UROLOGIE 2 2025-2026
Herhaling Ba2................................................................................................................................................. 8
Anatomie.................................................................................................................................................... 8
Urinaire continentie...................................................................................................................................11
Mictie........................................................................................................................................................ 13
Urinaire infecties.......................................................................................................................................... 18
Herhaling - natuurlijke verdediging...........................................................................................................18
Algemene inleiding urineweginfecties...................................................................................................... 18
Acute bacteriële cystitis............................................................................................................................22
Pyelonefritis..............................................................................................................................................24
Prostatitis..................................................................................................................................................25
Acute bacteriële prostatitis (categorie 1)............................................................................................ 27
Chronische bacteriële prostatitis (categorie 2)................................................................................... 28
CPPS (categorie 3)............................................................................................................................ 29
Urethritis................................................................................................................................................... 29
Orchi-epididymitis.....................................................................................................................................30
Nosocomiale, kathetergerelateerde infecties........................................................................................... 30
Recidiverende infecties............................................................................................................................ 31
Bijzondere infecties.................................................................................................................................. 32
TBC.................................................................................................................................................... 32
Schistosomiasis..................................................................................................................................33
HSV.................................................................................................................................................... 33
HPV.................................................................................................................................................... 33
Fournier’s gangrene........................................................................................................................... 34
Casus Lukas.............................................................................................................................................34
Genitale pathologie......................................................................................................................................37
Urethrastricturen.......................................................................................................................................37
Peniele kromstand....................................................................................................................................39
Varicocele.................................................................................................................................................40
Hydrocoele............................................................................................................................................... 42
Casus Bert................................................................................................................................................43
Urologische urgenties & trauma.................................................................................................................45
Torsio testes............................................................................................................................................. 45
Acute penispathologie.............................................................................................................................. 46
Parafimosis.........................................................................................................................................46
Priapisme........................................................................................................................................... 46
Seksuele accidenten.......................................................................................................................... 49
Vesico-vaginale fistula..............................................................................................................................50
Blaas/urethra pathologie.......................................................................................................................... 51
Macroscopische hematurie................................................................................................................ 51
Retentie.............................................................................................................................................. 51
Trauma urethra.........................................................................................................................................52
Posterieur urethra trauma bij bekkentrauma...................................................................................... 52
Anterieur urethra trauma.................................................................................................................... 53
Niertrauma................................................................................................................................................53
Uretertrauma............................................................................................................................................ 56
1
, Blaastrauma............................................................................................................................................. 56
Urologische urgenties...............................................................................................................................57
Sonderen.......................................................................................................................................................58
Indicaties.................................................................................................................................................. 58
Obstructie & stase.................................................................................................................................... 58
