Questions and Answers
Which of the following can be filling defects in the bladder? (Select all that apply)
Cystoscopy is only performed if diagnosis is certain.
False
What is the main medical treatment for acute infections due to schistosomiasis?
Praziquantel (Biltricide®)
What is the physiological mechanism behind erection?
Signup and view all the answers
Name one lifestyle modification that can help manage erectile dysfunction.
Signup and view all the answers
The lifetime risk of renal colic is approximately ______.
Signup and view all the answers
What dietary change can help prevent the formation of kidney stones?
Signup and view all the answers
All stone-forming salts promote the formation of kidney stones.
Signup and view all the answers
Which of the following is a symptom of renal colic?
Signup and view all the answers
Match the imaging studies with their descriptions:
Signup and view all the answers
What is the definition of hydronephrosis?
Signup and view all the answers
What is the most common urinary tract infection (UTI) risk factor?
Signup and view all the answers
What defines bacteriuria?
Signup and view all the answers
What are common symptoms of cystitis?
Signup and view all the answers
What is the standard treatment for uncomplicated cystitis?
Signup and view all the answers
Pyelonephritis can be caused by E.Coli.
Signup and view all the answers
The presence of WBC's in urine is known as ______.
Signup and view all the answers
What imaging technique is considered a good first-line test for urinary tract issues?
Signup and view all the answers
Match the definitions with the correct terms:
Signup and view all the answers
Which antibiotics are safe during pregnancy?
Signup and view all the answers
Acute prostatitis is commonly caused by viral infections.
Signup and view all the answers
What is the classic symptom of urinary schistosomiasis?
Signup and view all the answers
Fournier’s gangrene is a type of ______.
Signup and view all the answers
What is the mortality rate associated with Fournier’s gangrene?
Signup and view all the answers
What are typical clinical features of Urogenital TB?
Signup and view all the answers
What are the phases of the lower urinary tract?
Signup and view all the answers
What is the main function of the cerebral areas in micturition control?
Signup and view all the answers
Which of the following is NOT a cause of neurogenic bladder?
Signup and view all the answers
A lesion above the pontine micturition centre can lead to urinary incontinence.
Signup and view all the answers
Autonomic dysreflexia occurs in individuals with spinal cord injury at or above ______.
Signup and view all the answers
Which of the following is a management option for neurogenic bladder?
Signup and view all the answers
What is the definition of overactive bladder?
Signup and view all the answers
Which of the following is a common cause of acute scrotum?
Signup and view all the answers
Epididymitis is the most common cause of scrotal pain in adults in the outpatient setting.
Signup and view all the answers
Urinary incontinence (UI) has a considerable social and economic impact, and the bladder tends to be an ______ witness.
Signup and view all the answers
What is NOT considered a storage symptom of urinary incontinence?
Signup and view all the answers
Which of the following are voiding symptoms? (Select all that apply)
Signup and view all the answers
What is the most common type of urinary incontinence?
Signup and view all the answers
What are common causes of Stress Urinary Incontinence?
Signup and view all the answers
The treatment for urge urinary incontinence includes __________.
Signup and view all the answers
What is an example of a physiological cause of overflow incontinence?
Signup and view all the answers
Total urinary incontinence can be caused by a vesicovaginal fistula.
Signup and view all the answers
Which of the following are potential causes of transient incontinence? (Select all that apply)
Signup and view all the answers
What is the common surgical treatment for a vesicovaginal fistula?
Signup and view all the answers
What is the treatment modality used for managing overflow urinary incontinence?
Signup and view all the answers
Match the Urological conditions with their descriptions:
Signup and view all the answers
Phimosis is when the urethra opens on the dorsal aspect of the penis.
