Some notes in urology for

GPs
. /

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Renal colic
Diagnosis : colicky pain in the renal triangle , irritability , reffered pain to the
back or the inguinal area , in severe cases the pt cant stand still and may be
nauseated or even vomit +/- dysuria

-/+ -/+
Causes : crystals ( ( the commonest in Egypt especially urates
Infection : pyelonephritis, cystitis, urethritis
Stones
Rarely : ischemia, embolism, muscle spasm
1) renal stones :
Diagnosis : renal colic, dysuria, hematuria, strangury
Inv. :
1- Urine analysis : RBCs 5 HPF, pus cells,
PH 7.5 = infective stone ( alkaline PH = E-coli )
< 5.5 = urate stone mainly
2- Blood : urea, creatinine, uric acid
3- Radiology : KUb + U/S abdomen and pelvis
-/+ 4-2 12

If there is stone do IVU or spiral CT without contrast to decide ttt
plan
IVU :

Spiral CT : if unsure stone case or in difficult accessded site
Ttt :
1- general : fluid intake, milk intake, avoid chocolate, tea, beans, nuts
citrus fruits & cheese
4-3

2- analgesics : R/ ketolac amp 1*2*3
R/ ketolac tab 1*2*6
R/ urinex cap 1*2*6 to bladder pain and dysuria
3- urinary changes :
If urates : alkalinization of urine with NaHCO3 R/ reno eff
Allopurinol : R/ urosolvin eff 3

R/ zyloric 100/300 tab

If Ca oxalates : R/ epimag/xenomag eff
+/- thiazide diuretic
4- if infection : AB
R/ ciprofar 500 cap 1*2
R/ ciproquin 750 cap 1*2
Chronic suppressive therapy esp. in females R/ uvamin retard cap
10
Conclusion :
:
R/ ciprofar 500 cap
R/ ketolac amp 12
R/ urosolvin eff 3
R/ urinex cap
2) UTIs :
Cystitis : frequency, urgency, dysuria, +/- hematuria, incontinence ++ no
fever
Pyelonephritis : fever, loin pain, cystitis sympt., +/- vomiting or nausea
Inv : urine analysis ( before 1st AB dose )
+/- radiology according to case ( in pyelonephritis u may need U/S )
Ttt :
Cystitis : as previous
Pyelonephritis : do renal function tests 1st
R/ cefotax 1gm vial (2) 12
R/ ciproquin 750 cap 1*2
R/ ketolac amp 1*2*3
R/ reno eff 1*3
U have to F/U case after 2 ds if good response continue
if bad response refer
3) BPH :
Diagnosis : old age 50 yrs,
FUN WISE
F : frequency : ) )
U : urgency :
N : nocturia : ) )
W : weak stream :
I : incontinence
S : straining :
E : end dribbling :


BPH score :
Not at
Less
Less

More
always

 than
times
4
4
4
4

times

than
times
2
2
2
2

than 1
in 5
1
1
1
1

all

Freauency 0
3
5
Urgency
0
3
5
Nocturia
0
3
5
Weak
0
3
5
stream
Incontinen 0
1
2
3
4
5
ce
Straining
0
1
2
3
4
5
End
0
1
2
3
4
5
dribbling
Score :
0-7 : normal or mild case further inv. 1 drug ttt
8-19 : moderate case 2 drugs ttt
20-35 : severe case refer for urologist for surgery
Inv : -urine analysis
-serum PSA
-abdominal U/S
Ttt :
1- watchful waiting : in mild cases ( score 0-7 ) evening fluids, caffeine,
) prevent constipation and straining ( the pt must learn how to relax
2- drug therapy :
- agonist : e.g. prazosin SE : postural hypotention R/ prostacure cap 1*2
R/ cardura 1*2
-5- reductase inhibitor : e.g. finasteride SE : urinary retension R/ prostec
tab 1*1
-combination of 2 drugs
3- severe cases with retention catheterize and refer

: 10 1-
5
2-
3-
4-
5 5-
6-
7-
7-

7-5
8-


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