Transcript GU Patrick King - Peer Teaching Society

Phase 2
Patrick King
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Aims
To cover aetiology, presentation, diagnosis and
treatments of common urological problems such as:
UTI, AKI, chronic renal failure, BPH and prostate
cancer
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Structure of urinary tract
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Lower Urinary tract infection
E.Coli, Klebsiella spp., proteus
spp.,enterococci spp., staphylococcus
saprophyticus
Symptoms: suprapubic pain, dysuria,
frequency, foul smelling urine, nocturia,
incontinence, fever, delirium
Investigations: ?
Treatment: Nitrofurantoin or trimethoprim
Recurrent UTI (>=3 UTIs in a year)
warrants investigation – renal ultrasound,
cystoscopy, KUB-XR
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Upper UTI
Cause: ascent of LUTI, obstruction, bladder dysfunction
Symptoms – “loin to groin” pain, fever/rigors, vomiting,
lower UTS, haematuria. Unwell.
Investigation – U&Es, urine sample, catheter, CTKUB,
blood cultures
Treatment – ABCDE, rehydration,
IV antibiotics, drain hydronephrosis
e.g. percutaneous nephrostomy/
catheter
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Acute Kidney Injury
Cause: split into pre-renal, renal and post-renal
Presentation: 1st – reduced urine output (<0.5ml/kg)
2nd – raised creatinine, urea, K+, ↓eGFR
3rd – confusion, vomiting, overload
Treatment: pre-renal - ?
Renal – biopsy, steroids, removal, dialysis
Post-renal - ?
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Chronic renal failure
Cause: Diabetes, hypertension, old age, drugs
Stage 1-5 depending on eGFR, 1/2 very common (1/10)
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The prostate
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Benign prostatic hyperplasia
The prostate grows throughout life in response to
testosteroen. It doubles in size every 4.5 years
between 31 and 50. 90% at 90 will have symptoms.
Symptoms: ?
Can cause acute/chronic retention – catheterise
Ask about cancer symptoms, DRE
Treatment: alphablockers e.g. doxazocin, 5-alphareductase inhibitors e.g. finasteride, TURP
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Prostate cancer
80% of men in 80s have prostate cancer but only
causes 13% of all cancer deaths.
Symptoms: as before + bony pain, weight loss.
PSA – 1000 screened: how many deaths prevented?
how many false positives?
Investigation – TRUS-prostate, radioisotope/MRI
Treatment – watchful waiting & monitor
anti-androgen therapy
prostatectomy/radiotherapy – complications?
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Quiz?
• Which other structure in
•
Name
two
hormones
the retroperitoneum may
produced/activated in
have pathology that
the
kidney.
mimics upper UTI and
needs urgent treatment? • A patient develops AKI
1 day post-op. What are
• Why do middle aged
3 possible causes?
women have more UTIs?
•
What
3
areas
of
the
• A 120kg man on the ward
ureter provide
has a urine output of
anatomical narrows
45mls in the last hour.
likely
to
stop
stones?
Does this worry you?
Quiz?
• Management of an AKI
patient with a K+ of 7.9.
• What two structures
may be damaged in a
prostatectomy and
what complications
must the patient be
warned of?
• A 75 year old man
comes in with chronic
retention. Name one
examination, one
investigation and one
intervention that should
be done soon?
• Is PSA a good screen for
prostate cancer?