Академический Документы
Профессиональный Документы
Культура Документы
2- Symptoms related to micturition : frequency of micturition The normal bladder capacity is 400 ml. Frequency may be day (diurnal) or by night (nocturnal). Frequency means increase times of micturation (Normal=3-5) Nocturia means: Frequency by night (normally=0-1) ,differs from Nocturnal enuresis in which there is involuntary escape of urine Its a strong sudden desire to urinate caused by hyperactivity and irritability of bladder. In most circumstances the patient is temporarily able to temporarily control urine, but loss of small amounts of urine may occur (urgency incontinence). Painful urination is related to acute inflammation of the bladder, urethra,or prostate. BPHP and urethral stricture e.g: -hesitancy & straining,-difficulty in micturation,-terminal dribbling,-sense of incompleter emptying,-Retention of urine( acute & chronic)
urgency
3- Urinary incontinence
1 www.medadteam.org
anuria
Chyluria
Cloudy
Necroturia:
Haematuria
Definition :passage of blodd in urine Types : -frank or microscopic -painful or painless -total heamaturia , terminal haematuria or initial haematuria The most common causes : 1- urinary stones (the most) 2- urinary tract injuries 3- senile prostatic enlargement 4- renal tumors 5- bladder tumors 6- bilharziasis DD: red coulred urine 1- dietary 2- drugs 3- heamoglobinuria
2 www.medadteam.org
Polycystic kidney
Adult type (autosomal dominant) polycystic kidney disease This is the commonest form of cystic diseases of the kidney. It affects both kidneys. It is one of the leading causes of end stage renal failure. Almost 50% have associated cysts in the liver, but liver function remains normal. Cysts of lung, pancreas and other organs may be found. 30 to 40% of patients have intracranial aneurysms.
3 www.medadteam.org
Infantile type (autosomal recessive) polycystic kidney disease Very large kidneys may obstruct labour. Newborn infants with severe form of the disease may die from respiratory failure due to pulmonary hypoplasia. Renal failure.
Horseshoe kidney
More frequent in males. Pathology: Fusion occurs early in embryonic life when the kidneys lie low in the pelvis. Ascent of the horseshoe kidney is arrested by the isthmus being blocked against the inferior mesenteric artery. Furthermore, normal rotation cannot occur, and each renal pelvis lies on the anterior surface or its kidney. The ureters thus ride over the isthmus which connects the lower poles. A horseshoe kidney is prone to disease because ureteral obstruction may result from angulation of the ureter as it crosses renal isthmus. Stasis favours infection and stone formation.
4 www.medadteam.org
5 www.medadteam.org
Hypospadias
Hypospadias means that the urethral meatus opens on the ventral aspect of the penis at any point from glans penis to the perineum This anomaly is caused by incomplete development of the terminal part of the urethra and the corpus spongiosum. The missing distal part of the urethra is replaced by a fibrous band (chordae). Etiology: Hormonal causes: Deficiency of androgens or 5-alpha-dehydrotestoslerone reductase enzyme during intrauterine life. Deficient receptors in targel cells may play a role. Clinical features: Meatus is ventrally placed and stenosed. Prepuce is deficient venterolaterally. Shaft is ventrally curved due to the presence at chordee except in the glanular variety. Scrotum is bifid in the perineal type. Associated lesionsundescended testes or upper urinary tract anomalies Patients with posterior hypospadias may have a problem with sex differentiation Investigations: Ultrasound examination to detect upper urinary tract problems. Treatment: Circumcision should not be done to hypospadiac patients because the skin of the prepuce can be used for repair. Plastic surgery can be performed at the age of one year. The aim of surgery is to have a normally functioning male organ with normally situated meatus at tip of the glans. The principle of surgery is to release the chordee so that the ventral curvature of the penis is corrected. Then a new urethra is fashioned using neighbouring skin from the prepuce or the penile skin.
