A 56-year-old man presented to surgery with new-onset urinary tract symptoms over the preceding week. These consisted of urgency and frequency associated with suprapubic pain. There was no frank hematuria. He had no significant past medical history and no history of STIs.Clinically he was afebrile and his abdomen was soft with no palpable bladder. There were no testicular abnormalities. A provisional diagnosis of UTI was made and the patient was prescribed a seven-day course of ciprofloxacin 500mg daily. His symptoms improved over the week and the urine microscopy report revealed no growth but large quantities of white and red blood cells.ReviewThe patient was reviewed at 10 days and was asymptomatic. A repeat urine microscopy was normal. At the review appointment, digital rectal examination revealed a non-tender benign prostatic enlargement. Biochemical tests including a PSA, glomerular filtration rate and U+Es were normal. Three weeks later he presented with frank hematuria and incontinence with lower abdominal and left-sided loin pain. He had a palpable bladder and a large stone trapped at the urethral entrance. He was admitted as a surgical emergency and underwent a meatotomy and stone removal under anesthesia. A cystoscopy was normal and there was no evidence of further calculi in the renal tract. The stone was calcium oxalate and thought to have originated from the ureter. A coexistent UTI had caused urethral impaction secondary to epithelial slough and an element of BPH. He has been well since. Please provide a rationale.
What are ureteral stones?
What causes these stones to develop?
What is the prevalence of ureteral stones?
What complications or conditions would an untreated ureteral stone cause?
How are stones treated? Are all stones surgically removed?
Explain the signs and symptoms of renal stones.
What are a meatotomy and a cystoscopy?
What is BPH?
What is PSA? Why was this test ordered?
What is glomerular filtration? Why was this result important?
Explain why the test for urine eosinophils ordered.
What is the post procedure education for this patient?
●Uretral stones are referred to the presence if stone in one or both the ureter.This can block the flow of urine from kidney causing flank,loin pain,hematuria if severe.
●The main reason for the stones to develop are the presence of crystal formation due to lack of urine to dilute it (The common stones found are calcium,oxalate,uric acid
Dietary factors:eating fruits, vegetables, nuts,chocolate containing high oxalate content
Renal tubular acidosis ,gout,cystinuria
Decreased fluid intake or excess fluid loss(uric acid stones)
Medication (anti seizure mefication)
UTI (struvite stones)
Obesity
Abdominal surgery
Bacterial infection
●The prevalence of Uretral stones in US is approximately 1 in 1000 adults
●The complications of untreated uretral stones are
Chronic kidney disease
Kidney scarring
Renal failure
Urosepsis
Pus collection near prostate
Septic shock
●The stones are treated in the following ways
Fluid therapy(hydrotherapy ) and flushing out the stone,medication to relieve pain if smaller stone
If the stone is larger lithotripsy (breaking of stones by radiation ),if not successful and patient is in dangerous stage then a emergency surgery is done.
●The signs and symptoms of renal stones are
●Meatomy refers to the widening of the meatus by surgery.
Cystoscopy refers to visualization of the bladder via urethra ,it is a endoscopic procedure
●BPH stands for Benign Prostatic Hyperplacia .It is referred to the enlargement of the prostate and it is generally non cancerous.It is found a problem in case of urinary tract infects ,older age
●.PSA (Prostate Specific Antigen )..It is used to detect cancer of prostate gland. This test was ordered because the patient showed severe symptoms of UTI which leads to the suspicion of prostate enlargement due to infection ,hematuria,incontinence and pain
●Glomerular filteration refers to the kidneys ability to segregate the wastes from the blood and excrete it has urine.This in simple it gives an idea how the kidney functions and makes it necessary for test .This enables to calculate the amount of mefucation and fluids yo be administered
●The test for urine eosinophils was ordered to rule out acute interstial nephritis,also presense of it in the urine indicates infection
●The post procedure education are
A 56-year-old man presented to surgery with new-onset urinary tract symptoms over the preceding week. These...
