urologic disorders mohammad al omar, mbbs, frcsc assistant professor and consultant urologist kkuh,...

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