Urology

Urinary stones can be classified according to stone size, stone location, X-ray characteristics of stone, etiology of stone formation, stone composition (mineralogy), and risk group for recurrent stone formation.

Pain relief is the first therapeutic step.

Drainage should be performed using stenting, percutaneous nephrostomy, or stone removal.

Less than 1.

Do not take PSA.

Common etiologies include Benign Prostatic Hyperplasia (BPH), infections such as cystitis, prostatitis, prostatic abscess, urethral diverticulum, and malignancies like prostate cancer and urinary bladder cancer.

No, there is no clear correlation between total prostate volume and symptoms.

Effectiveness, rapid onset of action, sustained effect, prevention of detrusor hypertrophy, prevention or delay of disease progression, safety, and suitability for the patient.

Risk factors include diabetes and the use of antidiabetic medications, dietary factors, genetic predisposition, localized inflammation, obesity, and metabolic syndrome.

No, there is no clear correlation between total prostate volume and obstruction.

Flank bruising/mass and flank pain/tenderness.

MET is used for patients with ureteral stones that are expected to pass spontaneously through urination.

Indications include complex stone burden, failed previous SWL and/or endourological procedures, anatomical abnormalities, morbid obesity, and nephrectomy in case of non-functioning kidney.

Phytotherapy, such as dwarf palm (Serenoa Repens) and African plum.

Prostate volume is important in treatment decision making for medications and type of surgery.

NSAID tablets, suppositories, and α-blockers are included in MET to help reduce inflammation and the risk of recurrent pain.

CT scan.

Indications include large, impacted stones, multiple ureteral stones, concurrent conditions requiring surgery, and failure of other non-invasive or low-invasive procedures.

Hypercalciuria, Hyperoxaluria, Hypocitraturia.

TZI correlates with obstruction.

Bone scan

Ultrasound.

Chronic pyelonephritis is more common in people with urinary obstructions caused by UTIs, vesicoureteral reflux, or anatomical anomalies.

TZ is more important than TP volume in treatment decision making.

Abdominal palpation, inspection of genitalia and perineum, digital rectal examination (DRE) focusing on enlargement, mobility, margins, and elasticity.

The tumor is more aggressive.

Low calcium intake, high oxalate intake, high animal protein intake, high sodium intake, low fluid intake.

Used for embolization when bleeding persists, serving as both diagnosis and treatment.

Increased risk includes anyone with chronic kidney stones or other kidney or bladder conditions, older adults, people with suppressed immune systems (like diabetes, HIV/AIDS, cancer), those with vesicoureteral reflux, and individuals with an enlarged prostate.

Common laboratory investigations include urinalysis, urine culture, biochemistry (creatinine), and PSA.

JJ stent, nephrostomy, ultrasound drainage/puncture.

It evaluates the probability of obstruction and provides an objective assessment of urinary flow.

Surgical treatment is required to remove necrotized tissue, suture the urethral lesion, or spatulate the urethra and suture the ends in the presence of a defect.

It is a procedure where a small scope is placed through the back into the kidney to break up kidney stones using ultrasound and pneumatic probe or laser.

Increased intake of Vitamin C has been associated with a higher risk of stones in men.

2-4

Renal colic is pain that occurs when a stone blocks your urinary tract.

Blunt trauma, often from motor vehicle accidents.

ABCs, bed rest until gross hematuria clears, and serial vital signs and CBC.

Clinical signs include hematuria (micro and macro), dull flank pain, renal colic, asymptomatic disease (10%-15%), weight loss, anorexia, and bone pain.

Cystostomy or inserting a Foley catheter under optical control.

Indicators include prostate volume and PSA levels.

A volume greater than 150 ml should be considered.

Urethral injuries are most common during catheterization.

Contraindications include all contraindications for general anesthesia, untreated UTI, atypical bowel interposition, tumor in the access tract area, potential malignant kidney tumor, and pregnancy.

When it is full.

Blunt trauma, primarily from motor vehicle accidents, falls from heights, and assaults.

Tumor identified by needle biopsy due to elevated PSA.

Capsule Tamsulosin 0.4mg, taken 1 time per day.

