11. Urology Flashcards

1
Q

What is testicular torsion?

A

Surgical emergency when twisting of spermatic cord causes constriction of vascular supply.
Two types
Intravaginal
Extravaginal - torsion occurs at the level of the external inguinal ring. seen in neonates.

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2
Q

Risk factors for testicular torsion?

A

Age under 25 years

Bell clapper deformity

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3
Q

How does testicular torsion present?

A
Painful
Swollen, hot, tender scrotum
Unilateral
High riding testicle
Absent cremasteric reflex (stroke thigh on right thigh, right testicle lifts and vice versa)
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4
Q

How do we treat testicular torsion?

A

Emergency exploration of scrotum within 6 hours surgically to twisted it back

If surgery unavailable, manual de-torsion

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5
Q

What is epididymitis and orchitis?

A

Inflammation of those structures. Can occurs at same time. Most cases are caused by bacterial infection, chlamydia most common under 35, klebsiella over this age.

Risk factor is unprotected sex, bladder outflow obstruction and UTIs

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6
Q

How do epididymitis or orchitis present?

A
Pain
Swollen, hot, tender scrotum
Unilateral
Less acute than torsion
Dysuria and urgency and penile discharge - symptoms of cause
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7
Q

How do we investigate epididymitis and orchitis?

A

Urine dipstick
Bloods
Colour duplex USS (if unsure)
Surgical exploration if torsion can’t be excluded

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8
Q

How to manage epididymitis and orchitis?

A

Bed rest
Scrotal elevation
Analgesia
Antibiotics

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9
Q

What is a variocele?

A

Dilated veins of the pampiniform plexus forming a scrotal mass.
Caused by increased hydrostatic pressure in left renal vein or incompetent veinous valves.

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10
Q

How do varicoceles present?

A

Asymptomatic
Stand patient up, see “bag of worms” appearance.
Fertility analysis (sperm count)
Retroperitonaeal USS

If anything’s abnormal, surgical repair but normally left alone with obs.

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11
Q

What is a hydrocele?

A

Excessive collection of serous fluid in the tunica vaginalis (so can occur in women)

Communicating - open so peritoneal fluid can flow freely - inflammation, trauma, cancer
Non-communication - closed so more fluid produced is absorbed - increased fluid e.g. ascites

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12
Q

Presentation of hydrocele and investigations?

A

Scrotal swelling
Enlarges with coughing etc.
Transilluminates

Urine dip, USS and bloods to exclude worrying causes. Observation is solution or surgery if bad.

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13
Q

What are the most common testicular cancers?

A

Seminomas - 50%
Non - 30%
Cryptochidism, ectopic testes, test atrophy and FHx are risk factors.

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14
Q

How do testicular cancers present?

A
Painless nodules
Lymphadenopathy
Gynaecomastia
Backache
Hydroceles
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15
Q

How to investigate testicular cancer?

A
FBCs
U&Es
LFTs
Tumour markers - LDH, alpha fetoprotein, beta hcg
Testicular ultrasound, CTAP, CXR

Treat with chemo or removal

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16
Q

Most common UTI?

A

E.coli

17
Q

UTI symptoms?

A

Increased frequency
Urgency
Dysuria (urine smells too)

Red flag for acute pyelo
Flank pain
Fever
Malaise
Acute pyelonephritis
18
Q

What are the three points for urinary tract calculi?

A

Ureteopelvic junction
Pelvic brim
Ureterovesical junction

19
Q

What causes urinary tract calculi?

A

Urinary solutes are highly concentrated which precipitate out of solution. Can be uric acid, calcium, oxalate and sodium.
Can be metabolic, infection, drug causes etc. catheters and stents etc.

20
Q

Risk factors for urinary tract calculi?

A
Dehydration
High protein intake
High salt
Structural abnormalities
Male
30-50
21
Q

How do renal stones present?

A

When they get stuck it can cause acute, severe loin to groin pain called renal colic.
Can cause N&V and are unable to lie still
Urgency, frequency and microscopic haematuria.

22
Q

Renal stone investigations?

A

Urine dipstick (pregnancy in females too as could be ectopic)
FBC
Non-contrast CT-KUB or USS if pregnant.

23
Q

How to manage renal stones?

A

Fluids
Analgesia
Anti-emetics
Urine collection to collect any passed stone (see composition)

<5mm leave to pass with increased urine
<10mm alpha-blocker, tamsulosin, to let pass and after 4-6 week surgery
>10mm (or staghorn) surgical removal - shock wave lithotripsy (ESWL) or percutaneous nephrostolithotomy

24
Q

How does BPH present?

A
LUTS, storage and voiding symptoms.
Presents like prostate cancer - 
Frequency
Urgency
Nocturia
Dysuria
Hesistancy
Incomplete voiding
Poor stream
25
Q

How to investigate BPH?

A
Urinalysis
DRE for cancer (asymmetrical, hard nodular prostate. BPH would be smoothly enlarge with palpable groove)
PSA
U&Es
Transrectal US guided needle biopsy
26
Q

How to manage BPH?

A
Catheterisation if acute
Normally monitor, lifestyle
Alpha blockers
5A-reductase inhibitors
Surgical TURP
27
Q

Bladder cancer types?

A
Urothelial carcinoma (painters and hairdressers at risk)
Squamous cell carcinoma (schissto...)
28
Q

How do bladder cancers present?

A

Irritative/storage symptoms (normally painless)

FLAWS

29
Q

What is cystitis?

A

Inflammation of bladder caused by UTI or non-infectious cause

30
Q

What’s recurrent UTIs?

A

2 or more in last six months

3 or more in a year

31
Q

How do we treat recurrent UTIs?

A

Reccurent ABx possibility but unlikely
Manage acute UTIs
Consider referral for investigation e.g. urine stasis, HIV, structural causes
Discuss behaviour of hygiene e.g. peeing after sex and wiping

32
Q

Complications of UTIs?

A

Pyelonephritis, renal abscess, renal failure, urosepsis

Pre-term delivery or low birth weight of children.