Urology Flashcards
(44 cards)
Causes of acute urinary retention?
mechanical obstruction (BPH most common)
constipation
clot retention from haematuria
cancer
urethral stricture
urolithiasis
infection
post-operative
meds (antimuscarinics, opioids)
neurologic impairment
inefficient detrusor muscle
trauma to pelvis, urethra, penis
Presentation of acute urinary retention?
suprapubic tenderness
enlarged palpable bladder
dull to percussion
inability to pass urine despite urge
restlessness/distress/delirium
Mx of acute urinary retention?
urethral catherisation
self-intermittent catherisation
suprapubic catherisation
Contraindications to urethral catherisation?
recent urological surgery i.e., radical prostatectomy
pelvic fracture
Complications of urethral catheterisation?
urge sensation from irritation
leakage
blockage
urethral trauma / stricture formation
infection
abscess, fistula formation
bladder perforation
Complications from relief of urinary retention?
transient hypotension
post-obstructive diuresis
haematuria (transient)
What is BPH?
benign prostatic hyperplasia
benign enlargement of the transition zone of the prostate gland
Presentation of BPH?
LUTS voiding symptoms
poor flow
hesitancy
intermittent stream
dribbling
sensation of incomplete bladder emptying
nocturia
BPH on exam?
homogenous smooth enlargement of the prostate with preservation of the central sulcus
Mx of BPH?
conservative -> ‘watchful waiting’
medical ->
alpha-adrenergic antagonists (tamsulosin, silodosin)
5-alpha reductase inhibitors (finasteride)
surgical ->
minimally invasive procedures (transurethral needle ablation, thermotherapy)
Transurethral resection of the prostate (TURP)
open, laparoscopic or robotic radical prostatectomy
Complications of TURP?
post-operative haemorrhage
failure to resolve symptoms
sepsis
urinary incontinence
retrograde ejaculation and/or erectile dysfunction
urethral strictures
TURP syndrome
What is TURP syndrome?
caused by excessive hypotonic (glycine) irrigation solution absorption during surgery
hyponatraemia, hypervolaemia, hypertension and confusion
Mx of TURP syndrome?
treatment -> diuresis and fluid restriction
prevention -> sx < 1hr, decreased fluid pressure/hanging height, use of bipolar diathermy with saline as irrigation fluid
RFs for urolithiasis?
dehydration/ poor fluid intake
hypercalciuria
recurrent UTIs
diseases (gout, T2DM, PKD)
Presentation of urolithiasis?
severe ‘loin to groin’ pain
rigors/chills
nausea/vomiting
Types of kidney stones?
calcium oxalate (80%)
calcium phosphate
uric acid
struvite (staghorn)
cysteine
Investigations for urolithiasis?
non-contrast CT KUB is gold-standard
renal US for hydronephrosis
urinalysis
check for infection
calcium, phosphate and uric acid levels
Complications of urolithiasis?
AKI
obstruction
hydronephrosis
urinary infection or sepsis
severe pain
Mx of urolithiasis?
analgesia (IM diclofenac)
conservative (if no complications and stone <10mm)
surgical:
ureteroscopy lithotripsy (pregnant women)
extracorporeal shock wave lithotripsy (ESWL)
percutaneous nephrolithotomy (large stones, proximal stones, staghorn calculi)
open/laparoscopic stone retrieval
if infection or obstruction:
nephrostomy
RFs for renal cell carcinoma?
smoking
obesity
HTN
horseshoe kidney
CKD
VHL
ADPKD
tuberous sclerosis
Presentation of RCC?
mostly asymptomatic
classic triad -> haematuria, flank pain, abdo mass
paraneoplastic syndromes
Paraneoplastic syndromes associated with RCC?
polycythaemia (erythropoietin)
hypercalcaemia
HTN
Stauffer’s syndrome (elevated LFTs without liver mets)
Mx of RCC?
radical or partial nephrectomy
poor response to chemorads in general
arterial embolisation
percutaneous cryotherapy
radiofrequency ablation
chemorads for mets
Staging of RCC?
TNM
Stage 1 - <7cm
Stage 2 - >7cm
Stage 3 - local spread but not beyond Gerota’s fascia
Stage 4 - beyond Gerota’s fascia
