Romanian section Questions of Urology.

1 Anuria what is true?

Anuria Usually only show up if u have one kidney = empty
bladder. We can have Acute urinary retention that can lead to
urinary retention or even death. There can be different causes
of anuria on different places ->
anuria the empty bladder ( only one kidney)
acute urinary retention -> urinary retention can lead to death
anuria, hypertension
para renal cause if kidney failure -> shock,
Parenchyma enlargement hydronephrosis
Bloch in ureter lead to anuria.
Acute urinary retention cause->
anuria cause ( only one of them not bilateral)
kidney -> stone cause anuria, trauma cause by clot have
hematuria, tumor hematuria
(can obstruct by clot) block renal pelvis, infection UVI can
cause obstruction of ureter not
all the time cause septic shock, TBC necrosis of renal
parenchyma can communicate to
collecting system ( nonspecific cause or TBC), cause stenosis,
ect.
ureter -> stone, tumor of ureter, trauma, urinary tract
infection, TBC, Stenosis.
Compression of ureter from outside
bladder -> can be by obstruction of orifices of ureter or ells
NO, trauma move urinary
bladder in to peritoneum lead to no urine in urinary bladder. It
kidneys still produce urine, it is
a fals anuria
prostate -> urethra close to prostate p, if tumor of prostate
lead to anuria.
urethra -> not lead to Anuria.
In acute renal failure a symptom is acute renal failure.
2 DD in testicular tumor?
We Have to differentiate whit acute epididymitis. If we have
fever, pollakiuria, tumefaction and congestion of scrotal
suggest it to be epididymitis. On ultrasound over scrotum to

exclude inguinal scrotal hernia, hydrocele, spermatocele,

chronic testicular granulomatous inflammation or other benign
or malignant tumor of epididymis. For a positive diagnosis We
need to take the tumor markers (in absents of markers Do not
exclude TT)
3 Witch affirmation in testicular tumor IS NOT CORRECT?
KOMMER EFTER JAG HAR FRGAT CRISTINA VAD LRAREN
VILLE HA P FRGAN
4 Tumor in the urinary bladder? (different types)
epithelial tissue tumor-> papilloma, transitional carcinoma,
adenocarcinoma, epidermoid carcinoma. Mesenchymal tissue> fibroma, myoma, sarcoma, reticulum cell sarcoma, lymph
sarcoma.
Infiltrative/sessile/pedunculated tumors are the aspects of
urinary bladder tumors.
5 standard treatment for no metastatic urotelial carcinoma
located at pylo-calyxes and ureter?
The standard therapy of urothelial carcinoma with no
mestastasislocated in the pyelocaliceal and ureteral regions is
nephroureterectomy with perimeatic cystectomy.
The solitary superficial urothelial tumours that are well
differentiated may be treated through conservative
interventions too, in cases well selected, single functional
kidney, old age and organic diseases that do not allow a farreaching intervention: endoscopic resection, laser coagulation
followed by topic chemotherapy -Mitomicine, Adriamicine and
Epirubicine.
6 hematuria as a symptom in high urotelial tumors?
Total hematuria is present in over 90% of the cases. It has
the characteristics of neoplastic hematuria: it is spontaneous,
followed by pain due to ureter obstruction with clots and it is
capricious.

7 DD in renal tumor?
Polycystic kidney, hydronefrotic kidney, renal tuberculosis,
pyonephrosis, xantogranulomataus, pyelonephritis and solid
renal cyst. Cyst are the most common expansive process. US
are a good way to differentiate.
8 what are the symptoms of renal tumor except?
In the early stages, the kidney cancer presents no symptom. At
this stage, it is discovered incidentally at ultrasound
examination. The most common clinical manifestations are
urological and they are grouped in a triad represented by
hematuria, pain and kidney tumor
Hematuriais macroscopic, total, isolated or it accompanies
other clinical signs; it is difficult, unique or repeated, of low
intensity, or massive intensity with clots, which sometimes
determines the acute, complete retention of urine.
Flanktumor. The absence of the tumor cannot invalidate the
diagnosis of kidney cancer. When the tumor develops in the
upper pole of the kidney, the neo formation cannot be
palpated, unless it is larger. Like pain, the palpation of the
tumor is a sign of late diagnosis.
The palpation characters of the tumor are the lumbar contact
and baling. The tumor may be fix or mobile, which is very
important, because it shows a great tendency to local invasion
and even the impossibility of excision.
Rarely, the tumor ruptures spontaneously, especially when it
presents cystic areas or spread necrosis, making a syndrome
composed of brutal back pain, retroperitoneal hematoma,
signs of peritoneal irritation that associated with signs of
internal bleeding, leading to Wunderlich syndrome.