6 www.medadteam.org
C/P:
1- Asymptomatic. 2- Symptoms:
Important
a. Irritative symptoms i. Frequency: +++no. of micturition times / day ii. nocturia normally micturition at night 0-1 , if more ------ nocturia (differs from Nocturnal enuresis in which there is involuntary escape of urine) iii. urgency : sudden severe desire to micturate with NO escape of urine or: urge incontinence ( with escape of urine)
b. Obstructive symptoms i- Hesitancy: Delay instarting ii- Weak - interrupted (intermittent stream) ,may be forked iii-Sense of incomplete voiding
c. Symptoms of complications a- Retention: IAcute: due to edema and cong. Of bladder neck .., bladder still normal, Severe pain IIChronic: due to long standing obstruction Hypertrophy dilatation dilatational weakness + poor contraction Large amounts of urine are retained, may reach 1.5 L Normal bladder retains 350 650 ml urine IIIChronic retention with overflow How to differentiate from true incontinence bladder empty In chronic retention with overflow digital rectal examination full bladder Catheter U/S Pt. has a desire to micturate
N.B. Bladder trabeculation, sacculations and pulsation diverticulum may occur with chronic retention
b- Due to stasis cystitis and stone formation pain and frequency c- Reflux hydronephrosis & gradual deterioration of renal function (bilateral) N.B. Normally, detrusor muscle contraction is responsible for prevention of reflux from bladder to ureter, with dilational weakness loss of antireflex mechanism. d- Hematuria: due to rupture of dilated congested sub mucosal veins on enlarged gland N.B. hematuria in any old man should be investigated because it may have serious cause
7 www.medadteam.org
Investigation:
Laboratory 1) Urine analysis for pus cells, hematuria, sp. Gravity (if low fixed sp. Gravity at 1010 CRF) 2) Kidney functions tests 3) PSA (prostatic specific Ag) serum level to screen prostatic cancer (Norma level: 0-4 ng/ml) 1) 2) 3) Radiological Plain x-ray to visualize stone U/S: Hydronephrosis and UB size Residual postvoid residual volume to estimate degree of obstruction Transrectal U/Sbest to estimate prostate size IVP: 2 indications : Hematuria and Hydronephrosis Not a good indicator of renal function (radionucleide isotope scans are the best)
Treatment:
Watchful waiting: in asymptomatic or minimal symptoms medical : 1- 1-blocker e.g. : doxazosin (carclua) .. DRUG OF CHOICE -block receptors in prostatic urethra relax prostate smooth muscle improve symptomsesp.frequency. 2- 5 reductase inhibitors e.g. finasteide Inhibit 5-reductase enz. Responsible for conversion of testosterone to active dihydrotestosteron which slowThe progression & decrease prostate size However,not the drug of choice because e size of prostate not directly linked to severity of Symptoms. 3- phytotherapy. 4- decongestant suppositories. surgical : Indications: failure of medical treatment or complications 1- prostatism distributing pts life with failure of medical ttt. 2- complicated case:
more than one attack of acute retention. residual urine more than 200ml. severe hematuria. complications in bladder as cystitis and stones. complications in kidney as hydronephrosis.
Methods: 1-endoscopic : - TransUrethral Resection of Prostate (TURP) : PROCEDURE OF CHOICE. - visual laser ablation of prostate (VLAP) 2-open surgey : retropubic millen's operation transvesical.
8 www.medadteam.org
Predisposing Factors
1)+ve family history. 2) Race American Africans (least among Asian) 3) Genetic. 4) Environmental and diet
Pathology
Peripheral zone mainly.*
Symptomatology
1 -asymptomatic: esp. in countries with screening test done routinely. 2 -Symptoms:
a. Irritative symptoms :
Urgency, frequency, nocturia.