Double J............................................................................................................................................. 58
Nefrostomie........................................................................................................................................ 59
Transurethrale verblijfsonde............................................................................................................... 60
Sonderen..................................................................................................................................................62
Verblijfsonde.......................................................................................................................................62
Suprapubische sonde.........................................................................................................................63
Intermittente sondage (IC)..................................................................................................................65
Lage urinewegobstructie (BPH, LUTS)...................................................................................................... 68
Leerdoelen............................................................................................................................................... 68
Obstructie - classificatie........................................................................................................................... 68
Benigne prostaatvergroting...................................................................................................................... 69
Urolithiasis....................................................................................................................................................79
Leerdoelen............................................................................................................................................... 79
Neurourologie - neurogene blaas...............................................................................................................86
Leerdoelen............................................................................................................................................... 86
Lage urinewegen......................................................................................................................................86
Neurologische ziekten.............................................................................................................................. 88
Madersbacher classification..................................................................................................................... 89
Functionele stoornissen van LUW............................................................................................................. 92
Leerdoelen............................................................................................................................................... 92
Spectrum van functiestoornissen............................................................................................................. 92
Urinaire incontinentie (UI).........................................................................................................................92
Stress urinaire incontinentie (SUI)............................................................................................................97
Urgency urinaire incontinentie (UUI)...................................................................................................... 102
Urologische kinesitherapie - bekkenbodemreëducatie..........................................................................108
Bekkenbodem........................................................................................................................................ 108
Bekkenbodemdysfunctie (PFD)..............................................................................................................108
Bekkenbodemtherapie............................................................................................................................110
CPPS............................................................................................................................................................116
Definitie & terminologie...........................................................................................................................116
Inhoud.....................................................................................................................................................117
Urologisch pijn syndroom................................................................................................................. 117
Gynaecologisch pijn syndromen (externe genitalia).........................................................................120
Musculoskeletaal systeem............................................................................................................... 121
Gastro-intestinaal pelvisch pijn syndroom........................................................................................121
Pudendus pijn syndroom..................................................................................................................122
Fysiologie en pathofysiologie................................................................................................................. 122
Therapeutische benadering................................................................................................................... 125
4-stappenplan voor diagnose................................................................................................................. 127
Stap 1: anamnese............................................................................................................................ 127
Stap 2: vorige onderzoeken & verslagen......................................................................................... 128
Stap 3: KO........................................................................................................................................128
Stap 4: KO van het musculoskeletaal systeem................................................................................ 131
Behandeling........................................................................................................................................... 132
2
, Mechanisme-gebaseerde therapie...................................................................................................132
Osteopathische manipulatieve behandeling.....................................................................................133
Oncologie - blaas, testis & penis..............................................................................................................135
Oncologische urologie............................................................................................................................135
Blaastumoren......................................................................................................................................... 135
Oppervlakkige blaastumoren............................................................................................................137
Spierinvasieve blaastumoren........................................................................................................... 139
Gemetastaseerd blaasCa.................................................................................................................140
