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MRCS A - Dr Bishoy > 26- Urology Explaains > Flashcards

26- Urology Explaains Flashcards

1
Q

What is the prevalence of BPH in men over the age of 60?

A

BPH is present in 50% of men over the age of 60.

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2
Q

What is the prevalence of BPH in men by the age of 90?

A

BPH is present in nearly 90% of men by the age of 90.

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3
Q

Where does BPH occur in the prostate?

A

BPH occurs as a result of hyperplasia of the periurethral glands in the transitional zone of the prostate.

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4
Q

What are the two main groups of lower urinary tract symptoms (LUTS) associated with BPH?

A

The two main groups of LUTS associated with BPH are obstructive symptoms (hesitancy, poor stream, straining, etc.) and irritation symptoms (pain during bladder filling, frequency, urgency, etc.).

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4
Q

What role do androgens play in the development and progression of BPH?

A

Androgens play a role in the development and progression of BPH. Testosterone diffuses into prostatic and stromal cells and binds to the androgen receptor, leading to stimulation and proliferation.

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5
Q

What is the end result of the proliferative activity in BPH?

A

The proliferative activity in BPH results in varying degrees of obstruction and lower urinary tract obstructive symptoms.

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6
Q

What are the components of the clinical diagnosis of BPH?

A

The clinical diagnosis of BPH includes a degree of lower urinary tract symptoms, palpable prostatic enlargement, and evidence of impaired voiding on urodynamic assessment.

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7
Q

How do alpha adrenergic antagonists work in the management of BPH?

A

Alpha adrenergic antagonists block the action of noradrenaline on prostatic smooth muscle, causing relaxation and improved bladder emptying.

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8
Q

What are the conservative management options for BPH?

A

Conservative management options for BPH include alpha adrenergic antagonists and 5 alpha reductase inhibitors.

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9
Q

How do 5 alpha reductase inhibitors work in the management of BPH?

A

5 alpha reductase inhibitors, like Finasteride, inhibit the conversion of testosterone to dihydroxytestosterone (DHT), reducing intracellular activity and decreasing prostatic volume.

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10
Q

What is the gold standard surgical treatment for BPH?

A

Transurethral resection of the prostate (TURP) is the gold standard surgical treatment for BPH. In some cases, an open retropubic prostatectomy may be considered for a large gland.

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11
Q

What is the failure rate of vasectomy?

A

1 in 2000

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12
Q

What type of anesthesia is typically used during a vasectomy?

A

Local anesthesia

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13
Q

What are the success rates of vasectomy reversal if performed within 10 years of the procedure?

A

Approximately 55%

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14
Q

How is the vasectomy procedure typically performed?

A

Small bilateral incisions and formal dissection of the vas

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15
Q

What is the “no scalpel” technique for vasectomy?

A

A technique involving the use of haemostats for skin puncture

16
Q

Is it necessary to send the vas for histology after a vasectomy?

A

No, it is not necessary to routinely send the vas for histology

17
Q

Who should be cautious about undergoing a vasectomy?

A

Childless, single men under the age of 30

17
Q

What are the risks associated with vasectomy?

A

Chronic scrotal pain (reported by 12-52% of men), haematomas, and sperm granulomas

18
Q

When should clearance for contraception be granted after a vasectomy?

A

After a negative sperm sample is available, usually taken 12-16 weeks post-procedure

18
Q

Under what conditions may “special clearance” to stop contraception be given after a vasectomy?

A

When less than 10,000 non-motile sperm/mL are found in a fresh specimen examined at least 7 months after vasectomy

19
Q

Do the risks of sexually transmitted infections (STIs) change after a vasectomy?

A

No, the risks of STIs remain unchanged

20
Q

What are penile fractures?

A

Rare urological traumas involving the penile shaft, often involving the urethra

21
Q

What is the typical history given by patients with penile fractures?

A

A snapping sensation followed by immediate pain, usually during vigorous intercourse

22
Q

What are the signs of penile fracture upon examination?

A

Tense hematoma and blood at the meatus if the urethra is injured

23
Q

What is the recommended management for penile fractures?

A

Surgical intervention

23
Q

What is the surgical approach for penile fractures?

A

A circumferential incision made immediately inferior to the glans

24
Q

What is done during the surgical procedure for penile fractures?

A

The skin and superficial tissues are stripped back, and the penile shaft is inspected

25
Q

How are penile injuries typically treated during surgery?

A

They are sutured, and if the urethra is involved, it is repaired over a catheter

26
Q

What type of genetic condition is tuberous sclerosis (TS)?

A

Autosomal dominant inheritance

27
Q

What are the cutaneous features commonly seen in TS?

A

Depigmented ‘ash-leaf’ spots (fluoresce under UV light), roughened patches of skin over the lumbar spine (Shagreen patches), adenoma sebaceum (butterfly distribution over the nose), fibromata beneath nails (subungual fibromata), and café-au-lait spots

27
Q

What are the neurological features associated with TS?

A

Developmental delay, epilepsy (infantile spasms or partial seizures), and intellectual impairment

27
Q

What are some other features of TS?

A

Retinal hamartomas (dense white areas on the retina, known as phakomata), rhabdomyomas of the heart, gliomatous changes in brain lesions, and polycystic kidneys with renal angiomyolipomata

28
Q

What is schistosomiasis?

A

A parasitic flatworm infection

29
Q

What are the recognized types of schistosomiasis?

A

Schistosoma mansoni and Schistosoma intercalatum (intestinal schistosomiasis) and Schistosoma haematobium (urinary schistosomiasis)

29
Q

What are the features of Schistosoma haematobium infection?

A

‘Swimmer’s itch’ in patients recently returned from Africa, risk factor for squamous cell bladder cancer, haematuria (blood in urine), and bladder calcification

30
Q

What is the management for schistosomiasis?

A

A single oral dose of praziquantel

MRCS A - Dr Bishoy (58 decks)

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