1. Causes of Retroperitoneal Fibrosis
a) Idiopathic in 2/3rd of cases
b) Use of drugs-- Methysergide, Ergot derivatives
c) Retroperitoneal hemorrhage, Urinary Extravasation
d) Trauma
e) Inflamatory bowel disease, Collagen disease
2. Symptoms
a) Pain with girdle like distribution, Pain relieved by NSAIDs and not narcotics
b) Uremia occurs late
1.Most Common Cause of Lower Urinary tract symptoms- BEP
2. Tamsulosin works on alpha1 receptor
3. Newer Modalities like Microwave resection should not be used if prostate size is more than 100g
4. Rule out B/L Hydronephrosis if a person with BEP (Benign Enlargement of Prostate ) develops increased levels of serum creatinine
5. Methods to stop unidentified bleeding during TURP ( Transuretheral Resection of Prostate)
a) Check the other side of prostate capsule
b) Check Bladder neck
c) Fill the bladder
Most common electrolyte abnormality seen when the following conduits are used
1. Stomach- Hypochloremic metabolic alkalosis. This is secondary to the HCl secretion by the stomach segment, involving the H+/K+ ATPase secretory mechanism of the gastric mucosa.
2. Jejunum- Hyponatremic, hypochloremic, hyperkalemic metabolic acidosis. Also known as “jejunal conduit syndrome.” This syndrome can be quite debilitating, resulting in nausea, anorexia, lethargy, fever, and even death. The jejunum should be used only when there are no other acceptable segments available for use.
3. Ileum- Hyperchloremic metabolic acidosis. This is caused by the substitution of ammonium for sodium in the Na/H transport. Therefore, ammonium chloride is absorbed into the bloodstream in exchange for carbonic acid (CO2 and H2O).
Q) Management of ureteral injury at the time of Left Colectomy
A) Mobilization of the two ends of the ureter and anastomoses of the spatulated ends over a stent
Q) Which portion of the ureter is at chance of injury during hysterectomy
A) At the level of broad ligament where ureter passes under the uterine vascular pedicle in relation to the cervix
Q) What are the contraindications of using ileum as a ureteic implant
A) Impaired renal function (Creatinine more than 2mg%)
Bladder outlet obstruction
Impaired emptying of bladder
Q ) Is Wilm's tumor in older children associated with good or bad prognosis
A) Older patients have more aggresive tumor with bad prognosis
Q ) What is the most common site of metastasis for Wilm's tumor
A) Lungs
Q ) Would you do a biopsy to confirm a Wilm's tumor
A) Biopsy is not always indicated. If at all percutaneous biopsy should be done
Q What is the relation of obesity with renal stone formation
A Obesity causes changes in urine chemistry reflecting increased calcium, uric acid, sodium, and decreased citrate in the urine.
Calcium oxalate and uric acid stones are more common in obese.
ph of the urine decreases in obese. This is because insulin resistance at the cellular level results in hyperinsulinemia, which in turn causes defects in renal production of ammonia, lowering the pH of the urine.
Q How long should one wait before advising surgery for renal stones
A 1 month is the average time one should wait before advising surgery. After one month the rate of complications such as strictures develop
Q How is Fournier's gangrene treated. What is the mortality rate?
A. Fournier's gangrene is treated by prompt debridement , Broad spectrum antibiotics and surgical debridement. Mortality rate ranges from 6-20%
Q What is the most common organism associated with Fournier's gangrene
A Staphylococcus and Streptococci
Now even gram negative organisms and anaerobes are being cultured
Q. Is orchidectomy needed in debridement of Fournier's gangrene
A. No
Testis can be preserved because
1. They have a separate blood supply
2. They can be placed in a pouch in the thigh
