Urology Flashcards
(31 cards)
What is hematuria?
presence of blood in urine
MICROSCOPIC: > 5 RBCs/HPF
MACROSCOPIC: hemorrhage into urinary tract will give urine red or brownish volor
What is false hematuria?
discoloration of urine from food (beetroot), myoglobin, & some drugs (rifampicin)
What are the classifications of hematuria?
1- microscopic of macroscopic (gross)
2- intermittent or persistent
3- initial, total, or terminal
4- painful or silent
What does initial, total, or intermittent hematuria indicate?
initial: lower UT cause
total: pre-renal, renal, or ureteric cause
terminal: severe bladder irritation (caused by stone or infection)
Which type of hematuria is more dangerous, silent or painful?
SILENT: malignancy
painful: stones probably
What are the causes of hematuria?
PRE-RENAL: bleeding disorder
RENAL
- urinary stones
- renal tumors
- renal injury
- renal infarct
- glomerulonephritis
POST-RENAL
- bladder tumor
- cystitis & UTI
- Benign Prostatic Hyperplasia
- carcinoma prostate
What investigations should be done for a patient presenting with hematuria?
LAB
- Urine analysis: to confirm & search for cause of hematuria
- Blood tests: CBC, bleeding profile, renal function tests (urea, creatinine)
RADIOLOGICAL
- ultrasound
- CT abdomen
- IVU
INSTRUMENTAL
- cystourethroscopy
What are the types of pain that could present in any urological pathology?
RENAL PAIN -> dull aching pain in loin
URETERIC COLIC -> acute pain felt in loin radiating to ipsilateral iliac fossa & genitalia
BLADDER PAIN -> suprapubic dull aching pain made worse by bladder filling
PERINEAL PAIN -> penetrating ache in perineum & rectum (associated with inguinal discomfort)
PELVIC PAIN -> chronic prostitis or chronic prostate pain syndrome or prostadynia
URETHRAL PAIN -> burning in vulva or penis (especially during voiding)
What are the causes of renal pain?
Stretching of capsule of kidney due to:
- renal inflammation
- acute obstruction
- stones
What is the cause of ureteric pain?
- passage of ureteric stone
- blood clot or sloughed renal papilla gives identical pain
the site of pain is a guide to the progression of a stone
What is the cause of bladder pain?
- inflammation of the bladder -> extreme discomfort at end of micturition
- irritation of trigone of the bladder -> sharp pain referred to the tip of the penis
What are the common symptoms in benign prostatic hyperplasia?
- hesitancy: difficulty to start micturition
- intermittency: interrupted micturition
- dribbling: slow leak of urine after finishing micturition
What’s the difference between precipitancy & incontinence?
- precipitancy: inability to hold micturition & increase desire
- incontinence: uncontrolled escape of urine without desire
What are the common LUTS?
- Dysuria: difficulty in starting micturition
- Urgency: intense desire to micturate due to bladder irritation
- Strangury: painful desire to micturate
- frequency: frequent passage of urine without actual increase in the total volume of urine
- anuria: complete absence of urine production
- retention: failure of the bladder to evacuate urine
- polyuria: increase urine output >3L/day
- oliguria: decrease urine output <400mL/day
What are the urine function tests that should be preformed?
- serum creatinine: 0.5-1.2mg
- blood urea: 20-40mg
- creatinine clearance test
What is PSA?
tumor marker specific to prostate
How should a patient be prepared for a plain x-ray?
- enema, laxative is given the day before
- patient asked to fast in order to reduce bowel gas shadows
What are the normal interpretations seen on a plain x-ray?
- boney parts
- kidney shadows
- ureteric line
- psoas shadow
What are the causes of an obliterated psoas shadow in an plain x-ray?
- scoliosis
- TB spine with cold abscess
- enlarged kidney
- malignancy
- splenic injury (in left sided shadow)
- retroperitoneal tumors
What does ultrasonography demonstrate?
- size of kidney
- thickness of cortex
- presence & degree of hydronephrosis
- intrarenal masses
- stones (bright ultrasonic reflection & acoustic shadow)
- volume of urine
What is the golden tool to visualize prostate & guide biopsy?
transrectal ultrasonography
What method of investigation is best for detection of ureteric stones?
CT
What is the significance of CT?
- diagnose ureteric stones
- in renal carcinoma -> size & site of tumor
- > degree of invasion
- > enlarged lymph nodes at renal hilum
- > invasion of renal vein & vena cava - CRUCIAL in initial staging & follow up of men with testicular cancer
How is IV urography used?
- renal function must be normal
- overnight fasting for 8 hours
- contrast UROGRAFFIN is injected IV
- x-ray is taken in 1-5 minutes then after 15 minutes then 20-30 mins
