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Oh, I haven't. Ok. Yeah, you find the slides. So I think we're live now. Um and that's, yeah, so I think because we, we, we can give it a few minutes just to make sure a few, a few other people join. Um, ok, let me put this up. There you go. Right. Yeah, my sweetheart. It's. Yes. Yeah. Yeah. Yeah. Ok. That um each side. Oops. Ok. Yeah. Ok. Not it. Ok. Does that show up? Yeah, it's good. Sorry, that was a bit of a uh pretty much all that. Um Yeah. No. Ok, cool. Um Hello. Good evening. Uh Thank you for tuning in to apologies for that slight. Um That, that was just I was trying to get the technology to work. Um I'm Erin and this is Alex, our couple of F ones here to give you some teaching this evening. Um on urology, it'll just be 10 quick fire high yield teaching bits and Bobs. Um Yeah, on 10 topics. Um just whilst you wait for people to connect. So just if you could scan the QR code, if you haven't already and just fill in, I think it's a short survey regarding one of the research things that we're trying to run this year, it should only take a couple of minutes of your time and then we'll get started about five minutes past seven. Yeah. Yeah. Yeah cool controls work. So. Ok. Yeah, to be honest it's really alrighty um I'll let Alex do the first couple of questions and I'll take him for the end. All right. Ok. Yeah. So um so as we said earlier, we, we're gonna cover um urology um in this er lecture, we have put up the, the um different topics that we cover. Um So without further ado we can go on to the first question. So we'll give you a few minutes uh to read the question and answer it and we'll put a poll up as well. Um Just so you can sort of see how your answer, sort of how you do compared to other people. It what? So feel free to move on to the answer slide. Aaron, we uh OK. So, um in this first question, um essentially the diagnosis, um yy, you should have recognized as acute urinary retention. Um And then from that, um the, the immediate manager would be to insert a urinary catheter. Um sort of the way you could discern that the patient was in acute urinary retention. So, a bit about the history, uh so the fact that they were in abdominal discomfort and weren't able to pass urine, but then the bladder scan, um showing 500 mL quite a lot. Um And then looking at potentially some of the reasons he might be in urinary retention, um which we will go through in the next few slides. Um Sort of how to systematically assess a patient um for urinary retention and possible causes. Um But essentially this patient had a G A, so um a a an anesthetic drugs, um a risk factor for urinary retention. Um They were also sort of like displaying some other symptoms of um urinary retention, such as sort of becoming a bit more delirious as well. Um and the abdominal discomfort of course. Um So if we move on to the next slide, we'll talk a little bit about urine retention. So, um so it's the inability to um voluntarily empty, the bladder can be acute and chronic. So, th this patient, it was uh acute um in terms of thinking about causes. So, um the obstructive ones, um usually the more common ones and can be either chronic or acute, usually chronic, leading into acute retention. Uh So your prostate um enlarging either through er benign hyperplasia, um or prosthetic cancer, uh you can have urethral strictures caused by UTI S. You can have blood clots um within the urethra. Um also stones, um severe constipation, a another cause of obstructive tumors and then organ prolapse that you're thinking about uh cystoceles in um in females. Um So medications are another cause and these are more likely to be acute causes of retention. So your opioids, different anesthetic agents and your anticholinergics. Er, and then just thinking a bit more out there with causes and urological causes such as spinal cord pathology, diabetes. And also there could be a psychological element to urinary retention. So, think about some of the symptoms. So, um, you know, of course, like you might be just completely unable to um empty your bladder or, or start your urinary stream. We also might have some sort of especially in chronic er retention, some more or less severe symptoms such as dribble, weak stream that can cause to, you know, even though you're passing some urine, you are retaining a lot of urine as well. Um recurrent uti. So this is sort of like a bit of a um chicken and egg situation. So the UTI S could cause the obstruction but then sort of the urine um festering with it all like within the bladder can fess different um bacterias that can again lead to UTI S. Um of course abdominal discomfort and then when you come to assessing the patient. So the examination is key to try and um attain if this is new, acute chronic um different precipitating factors. Um in terms of the examination, um there won't be any significant sort of like physical findings apart from potentially um the um abdominal tenderness, you would do apr exam in a, in a guy to assess the prostate and we come on to some of the findings you might have there a bit later on, uh, psa in a, in a male. And again, we'll come on to the uses of that and when it is potentially not as useful, er, and because obviously you could get hydronephrosis or kidney impairments, a back flow of urine into the um, kidneys. Um, bladder scan will be useful for actually diagnosing urinary retention and the urine analysis looking for stuff like blood, looking for um, infected markers and they more sort of secondary um investigations like like urodynamic er studies and cystograms. Not gonna be something you do in the first instance, um, we spoke a bit about the complications you.