Testistumoren......................................................................................................................................... 140
Peniscarcinoom......................................................................................................................................142
Spinocellulair carcinoom van de penis (SCC).................................................................................. 142
Oncologie - prostaat.................................................................................................................................. 144
Incidentie................................................................................................................................................ 144
Oorzaken................................................................................................................................................144
Chemopreventie..................................................................................................................................... 145
Diagnose................................................................................................................................................ 145
Behandeling........................................................................................................................................... 149
Oncologie - nier..........................................................................................................................................156
Niertumoren............................................................................................................................................156
Renaal celcarcinoom (RCC)...................................................................................................................156
Nefroblastoma (Wilmstumor)..................................................................................................................161
Benigne niertumoren.............................................................................................................................. 161
Angiomyolipoma...............................................................................................................................161
Oncocytoma..................................................................................................................................... 162
Niercysten........................................................................................................................................ 162
Urotheeltumor van pyelum of ureter.......................................................................................................162
Hematurie....................................................................................................................................................165
Definitie.................................................................................................................................................. 165
Oorzaken................................................................................................................................................165
Oorzaken van rood verkleurde urine................................................................................................ 165
Oorzaken van hematurie.................................................................................................................. 166
Diagnose................................................................................................................................................ 167
Behandeling........................................................................................................................................... 171
Alle hoofdstukken te kennen behalve…
● Subhoofdstuk 2.3 Urinaire Incontinentie en Enuresis kind – niet in cursus urologie maar in
vakpediatrie Prof. Van Hoeck
● Subhoofdstuk 12.3 Erectiele functie / 12.4-12.5-12.6 Mannelijke infertiliteit (examen reeds behaald
in Bachelor)
EXAMEN
● multiple choice vragen – 4 mogelijke antwoorden
● theoretische vragen + toegepast klinische vragen
3
,Herhaling Ba2
Anatomie
● topografische anatomie
○ klinisch onderzoek
○ begrijpen pathologie
● chirurgische anatomie
○ begrijpen pathologie
Urinewegen
● hogere urinewegen ⇒ alles boven de blaas
○ nier, nierbekken (pyelum), ureter
● lagere urinewegen
○ blaas, urethra, prostaat
○ scrotum, liesregio
functie
● filtratie van bloed → uitscheiding van afvalstoffen
● gelinkt met circulerend volume, bloeddruk en samenstelling van bloed (bv. elektrolyten)
● gelinkt met reproductief systeem
Nier
● rechter nier ligt lager door lever
● cortex: filterend deel met glomeruli
○ dikte van cortex zegt iets over functionele capaciteit van nierweefsel
○ bv. nierstenen: blokkade van urineleider → nierinsufficiëntie → verdunning van niercortex
● medulla: transport doorheen tubuli en lis van Henle
ligging: retroperitoneaal
● barrière voor infecties: voorkomt verspreiding naar buikholte
○ nadeel: minder duidelijke tekens van infectie (geen peritoneale prikkeling, loslaatpijn…)
● tamponerend: kleine afgesloten holte geeft tegendruk bij bloedingen
● beschermd: ingebed in perirenaal vet en deels afgedekt door onderste ribben
niercirculatie
● 20% van cardiac output
● a. renalis (> aorta) splitst in segmentale arterie en
eindarterie
○ aa. interlobair → aa. arcuata → aa. radiata →
afferente arteriolen (1 per nefron)
○ nefron → efferente arteriolen → peritubulaire
capillairen → vv. radiata → vv. arcuata → vv.
interlobaris → v. renalis
4
,urineproductie
● urine = water + afvalstoffen
● 1,5-2,5 l / dag
○ > 3.5-4 l / dag = polydipsie
○ minstens 800 ml om afvalstoffen kwijt te geraken
● steriel, geel, helder, reukloos
Hoge tractus
ureter
● lopen op m. psoas en over grote iliacale bloedvaten
● lengte: 25-30 cm
● diameter: 1-3 mm
● komen langs achter in de blaas thv trigonium: ureterovesicale overgang
● antirefluxmechanisme: natuurlijk klepsysteem om terugvloei naar de nier te
voorkomen
○ passief: schuine uitmonding in blaas, zodat er een langer deel in de
spierlaag verloopt
■ hoe schuiner de inmonding, hoe langer dit stuk, hoe meer de
ureter wordt dichtgeduwd bij een volle blaas
■ als de blaas vult gaat de wand uitrekken, waardoor de ureter toeklapt door
toegenomen druk → geen reflux van urine door intramurale druk
○ actief: peristaltiek van prevesicale deel van de ureters
○ ↔ ectopische ureter: ureter mondt uit op afwijkende plaats, dus meer kans op
uretherovesicale reflux
5
, ● histologie
○ bekleding: urotheel = overgangsepitheel = meerlagig transitioneel epitheel met paraplucellen
○ spierlagen
■ extern circulair: ritmische contracties
■ intern longitudinaal: urine in druppels voortgeleiden
● continu proces: meer drinken → hogere snelheid
en grotere druppels
○ bindweefsel
transport door hoge urinewegen
● onderbroken peristaltiek
○ wanden van kelken duwen het lumen dicht
○ kelk samentrekkingen: 10-12 / min
○ nierbekken samentrekkingen: 4-6 / min
● bolus golf: 2-6 cm / min
○ boven bolus wordt ureter afgeplat
drukopbouw in hoge urinewegen
● druk wijzigt minder bij lage diurese
● hoge diurese (4-7 ml/min): druk neemt toe
○ ↑ aantal samentrekkingen
○ ↑ kracht van contracties
○ ↑ volume bolus
○ max. 5-10 ml/min
● atypische spiervezels = pacemaker
Blaas
● ligging: preperitoneaal (retro)
● inhoud: 350-650 ml
● wand: 1-2 mm dik
● urachus = fibreus overblijfsel van verbinding tussen blaas en navelstreng naar placenta
● blaashals = inwendige sfincter