Signup and view all the answers
Study Notes
Urogenital Infections
UTI Epidemiology
- Most prevalent bacterial infection, more common in females than males; male-to-female ratio decreases with age
- Risk factors include previous UTIs, spinal cord injuries, urinary obstructions, pregnancy, and immunocompromised states (e.g., diabetes, HIV, steroid use)
Definitions
- UTI: Inflammatory response of urothelium to bacterial invasion associated with bacteriuria and pyuria
- Bacteriuria: Presence of bacteria in urine; contamination should be avoided
- Pyuria: Presence of white blood cells in urine; differentiated between bacterial colonization and sterile causes like stones or TB
- Recurrent UTI: Defined as reoccurrence after symptom resolution; can result from reinfection or persistence
Presentation and Work-up
- Cystitis Symptoms: Dysuria, urgency, frequency, suprapubic pain, and hematuria
- Pyelonephritis Symptoms: Fever, rigors, flank pain, nausea, vomiting, and potential sepsis
- Urinalysis and specific urine collection methods (mid-stream, catheterized, suprapubic aspiration) are essential for diagnosis
- Uncomplicated UTIs typically affect non-pregnant females, while complicated UTIs can affect males, pregnant females, children, and those with abnormalities or immunosuppression
- Imaging methods like KUB X-ray, ultrasound, and CT scanning offer different insights into abnormalities and stones
Management
- Uncomplicated Cystitis: Treated with a 3-7 days course of empiric oral antibiotics without follow-up if symptoms resolve
- Complicated Cystitis: Requires systematic investigation and correction of underlying factors, treated with a 10-14 days course of antibiotics
- Recurrent UTIs: Generally due to reinfection; investigate for underlying risk factors in high-risk patients
- Acute Pyelonephritis Management: E. Coli causes 80% of cases, often leading to mild forms treated with oral antibiotics, severe cases necessitate IV antibiotics and potential imaging
- Bacterial Nephritis: Severe pyelonephritis with the necessity of aggressive IV antibiotics; emergency management critical
Pregnancy Related Infectious Issues
- Asymptomatic Bacteriuria: Most common infection complication in pregnancy, increasing the risk of more severe outcomes
- Screening with urinalysis and MCS in 1st trimester, treated promptly if positive
- Pyelonephritis in pregnancy: Affects about 4% of pregnant women, higher chance in the third trimester; treated with IV and subsequently oral antibiotics
Fournier’s Gangrene
- Definition: Necrotizing fasciitis of the genitalia and perineum, often mixed bacterial infection
- Symptoms include pain, fever, sepsis; management requires emergency fluid resuscitation and broad-spectrum IV antibiotics alongside urgent surgical debridement
- Mortality around 20%
Prostatitis
Acute Prostatitis
- Presents with fever, severe pain in pelvis, urinary difficulty, and a tender prostate on examination
- Requires hospitalization, blood and urine cultures, and typically treated with IV to oral fluoroquinolones
Chronic Prostatitis
- Bacterial causes are rare; diagnosis confirmed via prostatic fluid analysis
- Treatment involves reassurance, antibiotics, and various symptomatic management strategies like alpha-blockers, NSAIDs, and physical therapies
Urogenital Tuberculosis (TB)
- Accounts for 1% of TB cases in developed nations, up to 20% in developing ones, primarily affecting young adults
- Commonly presents with "cystitis" unresponsive to antibiotics; may lead to serious complications like renal failure
- Diagnosis via urine culture, imaging, and potentially cystoscopy
- Treatment includes a 6-month multidrug regimens targeting active TB with significant surgical intervention in half of cases
Schistosomiasis (Bilharzia)
- Endemic to Africa and the Middle East, caused primarily by Schistosoma haematobium
- Pathology includes acute inflammatory responses and chronic changes leading to bladder lesions and cancer risk
- Diagnosis requires targeted urine collection and imaging studies; treatment involves praziquantel and potential surgical interventions for complications
Male Sexual Dysfunction
Erectile Dysfunction
- Defined as the inability to achieve/maintain an erection sufficient for satisfactory sexual intercourse
- Physiologically linked to vascular mechanisms that regulate blood flow and muscle tone in genital tissues### Erectile Dysfunction (ED)
- Corporal veno-occlusive mechanism leads to reduced venous outflow during erection.
- Neurological control includes:
- S2-4 Parasympathetic fibers facilitating erection.
- T11-L2 Sympathetic fibers contributing to detumescence.
- Dorsal penile nerve, a branch of the pudendal nerve, plays a role in the somatic nervous system.
- Nitric oxide (NO) is the primary neurotransmitter for erection, enhancing cGMP production, which relaxes smooth muscle in the corpora cavernosa.
- The cessation of NO release results in decreased cGMP levels and ejaculation.