Transabdominal midline laparotomy for repair or removal of the kidney.

Immediate reconstruction of integrity is required.

Diagnostic tests include urine test, intravenous urography, retrograde urography, antegrade pyelography, CT, MRI, ultrasound, cystoscopy, ureteroscopy, nephroscopy, angiography, cytology, and fluorescence in situ hybridization (FISH).

The normal peak flow rate for men is greater than 15 ml/s.

Irritative symptoms include frequency, urgency, nocturia, and incontinence.

VEGF receptor kinase inhibitors, anti-VEGF antibodies, mTOR antibodies.

The types of anterior urethra injuries include partial rupture and complete rupture.

Penetrating trauma.

URS is a procedure where a small, flexible scope is inserted through the urethra into the bladder and ureter to diagnose and treat urinary tract problems, including stones.

Less than 20%, primarily from gunshot and stab wounds.

Renal cell carcinoma (RCC) accounts for 85-90% of all renal tumors.

Tumor involves 1/2 of 1 lobe or less.

Suppository Diclofenac 100mg per rectum or tablet Diclofenac 75mg, taken 2 times per day.

Reconstruction of urethral integrity and urethroplasty by stitching urethral ends.

Treatment options include radical nephroureterectomy, open segmental ureterectomy, distal ureterectomy with ureterocystostomy, open laparoscopic or robotic approaches, endoscopic treatment for small tumors, and topical immunotherapy or chemotherapy through a nephrostomy tube.

The types of posterior urethra injuries include stretched but not torn, partial rupture, complete rupture, and complex injuries involving the bladder neck or rectum.

Obstructive symptoms include hesitancy, poor urinary stream, straining, intermittency, prolonged terminal dribbling, and feeling of incomplete voiding.

<10 ml/s indicates a 90% probability of obstruction, 10-14 ml/s indicates a 67% probability, and >15 ml/s indicates a 30% probability.

Anti-PD-1 antibodies, anti-CTLA-4 antibodies, cytokines.

Underlying pathology such as cancer or obstruction.

A surgical procedure to remove the prostate gland through the bladder.

Grade 5.

Urethroplasty can be performed end to end or using a mucosal patch.

Risk factors include smoking, obesity, hypertension, and diabetes mellitus.

Tablet Ketorolac 10mg, taken 1 time per day.

Metastasis in regional lymph node(s).

Urethral bleeding (urethrorrhagia) is a clinical sign, which occurs while not voiding.

Hematuria.

ABCs, establish urinary drainage/diversion, and antibiotics.

Prostate volume, shape, third lobe, bladder wall thickness, stones in the bladder, and postvoid residual urine.

A prostate volume over 30 cc is considered an indicator of high probability of progression.

Immediate surgical treatment by suturing the ends of the urethra.

Risk factors include consumption of large amounts of analgesics containing fenacetin or acetylsalicylic acid, exposure to aristolochic acid from Aristolochia plants, and heredity.

A surgical procedure to remove the prostate gland through an incision in the lower abdomen.

It defines both the probability of recurrence or (re)growth of stones and is imperative for pharmacological treatment.

Partial nephrectomy, radical nephrectomy.

The classic triad includes flank pain, hematuria, and a palpable abdominal renal mass.

Tablet Nospa 40mg, taken 2 times per day.

Hematuria (gross or microscopic) and shock (hypotension, tachycardia, oliguria).

Urinary retention is another clinical sign of urethral trauma.

No distant metastasis.

Dizziness, headache, asthenia, peripheral edemas, first dose orthostatic hypotension, fainting, ejaculatory disorders, nose congestion, somnolence.

95%.

Conservative management with catheter drainage for 7-14 days, antibiotics, and cystogram; surgical repair may be needed.

It is recommended to insert a patch between the vagina and urethra to prevent fistulas.

Less than 12 ml, indicating practically no residual urine.

Decreased volume of semen.

Transurethral laser vaporization/enucleation, transurethral microwave therapy, transurethral needle ablation, prostate ablation with water jet, hot water steam injections, Urolift, prostate embolization, prostatic stents, and botulinum toxin A intraprostatic injections.