6
Herhaling Ba2................................................................................................................................................. 8
Anatomie.................................................................................................................................................... 8
Urinaire continentie...................................................................................................................................11
Mictie........................................................................................................................................................ 13
Urinaire infecties.......................................................................................................................................... 18
Herhaling - natuurlijke verdediging...........................................................................................................18
Algemene inleiding urineweginfecties...................................................................................................... 18
Acute bacteriële cystitis............................................................................................................................22
Pyelonefritis..............................................................................................................................................24
Prostatitis..................................................................................................................................................25
Acute bacteriële prostatitis (categorie 1)............................................................................................ 27
Chronische bacteriële prostatitis (categorie 2)................................................................................... 28
CPPS (categorie 3)............................................................................................................................ 29
Urethritis................................................................................................................................................... 29
Orchi-epididymitis.....................................................................................................................................30
Nosocomiale, kathetergerelateerde infecties........................................................................................... 30
Recidiverende infecties............................................................................................................................ 31
Bijzondere infecties.................................................................................................................................. 32
TBC.................................................................................................................................................... 32
Schistosomiasis..................................................................................................................................33
HSV.................................................................................................................................................... 33
HPV.................................................................................................................................................... 33
Fournier’s gangrene........................................................................................................................... 34
Casus Lukas.............................................................................................................................................34
Genitale pathologie......................................................................................................................................37
Urethrastricturen.......................................................................................................................................37
Peniele kromstand....................................................................................................................................39
Varicocele.................................................................................................................................................40
Hydrocoele............................................................................................................................................... 42
Casus Bert................................................................................................................................................43
Urologische urgenties & trauma.................................................................................................................45
Torsio testes............................................................................................................................................. 45
Acute penispathologie.............................................................................................................................. 46
Parafimosis.........................................................................................................................................46
Priapisme........................................................................................................................................... 46
Seksuele accidenten.......................................................................................................................... 49
Vesico-vaginale fistula..............................................................................................................................50
Blaas/urethra pathologie.......................................................................................................................... 51
Macroscopische hematurie................................................................................................................ 51
Retentie.............................................................................................................................................. 51
Trauma urethra.........................................................................................................................................52
Posterieur urethra trauma bij bekkentrauma...................................................................................... 52
Anterieur urethra trauma.................................................................................................................... 53
Niertrauma................................................................................................................................................53
Uretertrauma............................................................................................................................................ 56
1
, Blaastrauma............................................................................................................................................. 56
Urologische urgenties...............................................................................................................................57
Sonderen.......................................................................................................................................................58
Indicaties.................................................................................................................................................. 58
Obstructie & stase.................................................................................................................................... 58
