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Urologic DisordersUrologic Disorders
Mohammad Al Omar, Mohammad Al Omar, MBBS, FRCSCMBBS, FRCSC Assistant professor and Assistant professor and
Consultant UrologistConsultant UrologistKKUH, KSUKKUH, KSU
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Urologic DisordersUrologic Disorders
Urinary tract infectionsUrinary tract infections
UrolithiasisUrolithiasis
Benign Prostatic Hyperplasia and voiding Benign Prostatic Hyperplasia and voiding dysfunction dysfunction
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Urinary tract infectionsUrinary tract infections
UrethritisUrethritis
Epididymitis/orchitisEpididymitis/orchitis
ProstatitisProstatitis
cystitiscystitis
Acute PyelonephritisAcute Pyelonephritis
Chronic PyelonephritisChronic Pyelonephritis
Renal AbscessRenal Abscess
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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
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URETHRITISURETHRITIS
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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
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EpididymitisEpididymitis
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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
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ProstatitisProstatitis
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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
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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
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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
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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
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PyelonephritisPyelonephritis
Imaging:Imaging:– IVPIVP– U/SU/S– CTCT
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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
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UrolithiasisUrolithiasis
Risk factors:Risk factors:– Intrinsic FactorsIntrinsic Factors
GeneticsGenetics
Age (2Os-4Os)Age (2Os-4Os)
SexSex M>F M>F
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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 )
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UrolithiasisUrolithiasis
How do stones formHow do stones form– supersaturated→ Crystal Growthsupersaturated→ Crystal Growth– Aggregation of crystals →stoneAggregation of crystals →stone
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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
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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
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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
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UrolithiasisUrolithiasis
Cont. S&SCont. S&S
– RestlessRestless↑↑HR, ↑ BPHR, ↑ BP
fever (If UTI)fever (If UTI)
Tender CVATender CVA
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UrolithiasisUrolithiasisInvestigationInvestigation
UrinalysisUrinalysis : :– RBCRBC– WBCWBC– BacteriaBacteria– CrystalsCrystals
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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)
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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
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UrolithiasisUrolithiasisManagementManagement
Shock Wave lithotripsy (SWL)Shock Wave lithotripsy (SWL)
UreteroscopyUreteroscopy
Percutaneous Nephrolithotripsy (PNL)Percutaneous Nephrolithotripsy (PNL)
Open SxOpen Sx
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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
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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
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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
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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
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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
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Benign Prostatic HyperplasiaBenign Prostatic Hyperplasia
Surgical RxSurgical Rx– Endoscopic (e.g. TURP, laser ablation)Endoscopic (e.g. TURP, laser ablation)
– Open SXOpen SX