — Medical treatment (observative treatment)
2–5mm-2cm — ESWL (endoscopic shock wave lithotripsy)
3–5mm-2cm but in pregnant female — (Ureteroscopy)
4–Multiple-complex-staghorn stone (PCNL: percutaneous nephrolithotomy)
What are the complications of urinary tract stones?
Urinary tract obstruction
-Acute urine retention
-Chornic urine retention with sterile hydronephrosis
-Chronic urine retention with infected hydronephrosis (with long-standing retention and immune Om promised patients)
-Pelvi-Ureteric junction PUJ obstruction (loin to groin pain especially after caffeine and diuretic intake, it may lead to renal scarring)
What is the management of the followings?
1-Acute urine retention: Urinary catheter
2-Chronic retention with sterile hydronephrosis: stemming or pyeloplasty
3-Infected hydronephrosis: PCN (Percutanous nephrostomy)
4-PUJ obstruction management with possible scarring, but a urosurgeon must:
-Determine the cause: CT scan
-Exclude the complications (renal scarring): DMSA Scan
-Choose treatment according to renal function: DTPA or MAG3 renogram
•good renal function: pyeloplasty
•poor renal function: Nephrectomy
…. is better than ….. specially in cases of failed transplant and damaged kidney.
MAG 3 renogram - DTPA Scan
What are the other causes of urine retention?
-Postoperative urine retention: (mainly after spinal and epidural analgesia due to bladder neck inactivity)
-Post infection urine retention: (uretheral stenosis)
-Retention in diabetic patients: (under active bladder causing painless retention)
… of urinary tract injuries occur with pelvic fractures
85%
… injury is the most common injury and happens usually with straddle injury in bicycle riders (falling astride)
Bulbar uretheral injury
What is the mode of trauma in membranous urethral injury and bladder rupture?
Pelvic fractures
What is the clinical picture of bulbar urethral injury and membranous uretheral injury?
Both:
-Urine retention
-Perineal hematoma
-Blood at meatus
+Bulbar uretheral injury- Full bladder
+Membranous uretheral injury- Full bladder + high or non-palpable prostate on PR
What is the clinical picture of bladder rupture?
-Hematuria
-Retention
-Suprapubic pain
-Free Fluid infra abdominally
-Empty bladder
What are the investigations for urinary tract trauma?
-Ascending cystourethrogram
-Intravenous urography
What is the treatment of bulbar and membranous uretheral injuries?
Suprapubic catheter
(Uretheral catheter is contraindicated)
What is the treatment of bladder fracture?
-Extraperitoneal (conservative management)
-Intraperitoneal (laparotomy for fear of peritonitis)