Pain-dull and constant pain predominate, caused by the

distention of the capsule andrenal pedicletraction. The
renalcolic occurs in the case of hematuria with clots; in this
case, the secondary character of hematuria is essential.
Symptomatic right-sided varicocelethe control of
varicocele is necessary in all cases where there is as uspected
renal tumor. This exploration shall be made instanding
position. The varicocele may have an early onset, when renal
tumor is not yet palpable.
9 complication on long term after total prostatectomy?
Urinary incontinens and erectile dysfunction.
10 Differential diagnosis in prostatic carcinoma
Prostate adenoma
Prostate tuberculosis
Chronic prostatitis
Prostate cysts or stones
Paget's disease
11 Disectasi syndrome
Ectasia means dilatation. Couldnt find this term in the book or
internet. If someone finds it. Report!!!
12 Modification of the urinary system during BHP (All caused
by enlarged prostate)
Prostate urethra: Above veromontanum, it gets longer, curved
and flattened. Caused by the presence of an enlarged median
lobe.

Bladder neck: Raised and have the shape of an y. Caused by

the enlarged median lobe.
Bladder trigone: Raised hand a retro-trigon depression occur.
Detrusor muscle: Hypertrophy and the bladder has the
characteristics of an "trabeculae" (?)
Herniation: By the mucosa through the detrusor muscle.
Terminal ureter: Intramural part is compressed. Slow
elimination of urine. Orifices are opened with a reflux
mechanism.(Not the normal peristaltic movements). The rise of
the bladder trigone will cause a "fish hook" insertion into the
bladder.

13 Absolute indications for treating BPH

Severe obstructive symptoms. Urinary retention. Appearance
of renal insufficiency.
14 What is untrue of kidney stones
Hard one, need the answers for this one. If anyone knows
please, please tell me=)=)
15 Symptoms of obstructed kidney stones
Non-typical: Low grade lumbar pain with abdominal
projections. In women pain may be absent and the urine has a
bad odour, from the u.t.i:s the stone is causing.
Typical: Renal colic.

May be associated with bladder signs, like pollakuria,

contraction, and dim, bloody urine.
General signs: Agitation, paleness, perspiration, nausea,
vomiting, and rarely abdominal flatulence.
16 Causes of renal lithiasis(Metabolic)
Disorders of calcium metabolism. Disorders of oxalic
metabolism. Disorders or uric acid metabolism. Disorders or
amine acid metabolism.

17 Imaging and evaluation of trauma patients are true except

See number 14 for this tricky one. Otherwise chapter 2 is good,
page 24.
18 Surgical interventions of renal trauma are true except
Damn. Kidney contusions, page 26.
19 Infection cycle. TB
1st: Invasion: In an non-sensitized body. Primary complex in
lung, rare intestinal.
2nd: Dissemination: Body cant build an protection and spread
occur through lymphatic's(embolic) and by blood(bacillemia)
causing secondary extrapulmonary focuses.
Renal TB occurs at the end of second period!

3rd: Extensive lesions: Characteristics lesions with phtisis,

most common situated in the lung.
Read about renal TB and phases at page 84.
20 Medical treatment for urogenital TB
General: Vit. C, Vit. D, Antiinflammatory, Vit. B6, causing better
tolerance for TB infections
Tuberculostatics:
Major: Izoniazid, rifampicin, ethambutol, pyrazinamide
Secondary: Cycloserine, ethionamide, Capreomycin, Amikacin,
kanamycin, p-aminosalicylic acid.
Tertiary: Linezolid, Clarithromycin, arginine

21 clinical manifestation in acute pyelonephritis?