Less marked than BPH (Mainly in peripheral)
b. Obstructive symptoms
Hesitancy, sense of incomplete void, weak interrupted flow
d. Metastasis:
Commonly to bones, usually osteoblastic but weak-----pathological fractures .Examination
May be hard, nodular, asymmetrical(normally prostate is firm, smooth, symmetrical). Normal digital rectal examination doesn't exclude the diagnosis. Recently:TNM staging system
T1 a & b ) normal PSA,tumour discovered accidently on microscopic examination of prostate removed Due to BPH c) tumor not seen or felt but +++ PSA. nodule confined to prostate: a) in 1 lobe. b)in 2 lobes extends through capsule reach seminal vesicle. adjacent structure other than SV. N.B:
BPH arises ALWAYS from transisional zone Pr.carcinoma arises MAINLY from peripheral zone
T2 T3 T4
9 www.medadteam.org
Management A. Early
Organ confined (localized) AIM: Cure STANDARD:Any of the following 1) RADICAL prostatectomy: (never forget to write RADICAL) Remove prostate, S.V. + lymphadenectomy (if increased PSA) Then connect bladder to membranous Urethra( Patient remains continent to urine) 2) Radiotherapy: because tumor is radiosensitive 3) Brach therapy: inserted into prostate tissue NON-STANDARD: Watchful waiting if old age ,not fit for surgery
B. Late
T4 AIM: Palliation
2) TURP to relieve symptoms (Transurethral Resection in Pts with bladder outflow obstruction)
10 www.medadteam.org
Causes
1. 2. 3. 4. 5. 6. 7. Ureter:Bilateralpathology to affect renal function Urethra: Congenital or Stricture Bladder: Stricture, Congenital obstruction. Prostate: BHP, Carcinoma
pathology
Hydronephrosis Hydroureter Renal Failure Trabeculae in bladder Diverticular Elongated Prostatic urethra Later Dilatation Thick wall bladder
C/P :
Symptoms
Anuria Bladder Empty Obst. Above bladder Anuria= < 200 ml/24hr Retention Bladder Full Obst. at or below bladder
Investigation
Laboratory : 1. 2. 3. 4. Renal function test Electrolytes Na & K [Beware of Hyperkalemia] ABG Hb elective: If acute on top of chronic
11 www.medadteam.org
Treatment:
Relieve Obstruction: MOST IMPORTANT o Upper Obstruction: Percutanousnephrostomy o Lower Obstruction: Catheter orSuprapubic Cystoscopy Dialysis: if K +++ or severe acidosis ttt of cause when pt Stable N.B.: Obstructive lesions have a good prognosis, because recovery occur when once obstructionremoved Calcular anuria is anuria due to calcus [Stone] Most Common cause of Sterile Pyuria is Antibiotic use **Acute Tubular necrosis is Reversible While Acute Cortical necrosis is Irreversible
Urethritis
May be gonococcal Non-gonococcal n.gonorrhea others,most commonly Chlamydia trichomatis
Symptoms Profuse discharge (scanty in Chlamydia), burning micturation Investigation Urethral swab gram stained smear G-ve diplococci in PMNs, culture may be done Treatment
single dose ciprofloxcicin for gonococcal (or penicillin but not the best) Tetracycline (doxycyclin) for non-gonococcal 10 days ** Give together because may be mixed infection (STDs) If not treated Complications as fibrosis & ejaculatory duct obstruction
12 www.medadteam.org
Investigation: urine analysis (main invest.), culture, U/S, plain X-ray Treatment:trimethoprim / sulphamethoxazone(sutrim) for 5 days
Prostatitis
Types:
1. acute 2. chronic (bacterial, non-bacterial) 3. prostatodynia
Acute Symptoms
Frequency, urgency & dysuria Do NOTcathetarize help to flare infection, better do suprapubic cystoscopy Do NOT do prostatic massage very tender, may lead to chronicity or systemic spread
Chronic Symptoms irritation / discomfort rather than pain Treatment antibiotics usually not effective, give analgesics, phytotherapy
Epididymoorchitis
One of the causes of acute scrotal pain D.D. torsion of testis
13 www.medadteam.org
Treatment
If Obstruction: Remove BUT first DRAIN Abscess [U/S guided Percutanous nephrostomy] Antibiotics for 2 weeks, should be Strong Antibiotics Quinolones to avoid Chronicity
Bilharziasis
Symptoms
Itching at cercarial penetration, when reach Lungs Pneumonitis Spread to all body organs, Survive only in Liver Grows to Adult then move in Portal venous system to reach Vesicoprostatic Plexus in S.hematobium
pathology
Bilharzial Sandy patches- Brunn nests B. Tubercules B.Nodules B. Papillomatous Bilharzialgranulomala- B.Ulcers- Fibrosis Leukoplakia or Cystitis Glandular Malignancy SQ.Cell Carcinoma
Investigation
1. Urine analysis: Bilharzial Ova Hematuria [N.B.: Usually Terminal Hematuria] Pus Cells 2. CBC 3. Plain X-ray 4. U/S 5. IVP : (if U/S show Hydronephrosis)
Treatment
Anti Bilharzial drugs e.g.: Praziquantel ttt of Complications Surgical
14 www.medadteam.org
Causes
Mycobacterium Tuberculosis [ Human 75% & Bovine 25%] Route of infection - Always 2ry Hematogenous Spread - [1ry always Asymptomatic]
1. 2. 3. 4. 5.
