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Ch10: Urology (i) - Coggle Diagram
Ch10: Urology (i)
Causes of urinary retention
BPH
constipation
clot retention
tumour
stones
infection
phimosis
prolapse (cystocoele, rectocoele)
drugs: opioids, antimuscarinics, sympathomimetics
neuro causes e.g. MS, stroke, GBS, diabetic neuropathy, CES
Urological devices/procedures
2 way catheter
3 way catheter
additional irrigation channel to help prevent clot formation
suprapubic catheter
inserted via transcut approach
nephrostomy
in renal angle
done by IR when there's obstruction causing hydronephrosis
ureteric stent
to bypass obstruction e.g. stricture, tumour, stones
inserted anterograde via nephrostomy or retrograde via cystoscopy
2 curls @ either end stops migration
ileal conduit
type of urostomy where ureters are diverted to isolated portion of ileum that opens to ant abdominal surface as a stoma
can be performed after radical cystectomy
Urinary tract stones
types
ca oxalate (80%)
ca phosphate
uric acid (radiolucent)
struvite (staghorn, a/w klebsiella + proteus)
cysteine
plain film xray with see 80%
tx options
passage
if stones distal + <10mm + no comps
give analgesia (NSAIDs/opioids), antiemetics, lots of oral fluid, a-blocker
follow up in 4 wks to ensure passage
surgical
ureteroscopy + laser or pneumatic lithotripsy
ECSWL
percut nephrolithotomy
open/lap stone surgery if others fail
Acute testicular pain
torsion
high rising testis + absent cremasteric reflex
do colour duplux US to assess blood flow
6 hr window from onset of sx to save testicle
if viable orchidopexy, if non-viable orchidectomy
fix contralat testicle (in case of bell clapper deformity)
torsion of testicular appendix
hyatid of morgagni = embryonic remnant
difficult to distinguish from testicular torsion - scrotal exploration if any doubt + excise appendix
localised tender mass, cremasteric reflex preserved, blue dot sign
can be txed conservatively with scrotal support + analgesia
Acute epididymo-orchitis
STIs, UTIs, mumps, coxsackie
scrotal swelling (hydrocoele)
tx: elevation, ice, NSAIDs, abx depending on cause
BPH
sx: poor flow, dribbing, hesitancy, intermittent stream, incomplete/double voiding, nocturia, frequency, urgency, urge incontinence
Tx options
conservative: monitor until sx significant, diet changes
medical
a-blocker e.g. tamsulosin
5-a reductase i e.g. finasteride
shrinks prostate by blocking conversion of testosterone to dihydrotestosterone
surgery
when medical tx fails
TURP
TURP syndrome: excessive irrigation with hypotonic fluid leads to dilutional hyponatraemia, HTN, confusion, fluid overload
tx = diuresis
laser ablation
urolift