The symptoms may be sudden onset of fever, shaking chills,
degenerated general state, bilateral lumbar pains irradiating
towards hypogastrium, oliguria and oligoanuria. Pallakiuria,
pyuria. Cephalea (dont know what it is), asthenia, fatigue,
nausea, vomiting are also associated.
22 rectal exam in acute bacterial prostatitis? (what will feel
and fined)
Digital rectal exam is extremely painful, sometimes impossible
to perform. Prostate is enlarged and very sensible. Sometimes
one may feel at the level of one lobe a fluctuation which
means that an abcess is forming.
23 vascular abnormalitys of the kidneys?

Several types can be observed: polar cranial or caudal veins

and double or quadruple principle renal vessels. The anomaly
involves only the aorta and the corresponding vein.
24 congenital phimosis?
Is characterized by the existence of tight foreskin orifice, the
penis is not retractable due to the foreskin orifice which is too
tight or due to the fact that the skin is to adherent to the
gland. The treatment consists of circumcision.
25 shape abnormalitys of the kidneys?
Horseshoe kidney it is formed of two distinct renal masses,
situated on one side and the other of the spine, welded at the
inferior pole, exceptionally rare at the superior pole.
The sigmoid kidney is a rare malformation that consists in
welding in front of the spine of the inferior pole of one kidney
with the superior pole of the other, which is lowered.
26 post renal anuria?
Obstructive acute renal failure which is characterized by failure
of leakage of urine in the bladder due to mechanical
obstruction of the upper urinary tract. There is no particular
manifestation linked to the nature of obstacle, the
consequences are the same, whether intrinsic or extrinsic
obstruction is of neoplastic nature or calculus.
27 this is true in testicular tumor except?
Testicular cancer is about 1% of male cancers most common
between age 15-35. 80% derives from germinal tissue. White
people are more affected. Cryptorchidism is considered to have
4-8 times higher risk to cause testicular cancer.. The first

station of lymph node metastasis are the lombo-aorta lymph

nodes. Hematogenous metastatis occurs most frequently in
the lung.
28 what are the tumor markers in the diagnosis of testicular
tumors?
Tumor markers is an important role in diagnosis like alphafetoprotein, beta human chorionic gonadotropin and secretory
tumor marker
29 what is true about the treatment of urinary bladder tumor?
Surgical methods: transurethral resection of the bladder
tumors (TUR B) is open to all superficial bladder tumors. Total
cystectomy.
Adjuvant therapy: intravesical chemotherapy, a single dose of
mitomycin C, epirubicin or doxorubicin. This instillation is
carried out within 24 hours after TUR V and is designed to kill
circulating cells after resection. Intravesical immunotherapy
with BCG.
30 macroscopic urinary bladder tumor?
About 75% of all bladder tumors are localized in the trigone.
We have pediculated tumors: single or multiple implanted in
the bladder mucosa by a thin pedicle.
Sessile tumor: with large implantation basis, with short fringes,
less mobile, the seem to be fixed to the mucosa, less exophytic
than pediculated tumors.
Infiltrative tumors: they are vegetative tumors, with large
implantation in the bladder wall, with an irregular surface.

31mostfrequenttypeofhistologicaltypeofurotelialtumor?
Transitionalcellcarcinoma
32HOWDOSEUSLOOKINSIMPLERENALCYST?
Black/darkgray,hypoechoic,singlewelldefinedcysticlesion,thinnwalls,
acousticenhancementposterior
33renaltumorsclinicaltypes?(differentkinds)
Hematuriaform
Tumorform
Febrileform(prolongedhyperpyrexia,itisnotinfluencedbyantipyretics
andantibiotics,itosduetosomepyrogenicproteinsresultingfrom
tumoralnecrosis)
Theformwithpolyglobulia
TheHTNform(duetotheexistenceofanarterialvenousfistulainthe
tumororitmayoccursecondarytoatumorthatdevelopsintherenal
hilum.Thevascularcompressionmayleadtorenalischemia)
Hypercalcemiasyndromeforms(neuromuscular,gastrointestinaland
cardiovasculardisorders)
Silentforms(withhematuria,albuminuria,hypertension)
Metastaticforms(10%,thefirstsignofthediseaseiscausedby
metastasis)
Otherforms:withhepaticdysfunction(Stauffersyndrome),Cushings
syndrome,Sanarellisyndrome(calciumdeposits)

