urologic disorders mohammad al omar, mbbs, frcsc assistant professor and consultant urologist kkuh,...
Post on 20-Dec-2015
216 views
TRANSCRIPT
Urologic DisordersUrologic Disorders
Mohammad Al Omar, Mohammad Al Omar, MBBS, FRCSCMBBS, FRCSC Assistant professor and Assistant professor and
Consultant UrologistConsultant UrologistKKUH, KSUKKUH, KSU
Urologic DisordersUrologic Disorders
Urinary tract infectionsUrinary tract infections
UrolithiasisUrolithiasis
Benign Prostatic Hyperplasia and voiding Benign Prostatic Hyperplasia and voiding dysfunction dysfunction
Urinary tract infectionsUrinary tract infections
UrethritisUrethritis
Epididymitis/orchitisEpididymitis/orchitis
ProstatitisProstatitis
cystitiscystitis
Acute PyelonephritisAcute Pyelonephritis
Chronic PyelonephritisChronic Pyelonephritis
Renal AbscessRenal Abscess
URETHRITISURETHRITIS
S&SS&S– urethral discharge urethral discharge – burning on urination burning on urination – AsymptomaticAsymptomatic
GonococcalGonococcal vs. vs. NongonococcalNongonococcal DX: DX: – incubation period(3-10 days vs. 1-5 wks)incubation period(3-10 days vs. 1-5 wks)– Urethral swabUrethral swab– Serum: Chlamydia-specific ribosomal RNA Serum: Chlamydia-specific ribosomal RNA
URETHRITISURETHRITIS
EpididymitisEpididymitis
Acute : pain, swelling, of the epididymis <6wk Acute : pain, swelling, of the epididymis <6wk chronic :long-standing pain in the epididymis and chronic :long-standing pain in the epididymis and testicle, usu. no swelling. testicle, usu. no swelling. DXDX– Epididymitis vs. TorsionEpididymitis vs. Torsion– U/S U/S – Testicular scanTesticular scan– Younger : Younger : NN. . gonorrhoeaegonorrhoeae or or CC. . trachomatistrachomatis– Older Older :: E. coli E. coli
EpididymitisEpididymitis
ProstatitisProstatitis
Syndrome that presents with inflammation± Syndrome that presents with inflammation± infection of the prostate gland including:infection of the prostate gland including:– Dysuria, frequencyDysuria, frequency– dysfunctional voidingdysfunctional voiding– Perineal painPerineal pain– Painful ejaculationPainful ejaculation
ProstatitisProstatitis
ProstatitisProstatitis
Acute Bacterial Prostatitis :Acute Bacterial Prostatitis :– RareRare– Acute painAcute pain– irritative and obstructive voiding symptoms irritative and obstructive voiding symptoms – Fever, chills, malaise, N/VFever, chills, malaise, N/V– Perineal and suprapubic pain Perineal and suprapubic pain – Tender swollen hot prostate.Tender swollen hot prostate.– Rx : Abx and urinary drainage Rx : Abx and urinary drainage
cystitiscystitis
S&S:S&S:– dysuria, frequency, urgency, voiding of dysuria, frequency, urgency, voiding of
small urine volumes, small urine volumes, – Suprapubic /lower abdominal painSuprapubic /lower abdominal pain – ± Hematuria± Hematuria– DX: DX:
dip-stick dip-stick urinalysis urinalysis Urine cultureUrine culture
PyelonephritisPyelonephritis
Inflammation of the kidney and renal pelvisInflammation of the kidney and renal pelvis
S&S :S&S :– Chills Chills – FeverFever– Costovertebral angle tenderness (flank Pain)Costovertebral angle tenderness (flank Pain)– GI:abdo pain, N/V, and diarrhea GI:abdo pain, N/V, and diarrhea – Gr-ve sepsis-mild flank painGr-ve sepsis-mild flank pain– Dysuria, frequencyDysuria, frequency
PyelonephritisPyelonephritis
Investigation:Investigation:
– Urine C&S :+VE(80%)Urine C&S :+VE(80%)EnterobacteriaceaeEnterobacteriaceae ( (EE. . coli), Enterococcus coli), Enterococcus
– Urinalysis:↑ WBCs, RBCs,BacteriaUrinalysis:↑ WBCs, RBCs,Bacteria– (±) ↑serum Creatinine(±) ↑serum Creatinine– CBC : LeukocytosisCBC : Leukocytosis
PyelonephritisPyelonephritis
Imaging:Imaging:– IVPIVP– U/SU/S– CTCT
UrolithiasisUrolithiasis
Egyptian mummies 4800 BC Egyptian mummies 4800 BC
Prevalence of 2% to 3%,Prevalence of 2% to 3%,
Life time risk: Male : 20%, female 5-10%Life time risk: Male : 20%, female 5-10%
Recurrence rate 50% at 10 years Recurrence rate 50% at 10 years
UrolithiasisUrolithiasis
Risk factors:Risk factors:– Intrinsic FactorsIntrinsic Factors
GeneticsGenetics
Age (2Os-4Os)Age (2Os-4Os)
SexSex M>F M>F
UrolithiasisUrolithiasis
Extrinsic FactorsExtrinsic Factors
– GeographyGeography (mountainous, desert, tropics ) (mountainous, desert, tropics ) – Climate (July - October)Climate (July - October)– Water IntakeWater Intake – DietDiet (purines , oxalates, Na . (purines , oxalates, Na .– OccupationOccupation (sedentary occupations ) (sedentary occupations )
UrolithiasisUrolithiasis
How do stones formHow do stones form– supersaturated→ Crystal Growthsupersaturated→ Crystal Growth– Aggregation of crystals →stoneAggregation of crystals →stone
UrolithiasisUrolithiasis
Most people have crystals in their urine, so Most people have crystals in their urine, so why not everyone gets stones?why not everyone gets stones?