Double J............................................................................................................................................. 58
Nefrostomie........................................................................................................................................ 59
Transurethrale verblijfsonde............................................................................................................... 60
Sonderen..................................................................................................................................................62
Verblijfsonde.......................................................................................................................................62
Suprapubische sonde.........................................................................................................................63
Intermittente sondage (IC)..................................................................................................................65
Lage urinewegobstructie (BPH, LUTS)...................................................................................................... 68
Leerdoelen............................................................................................................................................... 68
Obstructie - classificatie........................................................................................................................... 68
Benigne prostaatvergroting...................................................................................................................... 69
Urolithiasis....................................................................................................................................................79
Leerdoelen............................................................................................................................................... 79
Neurourologie - neurogene blaas...............................................................................................................86
Leerdoelen............................................................................................................................................... 86
Lage urinewegen......................................................................................................................................86
Neurologische ziekten.............................................................................................................................. 88
Madersbacher classification..................................................................................................................... 89
Functionele stoornissen van LUW............................................................................................................. 92
Leerdoelen............................................................................................................................................... 92
Spectrum van functiestoornissen............................................................................................................. 92
Urinaire incontinentie (UI).........................................................................................................................92
Stress urinaire incontinentie (SUI)............................................................................................................97
Urgency urinaire incontinentie (UUI)...................................................................................................... 102
Urologische kinesitherapie - bekkenbodemreëducatie..........................................................................108
Bekkenbodem........................................................................................................................................ 108
Bekkenbodemdysfunctie (PFD)..............................................................................................................108
Bekkenbodemtherapie............................................................................................................................110
CPPS............................................................................................................................................................116
Definitie & terminologie...........................................................................................................................116
Inhoud.....................................................................................................................................................117
Urologisch pijn syndroom................................................................................................................. 117
Gynaecologisch pijn syndromen (externe genitalia).........................................................................120
Musculoskeletaal systeem............................................................................................................... 121
Gastro-intestinaal pelvisch pijn syndroom........................................................................................121
Pudendus pijn syndroom..................................................................................................................122
Fysiologie en pathofysiologie................................................................................................................. 122
Therapeutische benadering................................................................................................................... 125
4-stappenplan voor diagnose................................................................................................................. 127
Stap 1: anamnese............................................................................................................................ 127
Stap 2: vorige onderzoeken & verslagen......................................................................................... 128
Stap 3: KO........................................................................................................................................128
Stap 4: KO van het musculoskeletaal systeem................................................................................ 131
Behandeling........................................................................................................................................... 132
2
, Mechanisme-gebaseerde therapie...................................................................................................132
Osteopathische manipulatieve behandeling.....................................................................................133
Oncologie - blaas, testis & penis..............................................................................................................135
Oncologische urologie............................................................................................................................135
Blaastumoren......................................................................................................................................... 135
Oppervlakkige blaastumoren............................................................................................................137
Spierinvasieve blaastumoren........................................................................................................... 139
Gemetastaseerd blaasCa.................................................................................................................140