34whatistrueaboutclearcellcarcinoma?
8090%ofallrenalcellcarcinomasareclearcellcarcinomas,moreinfoon
page148

35whatisfalseaboutPSA?
Prostatespecificantigenisaglycoproteinsecretedbyprastate,whichprevents
spermclotting.PSAmaybedeterminedfromserumbyradioorimmunoassay
methods,withelevatedvaluesbothinHBPandinPC.Butappearanceofthe
PCtissueincreasesserumvaluesofPSA10timesmorethenthesamequanity
ofBPHtissue.However,20%ofthePCfoundareaccompaniedbynormal
levelsofPSA.Generally,themaximumnormalvalueofPSAis3,2ng/ml.
PSAisanextremelyusefulvalueforincipientandearlyprastatecancer
diagnosis.PSAhasaspecialvalueinthecontrolandmonitoringtherapy.We
mayconcludthatPSAisausefulmarkerforposttherapyscreeningand
tracking.PSAisanorganicspecifikmarker.Afteratotalprostatectomy,it
becomesatumorspecifikmarker,veryusefulinmonitoringtheevolutionof
surgery.BasedonserumPSAvalues,theeffectofradiotherapyorhormone
therapyismonitored.
36ProstatetumorT3cH3M1bhowisthetreatmentofthis?(T3c
H2M1bisatypeofclassification)
palliativetreatmentforpatientsw/boneMT(M1bMetastasesinBones):
Radiotherapy,admin.STRONTIUM89(p.146)
37whatabout5alphareductasisfalse?
MinimalAndrogenBlockade(treatmentoflocallyadvancedPCwithor
withoutMTT3,T4,N1,M1):combiofminimumnonsteroidantiandrogen5
alphareductaseinhibitor(FINASTERIDE).Testosteronelevelswillbelow,no
significanteffectonsexualfunction
enzymeresponsibleforthetransformationoftestosteroneinDHT,levelsof

thatenzymeincreasewithage(DHTbeinginvolvedinetiologyofBPH)
38fullerfreyeroperation
OpensurgeryforBPH,impliesdigitalcutofnucleusofadenoma
(adenomectomy)throughSUPRAPUBICtransbladderapproach.Notvery
commonanymore,onlyusedwhenademoais>60g.
(Millintechniqueretropubic)

39thetechnicsinsurgicaltreatmentofkidneystones?
PCNLanystone,nonregardingitslocation,size,hardness,volume,number
Ureteroscopyalsosolvebenignstenosesofproximalureter
Laparoscopyforpylo,ureteralandrenalcalculi
ESWLinsuperiorurinarysystem>1,5cmindiameter
Nephrectomy,Pylolithotomy,Pylonephrolithotomy,anatrophic
Nephrolithotomy,radialPolinephrotomy,Benchprocedurenotused
anymoreEXECPTURETEROLITHOTMYwhenESWL,PCLN,URSA,
URSRfail.
40whatistrueinactivesurgicalliteasis(theoneuneedtooperate)?
surgicaltreatmentisindicatedforallstoneswhichcannotbeeliminated
spontaneoisly.MostlybyESWL.Usedinstonesinthesuperiorurinarytract
associatedwithUTIinwhichothertreatmentfails.progessiverenal
parenchymalpain,obstructionofurinarychannelandpersistentpain(page109)
41 the pain in the renal colic? (what is it and why)
very intense, paroxistic (sudden) pain. Any obstacle that suddenly appears on the superior
urinary channel (clot, calculus, pus, external obstacles) can start the renal colic. From a
physiopathological point of view, the renal colic is the result of a hyper-pressure appeared

at the level of the superior urinary channels. Muscular spasm and the distension of the renal
capsule, which accompany it, contribute to the amplification of the pain.