– Anatomic abnormalities Anatomic abnormalities – Modifiers of crystal formation: Inhibitors/promotersModifiers of crystal formation: Inhibitors/promoters
CitrateCitrate
Mg, Mg,
urinary proteins(nephrocalcin)urinary proteins(nephrocalcin)
oxalateoxalate
UrolithiasisUrolithiasis
Common stone typesCommon stone types– Calcium stones 75%Calcium stones 75%
(ca Ox )(ca Ox )
– Uric acid stones Uric acid stones – Cystine stonesCystine stones– Struvite stonesStruvite stones
UrolithiasisUrolithiasis
S&SS&S– Renal or ureteric colicRenal or ureteric colic– Freq, dysuria Freq, dysuria – HematuriaHematuria– GI symptoms: N/V, ileus, or GI symptoms: N/V, ileus, or
diarrheadiarrhea– DDx :DDx :
GastroenteritisGastroenteritis
acute appendicitisacute appendicitis
colitiscolitis
salpingitis salpingitis
UrolithiasisUrolithiasis
Cont. S&SCont. S&S
– RestlessRestless↑↑HR, ↑ BPHR, ↑ BP
fever (If UTI)fever (If UTI)
Tender CVATender CVA
UrolithiasisUrolithiasisInvestigationInvestigation
UrinalysisUrinalysis : :– RBCRBC– WBCWBC– BacteriaBacteria– CrystalsCrystals
UrolithiasisUrolithiasisInvestigationInvestigation
ImagingImaging– Plain Abdominal Films (KUB)Plain Abdominal Films (KUB)– Intravenous Urogram (IVP)Intravenous Urogram (IVP)– Ultrasonography (U/S)Ultrasonography (U/S)– Computed Tomography (CT)Computed Tomography (CT)
UrolithiasisUrolithiasisManagementManagement
Conservative Conservative – HydrationHydration– AnalgesiaAnalgesia– AntiemeticAntiemetic– Stones (<5mm ) >90% spontaneous PassageStones (<5mm ) >90% spontaneous Passage
Indication for admissionIndication for admission– Renal impairmentRenal impairment– Refractory painRefractory pain– PyelonephritisPyelonephritis– intractable N/Vintractable N/V
UrolithiasisUrolithiasisManagementManagement
Shock Wave lithotripsy (SWL)Shock Wave lithotripsy (SWL)
UreteroscopyUreteroscopy
Percutaneous Nephrolithotripsy (PNL)Percutaneous Nephrolithotripsy (PNL)
Open SxOpen Sx
Voiding DysfunctionVoiding Dysfunction
Failure to storeFailure to store– Bladder problemsBladder problems
overactivityoveractivity
HypersensitivityHypersensitivity
– Outlet problemOutlet problemStress incontinenceStress incontinence
Sphincter deficiencySphincter deficiency
– combinationcombination
Failure to EmptyFailure to Empty– Bladder problemsBladder problems
NeurologicNeurologic
MyogenicMyogenic
idiopathicidiopathic
– Outlet problemOutlet problemBPHBPH
Urethral strictureUrethral stricture
Sphincter dyssynergiaSphincter dyssynergia
– combinationcombination
Benign Prostatic HyperplasiaBenign Prostatic Hyperplasia
Clinically: Clinically: – LUTS(Irritative/Obstructiv)LUTS(Irritative/Obstructiv)– poor bladder emptyingpoor bladder emptying– urinary retentionurinary retention– urinary tract infectionurinary tract infection– Hematuria, Hematuria, – Renal insufficiency Renal insufficiency
Benign Prostatic HyperplasiaBenign Prostatic Hyperplasia
Physical ExaminationPhysical Examination– 1-DRE 2- Focused neurologic exam1-DRE 2- Focused neurologic exam
Prostate CaProstate Ca
rectal Carectal Ca
anal toneanal tone
neurologic problems neurologic problems
– Abdomen: distended bladderAbdomen: distended bladder
Benign Prostatic HyperplasiaBenign Prostatic Hyperplasia
Urinalysis , cultureUrinalysis , culture– UTIUTI– HematuriaHematuria
Serum Creatinine Serum Creatinine
Serum Prostate-Specific Antigen Serum Prostate-Specific Antigen
Flow rate Flow rate
u/su/s
Benign Prostatic HyperplasiaBenign Prostatic Hyperplasia
Treatment optionsTreatment options– medical therapymedical therapy
α-Adrenergic Blockers α-Adrenergic Blockers – TamsulocinTamsulocin– AlfuzocinAlfuzocin– TerazocinTerazocin
Androgen Suppression Androgen Suppression – FinasterideFinasteride
Benign Prostatic HyperplasiaBenign Prostatic Hyperplasia
Surgical RxSurgical Rx– Endoscopic (e.g. TURP, laser ablation)Endoscopic (e.g. TURP, laser ablation)
– Open SXOpen SX