The mass is generally firm, homogenous, and nontender.

In all urinary tract organs that have urothelium, including the upper urinary tract and bladder.

Urethrography is the diagnostic test used for urethral trauma.

Capsule Nitrofurantoin 100mg, taken 2 times per day.

65-70 years

Patients may be diagnosed when a radiologic imaging study of the abdomen is performed for other purposes or during surveillance imaging in those with a prior history of stones.

Cystostomy, or suprapubic catheter placement, is indicated in cases of inability to perform urethral catheterization or if catheterization does not resolve acute urinary retention (AUR).

The IPSS is used to assess symptoms related to prostate conditions, driving treatment decisions.

Inability to void, abdominal pain, abdominal bruising, pelvic mass, peritoneal signs, and shock.

They block the activity of 5 alpha reductase, suppressing the concentration of dihydrotestosterone in the blood and prostate.

Surgical repair via midline laparotomy/cystotomy, two-layer closure of bladder injury, bladder drainage, Foley catheter ± suprapubic catheter for 14 days, perivesical drain, and antibiotics.

Prostate volume increases, deterioration of lower urinary tract symptoms (LUTS) and quality of life (QoL), deterioration of urinary flow, increased risk of urinary retention, and increased risk of surgery.

Repeatedly found PVR greater than 50 ml.

Cystostomy is the treatment of choice for complete or partial urethral rupture during blunt trauma.

Breast enlargement and tenderness.

Oral chemolysis is efficient for uric acid calculi only.

Symptoms may include edema, ascites, and hepatic dysfunction.

Start treatment with medication first.

Smoking and alcohol consumption.

African-Americans

Transurethral resection of prostate (TURP)

In typical AUR, the bladder contains at least 500 ml of urine.

PSA over 1.5 ng/ml is considered significant.

Non-contrast CT scan is the imaging of choice for suspected nephrolithiasis.

MILD (0-7), MODERATE (8-19), SEVERE (20-35).

Finasteride blocks 5 alpha reductase type 2, while Dutasteride blocks both types 1 and 2.

CT cystogram.

Urinary frequency, shock, peritonitis, and azotemia.

It indicates prostatic structure abnormalities and obstruction of ducts.

Transurethral Resection (TURP)

The risk of progression is higher when PSA > 1.5 ng/ml and/or prostate volume (PV) > 40 ml.

To detect anatomical and congenital abnormalities.

PVR is not stable and should be measured repeatedly.

Diagnosis can involve urinalysis, CBC, electrolytes, liver function tests, serum calcium, abdominal ultrasound or CT, excretory urography, ultrasonography, CT scanning, MRI, arteriography, and PET scanning.

5ARI combination with α blockers.

Alpha blockers are good for not so big prostate.

The urine pH should be adjusted to between 6.5 and 7.2.

Bleeding, infection, urethral stricture (5-9%), and permanent significant urinary incontinence (rare <1-3%)

Diet rich in animal fats and meat and poor in fruits and vegetables

Emergency prostate surgery in cases of AUR is not recommended due to a higher risk of complications and less favorable results.

Prostate volume reduces by 20-30%, leading to relief in obstruction.

Treatment should be initiated for moderate (8-19) or severe (20-35) symptoms.

Cystoscopy.

Shock and pelvic abscess.

Causes include BPH, bladder neck obstruction, stricture of the urethra, and stricture of the orifice of the urethra.

Low risk, Intermediate risk, High risk.

No, PSA is prostate specific but not prostate cancer specific.

Non-contrast CT scan is more sensitive than ultrasonography for visualizing stones.

Cystoscopy from 3 to 6 months according to the risk of disease progression and recurrence.

AUR is a painful desire and inability to void in case of a full urinary bladder.

The primary treatment for CIS typically involves endoscopic or organ-sparing therapy.

Treatment should be discontinued.

Transrectal ultrasound examination (TRUS).

SWL is a procedure that pulverizes stones in the kidney and ureter into small fragments using short-duration, high-energy shockwaves produced outside the body by a lithotripter.