Aetiology of ED
- Factors include pre-existing medical conditions, surgical history, psychiatric issues, medications, smoking, and substance abuse.
- Evaluate the onset, duration, and severity of ED, as well as past sexual history using the International Index for Erectile Function (IIEF).
Examination and Investigations
- Perform vital signs assessment, blood pressure check, neuro exam, and inspect secondary sexual characteristics.
- Conduct blood tests for FBC, lipid profile, HbA1c, and testosterone.
- Imaging like ultrasound can be done if abnormalities are detected.
Management of ED
- Options include lifestyle changes, psychotherapy, drug therapy, vacuum devices, and surgical treatments.
Lifestyle Modifications
- Recommendations include cessation of smoking, reduced alcohol intake, weight loss, active lifestyle, and management of comorbidities like diabetes and hypertension.
Psychosexual Therapy
- Particularly beneficial for psychogenic ED but can also aid those with organic causes due to psychological impacts.
Drug Therapy
- PDE5 Inhibitors (Sildenafil, Vardenafil, Tadalafil, Avanafil) enhance cGMP levels post sexual stimulation.
- Use with caution in patients on nitrates, with cardiovascular issues, or those taking medications affecting drug metabolism.
Intracavernosal and Intraurethral Therapy
- Intracavernosal injections for better efficacy when oral drugs fail, utilizing agents such as Papaverine and Alprostadil.
- Intraurethral Alprostadil is less invasive but less effective than injection options.
Vacuum Erection Devices
- Recommended for patients unresponsive to other therapies, effective for older patients with sporadic intercourse needs.
Surgical Treatments
- Options like penile prostheses (malleable or inflatable) serve as a last resort for ED management.
- Penile arterial revascularisation addresses arteriogenic ED.
Renal Colic and Stones
- Life-time risk of renal stones ranges from 1-15%, with increased prevalence in males and in hotter climates.
- Key physiological processes include supersaturation, nucleation, and crystal retention.
Clinical Manifestations
- Symptoms often include renal colic, nausea, vomiting, hematuria, and potentially obstruction leading to hydronephrosis.
Investigative Approaches
- Laboratory tests may include urine dipstick for red cells and blood tests for septic markers.
- Imaging options include KUB X-ray, ultrasound, and non-contrast CT as the gold standard.
Prevention and Management Strategies
- General prevention entails increased fluid intake, limiting sodium, and tailored approaches depending on stone composition.
- Medical expulsive therapy using alpha-blockers and calcium channel blockers is recommended for well-controlled patients.
Surgical Management for Stones
- Options include ESWL, laser lithotripsy, PCNL, and nephrectomy for non-functioning kidneys.
Neurogenic Bladder
- Involves the storage and voiding phases controlled by coordinated CNS areas affecting urinary retention and micturition.
Causes of Neurogenic Bladder
- Can stem from supraspinal, spinal cord, and peripheral nerve injuries or diseases.
Types of Neurogenic Bladder Dysfunction
- Lesions above the pontine micturition centre lead to overactivity; those between the centre and sacral cord result in upper motor neuron symptoms, and injuries to sacral nerves result in flaccid bladder.
Spinal Shock
- Characterized by a temporary flaccid bladder state post-spinal injury, management includes catheterisation until reflexes return.### Autonomic Dysreflexia
- Occurs in individuals with spinal cord injury at or above T6.
- Results from an imbalanced sympathetic discharge in response to noxious stimuli below the injury level.
- Can lead to life-threatening hypertension.
- Common urological stimuli include bladder distention, urinary tract infections, bladder stones, various catheterizations, and urodynamic studies.
Evaluation of Neurogenic Bladder
-
History:
- Assess for lower urinary tract symptoms (LUTS), incontinence, and infections.
- Review medication use and maintain a bladder diary.
- Consider the patient's neurological history.
-
Physical Examination:
- Perform genitourinary and neurological exams.
- Check for presence of spinal reflexes.
-
Bedside Tests:
- Use ultrasound to assess post-void residual urine and hydronephrosis.
- Conduct a urine dipstick test.
- Non-invasive uroflowmetry evaluates urine flow rate.
-
Laboratory Evaluation:
- Test urine for microscopy, culture, and sensitivity (MCS).
- Check serum electrolytes, urea, creatinine, and estimated glomerular filtration rate (eGFR).