pathology Kidney: Extensive destruction Autonephrectomy loss of affected kidney Ureter: Spread from kidney fibrosis [Multilevel] + Shortening If Intramural part High grade reflux GOLF HOLE APPEARANCE on Cystoscopy Bladder Tubercles, Tuberculous ulcers Beaded Vas Deference Obstruction Prostatic Nodules [Uncommon] Treatment Anti tuberculus drugs: Combined for a long time [9 months] e.g.: INH, Rifampicin ttt of Complications: Surgical AFTER Drug therapy to avoid spread T.B Toxemia N.B.: TB may be present with STERILE PYURIA [No Organism growth, on Ordinary culture]
Etiology:
Till now true pathogenesis not known SUPERSATURATION (Most important) Decrease natural inhibitors of crystallization as Pyrophosphates ,Mg,& citrates Water intake urine concentration crystalloids in urine diet Hereditary error or metabolic abnormality as GOUT ( uric acid stones) infection :Nidus formation , alter PH stasis F.B.
15 www.medadteam.org
symptomatology :
Asymptomatic in largenumber of cases Loin pain ( renal stone ) or ureteric colic ( ureteric stones ) Burning micturation or difficult micturationin urethra retention of urine with severe acute pain in bladder ( suprapubic ) Anuria ( different from retention NO desire to micturate anuria )Hematuria may be grossly evident ***N.B . The most common sites of impaction of calculs in ureter : # junction between ureter & renal pelvis # mid ureter passage of common iliac artery . # ureterovesical junction .
Investigations :
Laboratory : Radiology :
2-X-ray :radio opaque stones 85% e.g. ca oxalate BUT not show radiolucent stones e.g. uric acid stones 3- IVU :show radiolucent stones+ site
detection .
16 www.medadteam.org
Disolution of uric acid stone is possible by heavy alkalinization of urine Modaerat : extracorp.shock wave lithotripsy (ESWL) ultrasonic waves (several sessions) ( )+ medical TTT Large :surgery
B)Ureteric stones :
Upper segment Small Moderate Large Medical ttt ESWL Open surgery ( urertrolithotomy ) Middle segment Medical ttt Open surgery (recent uretroscopic removal) *ESWL not done (sacroiliac shadow obscure) Lower segment Medical ttt Ueretroscopic Open surgery *ESWL not done sacrum shadow obscure & site of ovaries
C)Bladder stones: Small :medicalttt. Moderate :cystoscopic removal or crushing Large: open surgery.(cystolithotomy)
back
17 www.medadteam.org
Bladder cancer
Commonest urologic malignancy in Egypt. Egypt one of the highest countries. In the past, when Bilharziasis was wide spread; squamous cell type was much higher than transitional cell type (Ratio Sq. :Transitional 90:10). Currently, Sq. cell carc. Has decreased owing to improved health care (Ratio Sq. :Transitional 40:60). Global ratio Sq. :Transitional 1:9
18 www.medadteam.org
TCC
High risk groups & risk factors include: 1. Smoking toxic metabolites in urine. 2. Industrial chemicals esp. Aniline dyes, Petrol . through inhalation, ingestion & contact. 3. Cancer therapeutic drug Cyclophosphamide 4. Artificial sweeteners as saccharine.
