1. Phase 2 Patrick King The Peer Teaching Society is not liable for false or misleading information…

2. To cover aetiology, presentation, diagnosis and treatments of common urological problems such as: UTI, AKI, chronic renal failure, BPH and prostate cancer The Peer Teaching Society is not liable for false or misleading information… Aims

3. The Peer Teaching Society is not liable for false or misleading information… Structure of urinary tract

4. The Peer Teaching Society is not liable for false or misleading information… Lower Urinary tract infection E.Coli, Klebsiella spp., proteus spp.,enterococci spp., staphylococcus saprophyticus Symptoms: suprapubic pain, dysuria, frequency, foul smelling urine, nocturia, incontinence, fever, delirium Investigations: ? Treatment: Nitrofurantoin or trimethoprim Recurrent UTI (>=3 UTIs in a year) warrants investigation – renal ultrasound, cystoscopy, KUB-XR

5. Cause: ascent of LUTI, obstruction, bladder dysfunction Symptoms – “loin to groin” pain, fever/rigors, vomiting, lower UTS, haematuria. Unwell. Investigation – U&Es, urine sample, catheter, CTKUB, blood cultures Treatment – ABCDE, rehydration, IV antibiotics, drain hydronephrosis e.g. percutaneous nephrostomy/ catheter The Peer Teaching Society is not liable for false or misleading information… Upper UTI

6. Cause: split into pre-renal, renal and post-renal Presentation: 1 st – reduced urine output (<0.5ml/kg) 2 nd – raised creatinine, urea, K +, ↓eGFR 3 rd – confusion, vomiting, overload Treatment: pre-renal - ? Renal – biopsy, steroids, removal, dialysis Post-renal - ? The Peer Teaching Society is not liable for false or misleading information… Acute Kidney Injury

7. Cause: Diabetes, hypertension, old age, drugs Stage 1-5 depending on eGFR, 1/2 very common (1/10) The Peer Teaching Society is not liable for false or misleading information… Chronic renal failure

8. The Peer Teaching Society is not liable for false or misleading information… The prostate

9. The Peer Teaching Society is not liable for false or misleading information… Benign prostatic hyperplasia The prostate grows throughout life in response to testosteroen. It doubles in size every 4.5 years between 31 and 50. 90% at 90 will have symptoms. Symptoms: ? Can cause acute/chronic retention – catheterise Ask about cancer symptoms, DRE Treatment: alphablockers e.g. doxazocin, 5-alpha- reductase inhibitors e.g. finasteride, TURP

10. The Peer Teaching Society is not liable for false or misleading information… Prostate cancer 80% of men in 80s have prostate cancer but only causes 13% of all cancer deaths. Symptoms: as before + bony pain, weight loss. PSA – 1000 screened: how many deaths prevented? how many false positives? Investigation – TRUS-prostate, radioisotope/MRI Treatment – watchful waiting & monitor anti-androgen therapy prostatectomy/radiotherapy – complications?

11. Quiz? Which other structure in the retroperitoneum may have pathology that mimics upper UTI and needs urgent treatment? Why do middle aged women have more UTIs? A 120kg man on the ward has a urine output of 45mls in the last hour. Does this worry you? Name two hormones produced/activated in the kidney. A patient develops AKI 1 day post-op. What are 3 possible causes? What 3 areas of the ureter provide anatomical narrows likely to stop stones?

12. Quiz? Management of an AKI patient with a K + of 7.9. What two structures may be damaged in a prostatectomy and what complications must the patient be warned of? A 75 year old man comes in with chronic retention. Name one examination, one investigation and one intervention that should be done soon? Is PSA a good screen for prostate cancer?