Common Urology/renal

cases Mr Patrick Gordon

CT1 Urology Derriford

Common OSCE topics

Histories

• Renal Colic

• UTI’s/pyelonephritis

• Prostate

• Haematuria

Examinations

• Renal Transplant

• Testicular

• Prostate

Skills

• Catheter

• Urine dip

30min presentation so will briefly touch on what commonly comes up in

exams, additional points can be discussed in breakout sessions.

Additional points in Urological

History Remember the actors will lead you in the right direction, stick to

usual format plus a few of these key points to score top marks

Prostate

Flow, double micturation, nocturia, urgency, perineal pain (prostitis)

: back pain, weight loss, retention, FHx, loss appetite

Pyelonephritis

Fevers, Rigors, dysuria, polyuria, vomiting, back/loin pain, previous episodes. Pregnant? DM?

Haematuria: ‘TITS’

Blood thinners? Previous episodes? Painless? Systemic features (rash-vasculitis), travel (parasites), new medications

Testicular swelling: unlikely to come up, additional info end of lecture

Testicular tumour:

80% painless lump, pain, signs mets, new hydrocoele, previous undescended testes.

Examination

Dialysis access Peritoneal dialysis:

1. Continuous ambulatory peritoneal dialysis (CAPD)

2. Continuous cycling peritoneal dialysis (CCPD)

Haemodialysis: around 6hrs x3 week

Investigations Bloods: renal function, Ca2+ & Uric acid, PSA

Urine dip/MSU: glucose, ketones, blood, bilirubin, protein,

pH. Micro RCC,WBC, casts, crystals, organisms (>106

bacteria/ml +ve).

Imaging: USS, X-KUB, IVU, CT, radionuclide scan.

Cystoscopy: flexible or rigid.

Urodynamics: assess storage and voiding function.

Renal Calculi Def: Crystal aggregates: pelvis>urethra

PP: 2% pop, : 4:1

Types:

1. Ca2+ oxylate (diet,>Ca2+, idiopatic)

2. Uric acid (gout, ileostomies)

3. UTI induced (urease>ammonia>stone)

Presentation NOTHING!!!

Pain: loin>groin, last hours, severe.

Nausea & Vomiting

Pyrexia (if assoc UTI)

Haematuria (micro)

Frequency: bladder stones

Renal failure

Differential Diagnosis Pyelonephritis

Renal Cell Carcinoma

Muscular/rib pain

Biliary colic

Pancreatitis

Appendicitis

Salpingitis

ECTOPIC

AAA/DISSECTION

Investigations Hx: diet, dehydration, predisposing illness

Bloods: U&E’s, calcium & oxylate

Urine dip/MSU

Imaging: CTKUB, KUB-XR: visible scout?

Treatment Analgesia: PR diclofenac

Antiemetics +/- abx

α-blockers

Increase fluid intake (>3L day)

<5mm, usually pass (follow up clinic)

If >6mm (pain, obstruction, growing):

1. ESWL (70%)

2. Endoscopy

3. Retrograde stents

Complications

Infected hydronephrosis: not to miss, rapid

sepsis>death. Sepsis 6’s. Urgent decompression.

Complete Ureteric obstruction

80% pass own, 20% hospitalised.

Recurrence 14% @ 1yr, 52% & 10yrs

Breakout sessions What would you especially find useful?

Though we could talk through catheters, and do a couple

of scenarios with interesting twists.

Transurethral resection of bladder Tumour

procedure used to diagnose bladder cancer and remove any unusual growths or

tumours on your bladder wall.

Procedure: last 14-45mins, rigid cystoscopy passed and fluid filling bladder to visualise bladder. With special loop with electrical current cut lesion out.

After: After catheter left in place (usually 24hrs) and irrigation if clots. Observed overnight and appointment for TWOC if needed. Drink +++ fluids and abx if given

SE: infection, haematuria, pain

Complications: hole, retention, pain.

Offer a leaflet!

basics GFR V-I: <15, 15-30, 30-60, 60-90, >90

GFR IV formula age, sex, race, normalised S.A. Can be

measured.

Nephrectomy/complete obstruction reduce GFR 20%

Testicular Swellings Cystic/separate testis: epididymal cyst, spermatocoele.

Testis lie within swelling: Hydrocoele (transilluminate), haematocoele (no transillumination).

Solid/separate testis: epididymitis, torsion hydatid morgagni.

Solid/within testis: torsion, tumour, gumma, orchitis

Can’t get above: direct inguinal, varococoele

***Prehn’s sign: pain testicle relieved on raising scrotum –ve torsion, +ve epididymitis