Pathology:
Transitional CC Gross picture Microscopic picture
Villous papillary growth Less commonly cauliflower or ulcer
Squamous CC
Cauliflower or Ulcer
Transitional cells with cellular features of Cell nests with keratin whorls & malignancy malignant features Local spread: surrounding organs, lately, reach pelvic bone . Bladder L.N.: EARLY Blood: late Local spread: ureters, prostate, sem. Vesicle, uterus, rectum L.N. Late.Because of Blood lymph.&vasc.Obstruction by
Bilh.fibrosis
Spread
Symptoms:
Pt > 50 yrs presenting with HEMATURIA is considered bladder carc. until proved otherwise Characters of Hematuria: Recurrent, Profuse ( bl. clots), Painless (except if obstruction occur) Other presentations: Clot retention (urinary obstruction by blood clots) Renal failure: if invading both ureters (wasting, malaise, hiccough, pallor) Mass in lower abdomen
Signs:
By Digital Rectal Examination (DRE) General examination signs of renal failure
19 www.medadteam.org
Investigations:
LAB Urine analysis - RBCs >100 - Necroturia - Malignant cells - Pus cells CBC: anemia Kidney Function Tests Coag. Profile & liver function tests to exclude coag. problem causing hematuria RADIOLOGICAL US: 1 to be done Advs. Accurate
st
Non-invasive IVP (IVU) - Delineate urinary tract - May show filling defect in bladder nonfunctioning kidney - CI in uremic pts. (renal impairment) due to obstruction CT with contrast:theMOST important - Shows degree of invasion of bladder wall, LN metastasis, hdronephrosis - CI in uremic pts. (bec. Contrast induced nephropathy) MRI Imaging of choice in pts with renal impairment
INVASIVE Cystoscopy Guided BIOPSY; most important If villous growth superf. - Complete resection + part of musculosa - Send for pathology - Free margins??
TTT
Transurethral resection + Intravesical chemotherapy + Immunotherapy (BCG vaccine to recurrence) Radical cystectomy
20 www.medadteam.org
2- Ureterocolic anastomosis
2 ureters are anastomosed to sigmoid colon There is single cloacafor both urine ,stool - Advantages : patient is continent - Disadvantages: a- absorption of chlorides in urinehyperchloremic metabolic acidosis Absorption of urea amonniaencephalopathy if liver impairement b- recurrent upper UT infections till renal failure c- Chemicals cancer colon after 10 years in 30%
d- continenceis partial as leakage occurs during sleep or flatus
3-Rectal ,bladder
Dividesigmoid colon colostomy{skin opening for stool} (rapidly tolerated by patient) 2 Ureters implanted in rectum now act as urinary bladder NB. Rectum has poor absorptive function compared to colon So ,Nohyperchloremic acidosis -
21 www.medadteam.org
NB.
Risk factors:
Smoking Von HippelLindow syndrome (cerebellar hemiangioblastoma ,Retinal Angioma) Acquired renal cystic disease Well understood molecular basis loss of short arm of chromosome 3{Tumour suppressor gene}
Pathology:
Gross: usually at upper pole of kidney ,BUT may occur at ANY site variable size ,Gold yellow {++lipid} Cutsection Mosaic (Hge,necrosis) & False capsule surrounding lesion Microscopic: ADENOCARCINOMA originating from PCTs of kidney Commonest formCLEAR CELL Type aggressive with sarcomatoid features Gradingsystem:Fuhrman Grading system Depending on nuclear shape Has prognostic value 4 grades from low to high grades
22 www.medadteam.org
N -
N2 (multi.)