-
Urodynamic Study:
- Provides definitive assessment of lower urinary tract dysfunction and evaluates bladder storage pressures and sphincter function.
Management of Neurogenic Bladder
-
Lifestyle Modifications:
- Establish a fluid schedule and manage constipation.
- Address sexual function concerns.
-
Pharmacological Treatments:
- Anticholinergics (e.g., oxybutynin, tolterodine) to reduce bladder overactivity and storage pressures.
- Symptomatic management of urinary tract infections (UTIs).
-
Catheterization:
- Self-Intermittent Clean Catheterization (SICC): Involves regular use of a “nelaton” catheter for bladder emptying or pressure control.
- Indwelling Catheter: Used for patients unable to self-catheterize or with severe incontinence.
- SICC enhances self-care and sexual intimacy while still risking UTIs.
-
Surgical Options:
- Reserved for those failing non-invasive treatments.
- Techniques include intravesical botulinum toxin injections, bladder augmentation, slings, artificial sphincters, and sacral neuromodulation.
Complications of Neurogenic Bladder
- Recurrent UTIs, incontinence-associated dermatitis, bladder stones, chronic urinary retention, hydronephrosis, renal failure, vesico-ureteric reflux, and impaired social/sexual function.
- Poor management in the early stages may lead to decompensation and future management challenges.
Overactive Bladder
- Defined by urinary urgency, often with frequency and nocturia.
- Symptoms stem from involuntary detrusor muscle contractions.
- Diagnosis involves detailed history, symptom questionnaires, physical exams, and lab tests to rule out other conditions.
Treatment of Overactive Bladder
- Non-Pharmacological: Behavioral therapies like bladder training and fluid management.
-
Pharmacological Options:
- Antimuscarinics (e.g., oxybutynin, solifenacin) and β3-adrenoceptor agonists (e.g., mirabegron).
- Botulinum toxin injections for refractory cases and neuromodulation as alternatives.
Acute Scrotum
- Refers to an emergency involving the scrotum's contents or wall.
- Differential diagnoses include ischemia (testicular torsion), trauma, hernia, infections, and inflammatory conditions.
- Testicular Torsion: Twisting of the spermatic cord leading to ischemia; requires immediate surgical intervention.
- Associated symptoms include sudden pain, nausea, high-riding testes (bell clapper deformity), and absent cremasteric reflex.
Treatment of Acute Scrotal Conditions
- For suspected torsion, immediate surgery is crucial to prevent testicular loss.
- Appendiceal torsion may manifest with scrotal pain; often self-limited.
- Infections such as epididymitis can mimic torsion; require urinalysis and proper management.
Urinary Incontinence
- Defined as involuntary leakage of urine, significantly impacting quality of life.
- Different types include mixed, stress, urge, overflow, and total urinary incontinence.
- Key symptoms include urgency, frequency, weak stream, and incomplete emptying.
Urinary Incontinence Management
-
Stress Urinary Incontinence: Most common, often related to urethral hypermobility.
- Treatment includes pelvic floor therapy, mid-urethral slings, and medications like Duloxetine.
-
Urge Urinary Incontinence: Characterized by strong urges and frequent small voids.
- Managed with anticholinergics, bladder training, and potentially neuromodulation.
- Overflow Incontinence: Linked to urinary retention, requiring clean intermittent catheterization.
- Total Incontinence: Addressed through surgical repair of fistulas and urinary diversion if necessary.
- Transient Incontinence: Caused by reversible factors like infection, delirium, or medications.
Pelvic Organ Prolapse
- Involves descent of vaginal walls and apex, potentially associated with urinary incontinence.
- Management options include surgical intervention or use of pessaries.
Urinary Retention
- Presents with suprapubic pain, incomplete emptying, and a palpable bladder.
- Investigations include blood tests, urinalysis, imaging, and urodynamics.
- Treatment focuses on resolving underlying causes and catheterization if necessary.
Studying That Suits You
Use AI to generate personalized quizzes and flashcards to suit your learning preferences.
Description
Test your knowledge on urology, focusing on bladder defects, schistosomiasis treatment, and erectile dysfunction management. This quiz covers important medical concepts and physiological mechanisms relevant to male reproductive health. Challenge yourself to see how well you understand these critical topics.