A 56-year-old man presented to surgery with new-onset urinary tract symptoms over the preceding week. These consisted of urgency and frequency associated with suprapubic pain. There was no frank hematuria. He had no significant past medical history and no history of STIs.Clinically he was afebrile and his abdomen was soft with no palpable bladder. There were no testicular abnormalities. A provisional diagnosis of UTI was made and the patient was prescribed a seven-day course of ciprofloxacin 500mg daily. His symptoms...
A 56-year-old man presented to surgery with new-onset urinary tract symptoms over the preceding week. These consisted of urgency and frequency associated with suprapubic pain. There was no frank hematuria. He had no significant past medical history and no history of STIs.Clinically he was afebrile and his abdomen was soft with no palpable bladder. There were no testicular abnormalities. A provisional diagnosis of UTI was made and the patient was prescribed a seven-day course of ciprofloxacin 500mg daily. His symptoms...
A 56-year-old man presented to surgery with new-onset urinary tract symptoms over the preceding week. These consisted of urgency and frequency associated with suprapubic pain. There was no frank hematuria. He had no significant past medical history and no history of STIs.Clinically he was afebrile and his abdomen was soft with no palpable bladder. There were no testicular abnormalities. A provisional diagnosis of UTI was made and the patient was prescribed a seven-day course of ciprofloxacin 500mg daily. His symptoms...
A 56-year-old man presented to surgery with new-onset urinary tract symptoms over the preceding week. These consisted of urgency and frequency associated with suprapubic pain. There was no frank hematuria. He had no significant past medical history and no history of STIs.Clinically he was afebrile and his abdomen was soft with no palpable bladder. There were no testicular abnormalities. A provisional diagnosis of UTI was made and the patient was prescribed a seven-day course of ciprofloxacin 500mg daily. His symptoms...
A 56-year-old man presented to surgery with new-onset urinary tract symptoms over the preceding week. These consisted of urgency and frequency associated with suprapubic pain. There was no frank hematuria. He had no significant past medical history and no history of STIs.Clinically he was afebrile and his abdomen was soft with no palpable bladder. There were no testicular abnormalities. A provisional diagnosis of UTI was made and the patient was prescribed a seven-day course of ciprofloxacin 500mg daily. His symptoms...
A 56-year-old man presented to surgery with new-onset urinary tract symptoms over the preceding week. These consisted of urgency and frequency associated with suprapubic pain. There was no frank hematuria. He had no significant past medical history and no history of STIs.Clinically he was afebrile and his abdomen was soft with no palpable bladder. There were no testicular abnormalities. A provisional diagnosis of UTI was made and the patient was prescribed a seven-day course of ciprofloxacin 500mg daily. His symptoms...
A 56-year-old man presented to surgery with new-onset urinary tract symptoms over the preceding week. These consisted of urgency and frequency associated with suprapubic pain. There was no frank hematuria. He had no significant past medical history and no history of STIs.Clinically he was afebrile and his abdomen was soft with no palpable bladder. There were no testicular abnormalities. A provisional diagnosis of UTI was made and the patient was prescribed a seven-day course of ciprofloxacin 500mg daily. His symptoms...
A 56-year-old man presented to surgery with new-onset urinary tract symptoms over the preceding week. These consisted of urgency and frequency associated with suprapubic pain. There was no frank hematuria. He had no significant past medical history and no history of STIs.Clinically he was afebrile and his abdomen was soft with no palpable bladder. There were no testicular abnormalities. A provisional diagnosis of UTI was made and the patient was prescribed a seven-day course of ciprofloxacin 500mg daily. His symptoms...
A 49-year-old male patient was admitted to the ER with moderate lower abdominal pain, mild-to-moderate dysuria, pollakiuria and nocturia (at least 5 – 8 times) in addition to hematuria. When taking his history, the patient tells the ER physician that this has gone on for approximately six months. Although the condition has not worsened over that time, it has not gotten better either. The patient also notes that he had been treated for urinary tract infections a total of three times over...
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