Renal
Colic
Colic refers to the
pain generated by smooth muscle spasm around a hollow structure.
Renal colic is caused
by calculi in the ureter
Epidemiology
Prevalence of urinary
stones, renal and vesical in the
Higher prevalence in
the
Seems to have been
higher in the
Normally patient
>30 years
Aetiology
In almost everyone
the concentration of some constituents of urine exceeds their solubility
Therefore the
presence of inhibitors of crystal formation seems to be important
Possible metabolic
abnormality Chemical
composition of urine
High calcium diet Immobility
Dehydration Obstruction
----- stasis --- infection
Poor nutrition in
children, eg. in
Stones often from in
renal pelvis
Pathophysiology
Stones may be
infective or metabolic
Infective are crumbly
and composed mostly of phosphates, metabolic stones are mostly calcium oxalate.
In the
Some contain
magnesium ammonium phosphate and uric acid
Urolithiasis Stones
< 0.3 cm should pass down the ureter
Staghorn calculus
Clinical features
Unilateral Renal
pain - varies but may be may be exquisite
Renal colic
May be acute and severe
and occur in waves which pass down the line of the ureter
May present as
infection
Bleeding and
infection may complicate calculi
Recurrence occurs in
50% of patients over a 10 year period
Complications include
infection, hydronephrosis, impaction, (jamming), renal atrophy
Management
Prevent with a high
fluid intake,
-
keep dissolved substances in solution, -
help to wash out solid material
Low calcium diet Treat
pain - pethadine 100 mg im.
Antispasmodics Screen
urine for the presence of stones
Lithotripsy, e.g.
ultrasonic Endoscopic
removal
Surgical removal of
larger stones, > 1cm Diet
depending on type of stone
Observe and sieve all
urine
Benign
prostatic hyperplasia
Hyperplasia an
increase in number of cells in a tissue or organ
Benign non-malignant
character of a neoplasm
Aetiology
From the age of 40
the prostate gland changes in size and consistency
Pathophysiology
Hyperplasia results
in periurethral adenomas
Rest of the prostatic
tissue is gradually compressed
Progressive obstruction
of the prostatic urethra and interference with normal sphincter function
To overcome increased
outflow resistance there is bladder detrusor hypertrophy and diverticulum of
the bladder may develop
Diverticula may lead to stasis, infection, stone formation and
malignancy
Progressive inability
to empty the bladder leading to chronic retention -------- infection and stone
formation
When 1 litre is
residual hydroureter and hydronephrosis may develop
Clinical features
Frequency, urgency,
dysuria
Nocturia
Hesitancy
Weak force of stream
with straining
Dribbling
incontinence
Acute retention may
be precipitated by infection Obstructive uraemia
Symmetrical smooth
enlargement on PR
Management
Catheters
Prostatectomy
Sometimes drugs
Carcinoma
of the prostate
A common malignancy
in the
Epidemiology
Common in Europe and
US especially in African origin men, rare in China and Japan Mean
age of presentation is 70 years, uncommon under 50
Common cubclinical carcinoma, 75% of men over the age of 80
Aetiology
Family history. Possible hormonal role, Cadmiun, tyre
and paint workers, farmers. Incidence increases with age. Less common in vegetarians. Meat and fat eating. Lack of lycopene
from tomato products. Low fruit
intake. High dietary calcium. Cannabis
Pathophysiology
Carcinoma - malignant
neoplasm derived from epithelial tissue TNM
is used
Localised –
within the prostatic capsule
Locally advanced
– spread outside the prostatic capsule
Metastatic –
spread away from local area, e.g. local pelvic lymph nodes then metastases to
pelvis and lumbar spine
Clinical features
Prostatic features Gland feels
nodular and stony hard Features of metastatic
disease
PSA (prostate
specific antigen) testing.
Management
Prostatectomy Radiotherapy Endocrine
treatment eg. stilboestrol 1 mg tds
Orchidectomy Symptomatic
Prostatitis
Inflammation of the
prostate may be acute or chronic
Acute
Febrile symptoms and
perineal pain
May be other urinary
features such as dysuria, bladder irritability, obstruction, abscess formation
and haematuria
May be caused by an
anatomical abnormality
Caused by bacterial
infection
Responds to iv
antibiotics. Antibiotic treatment may need to be continued for several weeks
Chronic
A long term condition
difficult to eradicate.
Characterised by
bacterial culture from secretions but the chronic abacterial
form is more common.
Infection may come
from the urethra, often caused by E. coli or Chlamydia.
Abacterial form may be caused by undocumented Chlamydia infections.
Factors –
inflammation, autoimmunity, hormonal imbalances, intra-prostatic urinary
reflux, psychological disturbance.
Destruction of
glandular epithelium
Aching in the
perineum, suprapubic pain, low back pain, low grade fever, possible burning
with ejaculation and urinary features, mild urgency and frequency, dysuria,
recurrent UTIs. Suppression with antibiotics is often the only option
Carcinoma
of the bladder
Aetiology
Smoking Environmental
carcinogens Analgesic abuse
Uncommon below 50 and
incidence increases with age
Pathophysiology
Transitional cell
carcinoma arising from the pear shaped
epithelial
transitional, stratified cells comprising the lining
of the bladder, i.e.
from the urothelium
TNM is used in
classification
Clinical features 80% have painless haematuria Blood
well mixed with urine
Retention occurs
uncommonly UTI Possible
hydronephrosis
Management
Cystoscopic resection or diathermy Radiotherapy Cytotoxics Radical
surgery