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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