Urolithiasis Quiz

Urolithiasis

• Renal stones formed in the kidneys, and Urolithiasis refers to stones that exit the renal pelvis and move into the remainder of the urinary collecting system (ureters, bladder, urethra)
• Causes:
  • Hypercalcaemia (80%)
  • Chronic UTI (15%, "staghorn" struvite stones)
  • Uraemia (urate stones, associated with gout)
• Risk Factors:
  • Family history
  • Recurrent UTIs
  • Obesity, high salt diet
  • Painful hematuria
• Symptoms:
  • Flank pain
  • Intense colicky pain
  • Dysuria
  • Tip of penis pain
• Diagnostic Tests:
  • Abdo USS (confirm stone, preferred for pregnant women)
  • Abdo XR (confirm calcium vs radio-lucent stone)
  • Urinalysis (hematuria +/- crystals in urine)
• Treatment:
  • Analgesics
  • Hydration
  • Surgery
  • Alpha blockers to relax distal ureter & diuretics
  • Uteroscopy scopic removal of the stones
• Complications:
  • Hydronephrosis
  • Post-renal failure
  • Infection

Pyelonephritis

• Inflammation of the pyelum (pelvis) of the kidney
• Causes:
  • Ascending UTI
• Symptoms:
  • Fever
  • Chills
  • Nausea/vomiting
  • Flank pain
• Diagnostic Tests:
  • Clinical diagnosis
  • Urinalysis (pyuria, bacteriuria)
  • Blood cultures
• Treatment:
  • Oral antibiotics (2 weeks)
  • IV antibiotics (severe cases)
  • Hospitalization (septic patients)
• Complications:
  • Chronic pyelonephritis
  • Chronic renal failure

Lower UTI's

Cystitis

• Inflammation of the bladder
• Causes:
  • Bacterial infection (E. coli most common)
• Symptoms:
  • Suprapubic pain
  • Dysuria
  • Frequency
  • Urgency
• Diagnostic Tests:
  • Urinalysis (pyuria, bacteriuria)
  • Urine culture
• Treatment:
  • Antibiotics (3 days, uncomplicated)
  • Oral antibiotics (7 days, complicated)
• Complications:
  • Pyelonephritis
  • Sepsis
  • Chronic cystitis

Urethritis

• Inflammation of the urethra
• Causes:
  • Neisseria gonorrhoeae
  • Chlamydia trachomatis
• Symptoms:
  • Urethral discharge
  • Dysuria
  • Obstructive symptoms
• Diagnostic Tests:
  • Urinalysis (pyuria, bacteriuria)
  • Urine culture
• Treatment:
  • Antibiotics (ceftriaxone or azithromycin)
• Complications:
  • Epididymitis
  • Orchitis
  • Chronic urethritis### UROLOGIC EMERGENCIES
• Acute Urinary Retention:
  • Inability to pass urine
  • Painful urgency
  • Palpable bladder
  • Treatment: Urethral catheterization
  • Risk factors: BPH, Urethral stricture, Neurogenic bladder, Diabetes
• Epididymo-Orchitis:
  • Inflammation of epididymis and testis
  • Gradual onset of pain, swelling, and fever
  • Risk factors: HIV, Homosexuality, Prolonged sitting
  • Treatment: Antibiotics, Pain management, Supportive care
• Testicular Torsion:
  • Sudden onset of severe testicular pain
  • Scrotal swelling
  • Absence of cremasteric reflex
  • Treatment: Emergent surgical exploration and detorsion
  • Risk factors: Undescended testes, Trauma, Torsion of the appendix testis
• Paraphimosis:
  • Trapping of foreskin behind the glans penis
  • Progressive pain and swelling
  • Treatment: Manual reduction, Ice packs, Analgesia, Circumcision
  • Risk factors: Phimosis, Uncircumcised males, Poor hygiene
• Urinary Tract Infections (UTIs):
  • Lower UTIs: Cystitis, Urethritis
  • Upper UTIs: Pyelonephritis
  • Symptoms: Dysuria, Frequency, Urgency, Hematuria
  • Risk factors: Female gender, Age, Diabetes, Catheterization
  • Treatment: Antibiotics, Fluid management, Pain management### Reducing Oedema
• Similar technique for reducing oedema can be performed with ice packs
• "Dundee Technique" involves the use of needle punctures into the glans penis to allow drainage of oedematous fluid

Fournier's Gangrene

• Necrotizing fasciitis of the genitalia and perineum
• Severe pain and fever
• Clinical features: crepitus and altered mental state
• Routinely performed blood and cultures
• Broad-spectrum antibiotics and immediate surgical debridement

Varicocele

• Dilated/enlarged veins in the scrotum
• Pain dull, aching, and when standing late
• Visual inspection and palpation
• US or physical examination
• Pain killers and ibuprofen
• Surgery may be required

Hydrocele

• Elevated fluid levels around the testicle
• Painless swelling of one or both testicles
• Physical examination and US
• Blood and urine tests
• Goes away on its own within 6-12 months
• Surgical drainage may be needed

Haematocoele

• Swelling of the testicle due to blood collection
• Unusual lump and sudden pain
• Physical examination and US
• CT or MRI
• Conservative treatment and small
• Painless and small: If painless and small

Urological Cancers

Bladder Cancer

• Most common cause of gross hematuria in a patient > 50 years
• Risk factors: tobacco, analgesics, family history
• Symptoms: painful, frequent, and urgent urination
• Diagnostic tests: history, and examination, CBC, cystoscopy/biopsy
• Treatment: intra-vesicular chemotherapy, TURBT, radical cystectomy
• Complications: metastasis