N3 (fixed)
MsNo evidence of metastasis Mx Can't be assessed M1distant metastasis documented Metastasis sites
Lungs (no 1) Liver Adrenal Bone
C/P
Classical triad (advanced case) - Lion pain 40% of patients Cause a) renal capsule stretch b) passage bl.clots ureteric - Loin mass : irregular hard renal swelling 30% - Hematuria painless, recurrent, profuse 50% of cases,+ NECROTURIA(passage of necrotic tissue in urine,..differentiate from Nocturia !!) Other presentation - 1-non-reducible varicocele especially left sided LL edema - 2-paraneoplastic syndrome - Erythropoietin polycythemia - 3-cancer cachexia - PTH Hyppercalcaemia - 4-Fever of unknown origin - renin hypertension Liver dysfunction (stauffer$)
23 www.medadteam.org
Management
Surgical is the mainstay of ttt A) - radical nephrectomy (open or laparoscopic) b) - nephron sparing surgery (NSS) Or partial nephrectomy . At local excision with leaving the largest possible amount of functioning nephron In advanced cases: IFN, IL-2, recently tyrosine kinas inhibitors (TKI) Follow up every 6 months with lab inv. + x-ray chest
WILMS TUMOUR
ORIGIN: embryonic nephrogenic tissue INCIDENCE:10% OF
CHILDHOODMALIGNANCIES Age group: peak 3-4 yrs
GROSSPICTURE:
solitary sharply demarcated,encapsulated mass bilateral in 5-10 % of cases
MICROSCOPIC
both epithelial( 1ry glomeruli & tubules ) &Connective tissue(cartilage,fat,smooth&striated muscles..) - may be well differentiated (Favourable Histology FH) or poorly differentiated(Unfavourable histology UH)
24 www.medadteam.org
DIFFERENTIALDIAGNOSIS:
Neuroblastoma: in contrast to Wilmstumour, it - can cross midline - has irregular surface, Hard consistency - urinary catecholamines are elevated -may be associated with diarrhea(VIP secretion) OTHERS:hydronephrosis ,Multicystic dysplastic kidneys ,polycystic kidney (infantile type)
INVESTIGATIONS
Laboratory: Urine analysis: Microhematuria(50%) CBC,liver&kidney function tests Urinary catecholamines are NORMAL (Vs neuroblastom) Radiological : U/S:consistency solid Not cystic(exclude hydronephrosis& renal cystic disease) can detect liver metastasis CT Scan: v.important differentiate cystic from solid spread response to chemotherapy & radiotherapy Chest X-ray & isotope bone scan to detect metastasis
TREATMENT :
Surgical exicision (Radical nephrectomy ) remains the cornerstone for treatment,withpostoperative chemotherapy. For large unresectabletumours: preoperative chemotherapy to shrink tumour(neo-adjuvant) ,which can then be removed ,remaining tumour directed radiotherapy
25 www.medadteam.org
Etiology:
Blunt injuries: commonest e.g. road traffic accident , fall from height and direct kick Penetrating: e.g. stabs and gun shots Iatrogenic: e.g. during renal biopsy or percutaneous nephrostomy
Pathology:
Bleeding can be retroperitoneal or less commonly intraperitoneal. NB.Retroperitoneal: stop further bleeding by tamponade effect. Thus if opened in operation massive bleeding so take precautions and dont open unless necessary
C/P
History of trauma. Pain and tenderness over renal area but may be obscured by organ injury. Hematuria:gross hematuria after trauma = urinary tract injury However hematuria doesnt correlate with severity of injury 30% of renal vascular injuries are not ass. With hematuria This is due to either complete avulsion of pedicle or ureteric injury Blunt trauma + shock ( systolic BP. < 90 mmHg ) + microscopic hematuria is a good predictor of renal injury Hemorrhagic shock with oliguria Nausea , vomiting and illeus ( abd. Distention ) are very common. Other injuries.
Investigations
Lab: Urine analysis hematuria ( also for medico- legal purpose ). CBC serial hematocrit persistant bleeding.