42 what is true about kidney stones that move? (Hitta

inte s mycket frn boken p denna frga)
The severity of the pain is no indicator of the size of the passing kidney
stone. This pain is often described as the worst pain a person has ever suffered
even by women who have given birth. It is reported to be more painful than gun
shots, surgery, broken bones, or even burns. The pain is not a result of the
stone moving or tearing the ureter as a sufferer might suspect. Rather, the pain
is caused by the dilating or stretching of the urinary tract being blocked by the
stone when it gets stuck in the ureter.

so the pain is intermittent while passing down and have irradiations

towards the inguinal channel, tescticles and basis of the thigh. In women
the pain radiates to the hypogastrium and big labia.
If stone is in the upper one-third of the ureter - pain radiates to the perineum,
if at the pelvic brim - pain radiates to the inner aspect of the thigh,
if present in the middle one-third of ureter - pain radiates to the iliac fossa.

Many stones gets stuck at the membranous ureter and the

Majority gets stuck at the Anterior ureter. ( stood I lrans
material men fattar inte var det ligger)
Tror han skrivit fel och menar urethra. (Sid 105)
43

when dose kidney stone appear more

frequently?
The most common stone is calcium oxalate, also men have bigger risks, and it runs in family.
(secondary hyperurecemia du to purines from food/alchool is also more common type)

Not drinking enough water. When you don't drink enough water, the salts, minerals, and other
substances in the urine can stick together and form a stone. This is the most common cause
of kidney stones.
Medical conditions. Many medical conditions can affect the normal balance and cause stones to
form. Examples include gout and inflammatory bowel disease, such as Crohn's disease. HPT, Vit d
excess, immobilization etc

44 renal contusion?
Cloused trauma = contusions
More in Men and adults. Right is more vulnerable due to its
lower position.
The blood filled kidney causes an hydrostatic pressure and has
friable tissue also contributing to contusions.
2 groups of contusion
Direct - for example in car accident
Indirect ex falling from great hight causing lesions of renal
pedicle. Body stops when hit ground the heavy kidney (blood
filled) continues to fall rupturing the pedicle. Usually
associated with pollytrauma.
lesions can occur at 2 components of the kidney
1 Parenchymal lesions (hemorrhagic and ischemic)
1) Subcapsular hematoma = Renal capsul is intact after minimal superficial fissure,
single or multiple, or when deep lesions are produced, interested in parenchyma, associated
with or without calyx and renal pelvis lesions, hemorrhage followed by an accumulation of
subcapsular blood, making subcapsular hematoma witch may or may not be associated
with hematuria deepending on if there are lesions on the excretory pathways.
2) Perirenal hematoma = When renal capsule is affected, blood flows perirenal.
If severe parenchymal injury with severe injury to the capsule can result in
Renal rupture
Crushing and Kidney explosion depends on trauma that occurred

. A -partial sfissure; B - kidney explosion, C - subcapsular hematoma with external fissure, D

fissure that opens in the colecting system; E - fissuree open in the renal pelvis F - subcapsular
hematoma limited to the cortex fissures.

2. Pedicle lesions
The pelvis is detached, Also arteris or/and veins can be teared causing massive
retroperitoneal hemorrhage, wich can lead to hemorrhagic shock and death.
When less severe, when there is partial fractures it can cause vessel thrombosis, or scar
stenosis, with post traumatic hypertension. Hematuria does not accompany the isolated
lesion of the renal pedicle.
3. Intrarenal excretory pathway lesions (calyx, basin)
Not isolated lesion, The Urine goes into the retroperitoneal space, its associated with
fissure or parenchymal rupture, with hematuria leading to AUR by clots (inferior Urinary
trackt)

4.Associated lesions
Parietal ruptures are more common, fractured ribs (11,12) lesion of abdominal organs. At
the perineal fat it can form a perineal hematoma.

Clinical manifestations
Patient history (what happened)
General signs: vary depending on severity
Local signs: pain, hemorrhage, perirenal hematoma (blood to kidney fat), Internal
hemorrhage (into peritoneal cavity), hematuria, hematuria can be absent if

ureter is

ruptured or blocked by a clot.

