Differential Diagnosis:
Stones
Kidney
Ureter
Bladder
BPH
UTI/cystitis from chemo or radio
Bladder CA
Acute nephritis
Trauma and anti-coagulants
Renal cell CA
Stones:
History
Continuous loin to groin pain
Suggesting ureteric stone
Dull and aching pain
Suggesting stone in minor/major calyces
Hematuria
Vomiting
Sweating
UTI symptoms
Risk factors
Poor fluid intake
Hyperparathyroidism
Examination Patient in agony
Benign Prostatic Hypertrophy:
History
Elderly men
Symptoms of
Obstruction
Poor, intermittent stream
Hesitancy
Dribbling
Retention
Irritative
Frequency
Urgency
Nocturia
Renal failure
Drowsiness
Headaches
Disorientation
Examination
Uremia
Pale and wasted
Dry furry tongue
Mentally confused
Large bladder
DRE
BPH
Lateral lobes enlarged
Sulcus palpable
CA
Posterior part hard and craggy obliterating sulcus
Bladder Tumors:
History
Painless gross hematuria
Older patient
With/without irritative symptoms (ulcerating CA)
Risk factors
Smokers
Industrial chemicals
Dye and rubber industry
Radiation therapy
Examination
Malignant tumor
Felt on bi-manual exam
Pale
Cachexic
Anemic
Benign
May be negative
Acute Nephritis (post strep. glomerular nephritis):
History
Young child with history of
Sore throat
Ankle face swelling
Recurrent infections
Examination
Edema
Peri-orbital swelling
Renal Cell CA:
History
Flank pain *
Hematuria
Weight loss
40-60 yr
Male > female
Examination
Palpable mass *
HTN *
Cachexia
* Classical Triad
UTI (Cystitis):
History
Females predominate
Sequelae of
Sex
Urethral catheterization
Symptoms of urgency
Frequency and dysuria
Fever and loin pain (ascending infection)
Examination
Pyrexia
Suprapubic tenderness
Loin tenderness
Investigations:
CBC
Hb
Reduced in CA
Reduce in BPH due to uremia
WBC
Increased in UTI
Platelets
Thrombotic Thrombocytopenic Purpura (TTP)
U&E
Increased urea due to BPH
Kidney function
PT/PTT/INR & FDP
Anticoagulant drugs
LFT
Metastases in Ca
Increased ALP
PSA
Serum calcium, phosphate, & uric acid
Urine
Microscopy
Pus cells and organisms in infection
Casts in nephritis
Culture
To identify organism
If no active bleed
IVP
Filling defects in bladder
Kidney: shows stones
Back pressure of kidneys in BPH
Cystoscopy
Bladder CA and biopsy
Abdominal ultrasound
Kidney mass/polycystic kidney disease
Calculi in bladder
If bleeding
Catheterise
Irrigate bladder
Cystoscopy
Treatment:
Fluid resuscitate if necessary
Treat underlying condition
Stones
Pain relief
90% will pass
Increase fluid intake (2L a day minimum)
Change the precipitating diet (dairy/red meat/tea/red wine)
Surgery
Nephrolithotomy(PCNL)/pyelolithotomy
Lithotripsy (ESWL)
Note Urethral stones are a surgical emergency: Urethrotomy
UTI
Antibiotic and then treat underlying cause e.g. stones, BPH
Bladder CA
Transurethral resection of the bladder (transurethral cystectomy)
Radical cystectomy and chemotherapy
BPH
Medical
Proscar (Finasteride)
Inhibits 5 Alpha Reductase
Alpha blockers
Prazosin
Relaxes prostatic smooth muscle
Surgical
Indications
Urinary retention
Hydronephrosis
UTIs
Severe symptoms
TURP (transurethral resection of prostate)
Complications of TURP
Failure to void
Bleeding
Clot retention
UTI
Incontinence
Open prostatectomy (rarely done)
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