26 www.medadteam.org
Treatment:
1) Resuscitation ( very important ) 2) Conservative : grades 1 , 2 , 3 ( i.e. most cases ) Hospitalization with bed rest and monitoring : clinical : vital signs Lab (CBC) : Hg & Hematocrit Radio : U/S for expanding hematoma Analgesics Large fluid intake : hypovolemia Avoid cast retention 3) Surgery :midline exploratory laparotomy Indications :
27 www.medadteam.org
Rupture bladder
Bladder injuries are most often from external force and are frequently associated with pelvis fractures. - extraperitoneal rupture . 80% - intraperitoneal rupture. 20%
Etiology:
1- Fracture pelvis is the commonest cause of extraperitoneal rupture. 2- A blow or kick to the lower abdomen, in presence of full bladder, is the commonest cause of intraperitoneal rupture. 3- Stabs or bullets 4- Surgical operations or cystoscopic procedures
Clinical features:
Extraperitoneal rupture: 1- History and signs of fracture pelvis. 2- Hypovlaemic shock. 3- Urine starts to collect in the retropubic space giving rise to an intense desire to void. 4- Swelling in suprapupic area. 5- Digital rectal examination: prostate in its normal position. 6- If not treated: irritation of anterior abdominal wall, a necrotizing phlegmon will develop
28 www.medadteam.org
Invetigations:
1- Ascending cystogram provides definite diagnosis by demonstrating leakage of contrast outside the bladder. 2- X ray: fracture pelvis and hazziness over the lower abdomen. 3- I.V.U : exclude other urinary injuries
D.D:
Intrapelvic complete rupture of the urethra. The prostate migrate up from the pelvis and is felt higher than normal on Digital rectal examination.
Complications:
Pelvic abscess Delayed peritonitis Partial incontinence if bladder neck is injuried
Treatment:
Emergencysurgery after proper patient resuscitation. - Exploration through a mid line incision and bladder tear exposed, its edges are trimmed and the defect is closed in two layers with polygalactin or chromic gut. - Suprapubic catheter is left in the bladder and drain is placed in retropubic space. - In intraperitoneal rupture, the peritoneum has to be opened to drain extravasated urine and exclude intraperitoneal injuries. - Antibiotics - Small tear with minimal extravasation on cystogram: uretral catheter for few days without the need for surgery. - Pelvic fracture is then treated; internal fixation of broken bone is contraindicated in the presence of urine extravasation for fear of causing osteomyelities. -
29 www.medadteam.org
Etiology Types
Treatment
Special Thanks To our dear colleague RAMY DOSS For his great effort in preparing this note
30 www.medadteam.org
MCQ
1. Bengin cyst by u/s all is correct except:
a. is smooth containing clear fluid. b. leaves residual mass after aspiration. c. no rapid recollection. d. all of the above.
2.Nocturia is:
a. passage of necrotic tissue in urine. (necroturia) b. sudden sever desire of micturation. c. passage of urine during sleeping. (Nocturnal enuresis) d. all of the above. e. non of the above.
14. UTI:
a. Gonococci is the most common causative organism. b. Stone & catheterization are the major predisposing factors. c. More common in males. d. All of the above. e. Non of the above.
16. Bilharziasis:
a. Commonly affects lower end of ureter. b. Hematuria is characterized by being total hematuria. (terminal) c. Fibrosis of urinary bladder is not common.
17. Stones:
a. Most common type of stone is uric acid. (ca oxalate) b. Radiolucent stones are more common. c. They are always asymptomatic. d. All of the above. e. Non of the above.
18. Risk factors of transitional cell carcinoma include all the following except:
a. Smoking. b. Cyclophosphamide. c. Pelvic irradiation. d. Exposure to benzidine. e. Exposure to shistosomiasis.
24. BPH:
a. Commonly affects old males at the age of 40. b. May present by frequency, hesitancy, weak stream and sense of incomplete voiding. c. Best way for examination is suprapubic abdominal examination.
ANSWERS
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. b e c a d c d c e c c d d b a 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. 29. 30. a e e d d d a d b c e d c d a