Brusing, increased muscular defence = retroperitoneal urohematoma (can be very difficult
to differ from localized peritonitis)
Lab: hemogram, hematocrit, renal function tests, blood glucose, coagulation. The decrease
in hematocrit values to the values initially found means persistent bleeding.
Imagining:
KUB X-ray) - informs on the status of the skeletal system x-rays (ribs, hip bones,
spine), the presence or absence of psoas shadow (lumbar hematoma), the presence of
pneumoperitoneum.
IVU - is made in emergency before in any patient with macroscopic hematuria, in
shock, but with systolic arterial tension values above 70 mm Hg or in case of
palpable lumbar hematoma inform the morpho-functional status of the contralateral
kidney and also provides information on the traumatized kidney.
Chest X-ray inform about the integrity of the ribs, allows assessing the
existence of pneumothorax or of hydrothorax (hemothorax).
Computer tomography (CT) - is the most important paraclinical investigation in
cases of renal trauma. It sets the renal pedicle integrity, renal rupture lines, the size of
retroperitoneal hematoma. It gives information on the morpho-functional state of the
opposite kidney and on the intraperitoneal abdominal organs.
Renal arteriography is less used since the CT entered in current use. It is a very
accurate investigation, which gives the most accurate informations on the renal
pedicle and on the vascularization of renal parenchymal trauma. Reveals the
presence of aneurysms, arteriovenous fistulas, arterial thrombosis and posttraumatic
arterial stenosis.
Ultrasound - unlike the radiological investigations mentioned before, it is a purely
morphological method of investigation. It provides important details on the integrity
of renal parenchyma, the presence of subcapsular or perirenal hematoma and their
size. It is available at the bedside whenever the situation requires, being a valuable
investigation for determining the development of the hematoma and thus in the

therapeutic attitude tracking. Also it informs about the state of other abdominal
parenchymal organs (liver, spleen, pancreas). Instead it does not provide a large range
of information or the accuracy of the CT and arteriography of the renal pedicle.
Doppler ultrasound increases the accuracy of the ultrasound about the damage of the
renal pedicle.
EVOLUTION
In most of the cases, the evolution is favorable with spontaneous disappearance of
hematuria, the return to normal of the heart rate, arterial tension (AT) and the
stabilization limits of lumbar hematoma. Sometimes the evolution is severe, bleeding
continues and lumbar hematoma increases in size, requiring emergency surgery for the
purpose of hemostasis (renal suture, partial nephrectomy or nephrectomy). Sometimes, in
a variable interval, between 8 days and 2 months, when everything seemed to come into
normal, signs of a major internal bleeding appear, with signs of hemorrhagic shock with or
without abundant hematuria, by kidney rupture. Emergency surgery is required.
COMPLICATIONS
Bleeding occurs as a perirenal hematoma with a two-stage evolution, or as a total
hematuria.
Early infection of the urinary tract. Late complications are: posttraumatic hydronephrosis,
after a interstitial hematoma is formed, with progressive dilatation and renal parenchymal
destruction. Urohematic cyst, posttraumatic hydronephrosis and arterial hypertension of
posttraumatic renal origin that is caused by renal vascular lesions, such as
arteriovenousaneurysm.
DIAGNOSIS
Renal contusion diagnosis relies on case history (information on the circumstances of
the accident) and on the cardinal symptoms (hematuria and pain). In addition, the
lesions associated with other viscera must be specified (abdominal or thoracic), which
almost always coexist. To specify the type of renal injury and to determine the
prognosis and therapeutic attitude in conditions of renal contusions, described
radiological explorations and ultrasound are indicated. From the beginning it should be
noted that at 3-6 months after trauma, an ultrasound and an urography examination
will be performed to assess the progress of the perirenal scar and / or retroperitoneal,
with secondary effects on urinary paths and on renal pedicle.

TREATMENT
Statistics show that 80% of the renal contusions receive a conservative
treatment consisting of:
compulsory bed rest;
shock removal when necessary;
monitoring of vital functions and of the development of renal trauma;
pain relievers;
preventive antibiotics;
Perfusions for balancing volume and electrolyte and for diuretic effect.
When with all the above measures the hematuria persists and / or perirenal
hematoma increases and it is associated with signs of anemia and the general condition
declines, the question of surgery appears, which should be conservative. Nephrectomy is
required only in cases of irreversible kidney damage, or where vital necessity requires. The
access path is represented by a lobotomy or a laparotomy which allows the treatment of any
associated abdominal injuries.
Surgery consists of:
evacuation of retroperitoneal urohematoma;

simple fissure, unique, is sutured with wires in X, polar localized lesions can be

followed by partial nephrectomy. Large lesions, explosive, pediculare lesions, that are not
easily rebuilt require nephrectomy;
ensuring a safe hemostasis;
effective lumbar drainage
The patient will be followed from 6 months to assess the degree of functional recovery and
the occurrence of late complications, which may require secondary surgical therapy.