Testistumoren......................................................................................................................................... 140
Peniscarcinoom......................................................................................................................................142
Spinocellulair carcinoom van de penis (SCC).................................................................................. 142
Oncologie - prostaat.................................................................................................................................. 144
Incidentie................................................................................................................................................ 144
Oorzaken................................................................................................................................................144
Chemopreventie..................................................................................................................................... 145
Diagnose................................................................................................................................................ 145
Behandeling........................................................................................................................................... 149
Oncologie - nier..........................................................................................................................................156
Niertumoren............................................................................................................................................156
Renaal celcarcinoom (RCC)...................................................................................................................156
Nefroblastoma (Wilmstumor)..................................................................................................................161
Benigne niertumoren.............................................................................................................................. 161
Angiomyolipoma...............................................................................................................................161
Oncocytoma..................................................................................................................................... 162
Niercysten........................................................................................................................................ 162
Urotheeltumor van pyelum of ureter.......................................................................................................162
Hematurie....................................................................................................................................................165
Definitie.................................................................................................................................................. 165
Oorzaken................................................................................................................................................165
Oorzaken van rood verkleurde urine................................................................................................ 165
Oorzaken van hematurie.................................................................................................................. 166
Diagnose................................................................................................................................................ 167
Behandeling........................................................................................................................................... 171
Alle hoofdstukken te kennen behalve…
● Subhoofdstuk 2.3 Urinaire Incontinentie en Enuresis kind – niet in cursus urologie maar in
vakpediatrie Prof. Van Hoeck
● Subhoofdstuk 12.3 Erectiele functie / 12.4-12.5-12.6 Mannelijke infertiliteit (examen reeds behaald
in Bachelor)
EXAMEN
● multiple choice vragen – 4 mogelijke antwoorden
● theoretische vragen + toegepast klinische vragen
3
,Herhaling Ba2
Anatomie
● topografische anatomie
○ klinisch onderzoek
○ begrijpen pathologie
● chirurgische anatomie
○ begrijpen pathologie
Urinewegen
● hogere urinewegen ⇒ alles boven de blaas
○ nier, nierbekken (pyelum), ureter
● lagere urinewegen
○ blaas, urethra, prostaat
○ scrotum, liesregio
functie
● filtratie van bloed → uitscheiding van afvalstoffen
● gelinkt met circulerend volume, bloeddruk en samenstelling van bloed (bv. elektrolyten)
● gelinkt met reproductief systeem
Nier
● rechter nier ligt lager door lever
● cortex: filterend deel met glomeruli
○ dikte van cortex zegt iets over functionele capaciteit van nierweefsel
○ bv. nierstenen: blokkade van urineleider → nierinsufficiëntie → verdunning van niercortex
● medulla: transport doorheen tubuli en lis van Henle
ligging: retroperitoneaal
● barrière voor infecties: voorkomt verspreiding naar buikholte
○ nadeel: minder duidelijke tekens van infectie (geen peritoneale prikkeling, loslaatpijn…)
● tamponerend: kleine afgesloten holte geeft tegendruk bij bloedingen
● beschermd: ingebed in perirenaal vet en deels afgedekt door onderste ribben
niercirculatie
● 20% van cardiac output
● a. renalis (> aorta) splitst in segmentale arterie en
eindarterie
○ aa. interlobair → aa. arcuata → aa. radiata →
afferente arteriolen (1 per nefron)
○ nefron → efferente arteriolen → peritubulaire
capillairen → vv. radiata → vv. arcuata → vv.
interlobaris → v. renalis
4
,urineproductie
● urine = water + afvalstoffen
● 1,5-2,5 l / dag
○ > 3.5-4 l / dag = polydipsie
○ minstens 800 ml om afvalstoffen kwijt te geraken
● steriel, geel, helder, reukloos
Hoge tractus
ureter
● lopen op m. psoas en over grote iliacale bloedvaten
● lengte: 25-30 cm
● diameter: 1-3 mm
● komen langs achter in de blaas thv trigonium: ureterovesicale overgang
● antirefluxmechanisme: natuurlijk klepsysteem om terugvloei naar de nier te
voorkomen
○ passief: schuine uitmonding in blaas, zodat er een langer deel in de
spierlaag verloopt
■ hoe schuiner de inmonding, hoe langer dit stuk, hoe meer de
ureter wordt dichtgeduwd bij een volle blaas
■ als de blaas vult gaat de wand uitrekken, waardoor de ureter toeklapt door
toegenomen druk → geen reflux van urine door intramurale druk
○ actief: peristaltiek van prevesicale deel van de ureters
○ ↔ ectopische ureter: ureter mondt uit op afwijkende plaats, dus meer kans op
uretherovesicale reflux
5
, ● histologie
○ bekleding: urotheel = overgangsepitheel = meerlagig transitioneel epitheel met paraplucellen
○ spierlagen
■ extern circulair: ritmische contracties
■ intern longitudinaal: urine in druppels voortgeleiden
● continu proces: meer drinken → hogere snelheid
en grotere druppels
○ bindweefsel
transport door hoge urinewegen
● onderbroken peristaltiek
○ wanden van kelken duwen het lumen dicht
○ kelk samentrekkingen: 10-12 / min
○ nierbekken samentrekkingen: 4-6 / min
● bolus golf: 2-6 cm / min
○ boven bolus wordt ureter afgeplat
drukopbouw in hoge urinewegen
● druk wijzigt minder bij lage diurese
● hoge diurese (4-7 ml/min): druk neemt toe
○ ↑ aantal samentrekkingen
○ ↑ kracht van contracties
○ ↑ volume bolus
○ max. 5-10 ml/min
● atypische spiervezels = pacemaker
Blaas
● ligging: preperitoneaal (retro)
● inhoud: 350-650 ml
● wand: 1-2 mm dik
● urachus = fibreus overblijfsel van verbinding tussen blaas en navelstreng naar placenta
● blaashals = inwendige sfincter
6