Alpha blockers are not effective; consider 5 alpha reductase inhibitors (5ARI) or a combination with alpha blockers.

Qmax increases significantly by 125-175%

No clinical signs; cancer mostly arises in the peripheral zone of the gland.

Tadalafil 5 mg once daily.

Risk factors for bladder cancer include smoking, being over 65 years of age, being male, family history, occupational exposure to carcinogens, chronic inflammation of the bladder from long-term catheter use, diabetes medications, and obesity.

Screening, but it does not confirm diagnosis.

Qmax increases by 15% (1.3-1.6 ml/s).

Involuntary detrusor contractions, poor detrusor contractility, and psychogenic voiding dysfunction can cause LUTS due to impaired detrusor function.

Symptoms and quality of life (QOL) questionnaire results drive BPH treatment decisions.

Infection, trauma, acute urinary retention (AUR), prostate volume, biopsy, manipulations in the lower urinary tract, digital rectal exam (DRE), sexual intercourse, and bicycle rides.

2-6.

The main causes include BPH, prostate cancer, urethral stricture, bladder neck contracture, clots in the bladder, and critical phimosis.

Non-contrast CT scans are associated with radiation exposure, and cumulative radiation doses can be high in patients requiring frequent imaging.

Yes, it can be performed with only a moderate increase in complications.

80% of nephrolithiasis patients form calcium stones.

Transurethral Resection (TURB) and single intravesical instillation of a chemo agent.

The success rate depends on the size, location, and composition of the stones, the patient’s habitus, and the performance of SWL.

Surgery after medication.

Urinary hesitancy, decreased force of urine stream, intermittency.

Treatment of BPH symptoms.

Gross hematuria is a clinical sign that always warrants suspicion of bladder cancer until proven otherwise.

A high residual volume of urine (>200 ml) indicates a need for surgical intervention.

PSA level drops down by 50%.

Interventions, urinary retention, infections, hematuria, diabetes, neurological diseases, and concomitant medications.

Complications include bilateral hydronephrosis leading to renal insufficiency, bladder wall hypertrophy and atrophy, bladder stones, infections, bleeding, and bladder diverticula.

A PSA level greater than 3 ng/ml, especially above 10 ng/ml.

Predisposing factors include alcohol, colds, surgical interventions, medications (like cholinoblockers), spicy food, and constipation.

The components of BPH obstruction are the static component, which involves increased volume of the prostate, and the dynamic component, which involves increased smooth muscle tone due to sympathetic overactivity.

Contraindications include pregnancy, bleeding diathesis, uncontrolled urinary tract infections, severe skeletal malformations, severe obesity, arterial aneurysm near the stone, and anatomical obstruction distal to the stone.

Ultrasonography is not associated with radiation exposure.

Complete stone removal.

Calcium stones are primarily composed of calcium oxalate or, less often, calcium phosphate.

TURB + reresection after 4-6 weeks (reTURB) + 6 weekly intravesical instillation of BCG.

Symptoms, not objective parameters like Qmax, PVR, or prostate volume.

Other clinical signs of bladder cancer include dysuria, irritative symptoms, and upper urinary tract obstruction.

Phytotherapy comprises the medical use of various extracts of different plants.

Digital rectal examination (DRE)

HoLEP stands for holmium laser transurethral enucleation of prostate, an endoscopic procedure for big prostates.

Decreased libido and impotence.

It suggests a higher probability for future BPH progression.

The dynamic component is responsible for 40% of obstruction caused by BPH.

Treatment includes intermittent catheterization with α adrenoblockers (tamsulosin 0.4 – 0.8 mg OD) for 2-3 days or permanent catheterization with the same medication.

Transurethral Resection (TURB) and single intravesical instillation of a chemo agent + 6 weekly intravesical instillation of BCG.

Watchful waiting (active surveillance).

'Smash and go' strategies.

Many patients who undergo ultrasonography may still require a CT scan to confirm stone presence, as ultrasonography is less sensitive than CT.

Other types of kidney stones include uric acid, struvite (magnesium ammonium phosphate), and cystine stones.

PNL is a surgical procedure used to remove kidney stones.