45 signs and symptoms of trauma of anterior part of the

urethra?
Bleeding from urethra

is a symptom seen in all cases and

it is installed immediately after the accident. Dysuria is intense,

reaching up to the complete urine retention. Living pain
appears in the time of the accident, located locally and
generally in the perineum. Periurethral hematoma, by blood
and
Urine accumulation. Causes the appearance of perineal
sweeling more or less paiful, not exceeding crainial urogenital
diaphragm. Through contact with septic urine, hematoma may
become infected, causing abscess or phlegmon.
46 renal TBC are always?
(answer is secondary)
47 they are considered major tuberculostatics whit the
exception of?
The 4 major tuberculostatics are:
Isoniazid, Rifampicin, Ethambutol, Pyrazinamide
48 witch gram negative are more frequent in the urinary
infection?
E.coli, Pseudomonas aeruginosa, Klebsiella, Enterobacter,
Proteus.
49 acute cystitis three symptoms?
It manifests through polakiuria, pyuria and pain

50 what is false in horse shoe kidney?

Horseshoe kidney it is formed of two distinct renal
masses, situated on one side and the other of the spine, welded
at the inferior pole, exceptionally rare at superior pole. The area
is usually a fibrousisthmus, rarely parenchymal, which overlaps
the spine. Due to the fact that the anomaly was produced
before the ascension and the complete kidney rotations, it has
some characteristics:
The kidneys are usually situated lower than usual, the isthmus being situated in the region
of L2-L3 lumbar vertebrae;
The longitudinal axe of the kidneys is transverse, top-down and inside out, describing a
V with cranial opening;
renal pelvis is anterior facing (insufficient rotation);
The ureters descending to the bladder cross the isthmus.
The vascularization is abnormal (from mesenteric arteries, iliac arteries and from
the aorta) and approaches the medial edge of the horseshoe and the superior edge of the
isthmus.
Clinical. The symptomatology is related to the appearance of complications, usually the
infectious ones, the tumors and the calculus being the most frequent. Thus, the anomaly
is very well tolerated. The symptomatology takes the charactereristics of stated above
disorders.
The diagnosis is based mainly on X-Ray investigations (reno bladder X - ray, IVU)
and radioisotopic ones.
The KUB X - ray can emphasize the two welded renal shadows, lower situated,
especially at patients with thin abdominal wall. IVU, in normal functioning renal
conditions, allows anomaly recognition (modification of longitudinal axes of the kidney,
the renal pelvises are anterior, the ureters cross the isthmus, the calyx have an anarchic
orientation, they look on a medial direction and less external).
The reno-scintigraphy, or ureter-pielography

(retrograde

ureteropyelography)

are useful in functional renal deficiency.

The ultrasound is less useful, contrasting the position modification of kidneys,
related to the normal position, both kidney masses being moved medially; it outlines

eventual dilatations (transonic formations) and/or calculus (ecogene formations with

shadow cone).
The treatment: when the anomaly is associated to calculus, the treatment consists
in

extracorporeal

lithotripsy

(ESWL),

or

percutaneous

extraction

(percutaneous nephrolithotomy - PNL). Rarely, pielolitotomy and the dissection of

fibrous isthmus are performed, if this is actually an obstructive factor for ureters. The
approach is on medial line, transperitoneal. Surgical interventions of any kind are
difficult due to associated anomalies: of rotation, vascularization and due to fusion
anomaly.

51 hypospadias ?
The Hypospadias is an anomaly of the urethra opening from the
ventral side of the penis. Usually this is small and curved down.
The anomaly is the consequence of a development interruption
that leads to an incomplete welding of genital fold or to an
incomplete growth of genital buds. According to the location of
the ectopic urethral meatus, several anatomic forms of
hyspodias can be distinguished: balanic, penian, penoscrotal,
perineoscrotal hypospadias (vulviform). The sponge body stops
developing and with him, the urethra stops too and it is
replaced by a tissue blade that keeps the penis curved. Urethral
plasty techniques use skin flaps from the penis or scrotum.