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Year 3 - Surgery > 5.01 Urology - Presentations > Flashcards

5.01 Urology - Presentations Flashcards

1
Q

What is haematuria and how can it be classified?

A

The presence of blood in the urine.

Either visible (seen by the naked eye) or non-visible (confirmed by urine dipstick or urine microscopy).

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2
Q

Give some possible causes of haematuria?

A
  • urinary tract infection
  • renal cancer
  • bladder cancer
  • renal calculi
  • prostate cancer
  • benign prostatic hyperplasia
  • glumerulonephritis
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3
Q

What is pseudohaematuria?

A

Red or brown urine that is not due to the presence of blood in the urine.

Causes include medication (e.g. rifampicin), hyperbilirubinaemia, and foods (e.g. beetroot).

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4
Q

How should haematuria be investigated?

A

Urinalysis - presence of nitrates and/or leukocytes indicates infection as potential underlying cause.

Baseline bloods (FBC, U&Es, clotting, PSA).

Abdominal examination and DRE.

Following urological referral, flexible cytoscopy can be used to assess the lower urinary tract. Ultrasound imaging and CT urograms may also be used to image the upper urinary tract.

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5
Q

Give some causes of lower urinary tract symptoms (LUTS).

A
  • BPH
  • UTI
  • bladder cancer
  • prostate cancer
  • detrusor muscle weakness
  • prostatitis
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6
Q

Give the storage LUTS.

A
  • increasing urinary frequency
  • nocturia
  • increased sense of urgency
  • urge incontinence
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7
Q

Give the voiding LUTS.

A
  • hesitancy or straining in mictruition
  • poor flow
  • terminal dribbling
  • feeling of incomplete emptying
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8
Q

Give some clinical features that may be associated with LUTS.

A
  • visible haematuria
  • suprapubic discomfort
  • medication history
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9
Q

What tool can be used to assess and monitor the impact of LUTS on quality of life in men?

A

International Prostate Symptom Score

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10
Q

What general investigations are warranted for a patient presenting with LUTS?

A
  • bladder diary
  • urinalysis and urine culture
  • routine blood tests (including FBC & U&Es; PSA)
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11
Q

What specialist investigations are warranted for a patient presenting with LUTS?

A
  • urodynamics to assess flow rate, detrusor pressure, and storage capacity
  • cystoscopy
  • upper urinary tract imaging (ultrasound, CT)
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12
Q

How are LUTS managed?

A
  • regulate fluid intake
  • urethral milking
  • double voiding
  • pelvic floor exercises
  • bladder training techniques
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13
Q

What is the MOA of anticholinergics in the treatment of LUTS?

A

Relax the bladder by opposing parasympathetic cholinergic control of contraction.

First line in patients with overactive bladder - e.g. oxybutynin

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14
Q

What is the MOA of tamsulosin and finasteride in the treatment of LUTS?

A

Tamsulosin is an alpha blocker;

Finasteride is 5a-reductase inhibitor;

Reduces prostate size by relaxing prostate muscle.

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15
Q

What is acute urinary retention?

A

The new onset inability to pass urine, subsequently leading to pain or discomfort.

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16
Q

What is the most common cause of acute urinary retention?

A
  • BPH

May also be caused by:
- prostate cancer
- UTI (causes urethral sphincter to close)
- constipation (compresses urethra)
- severe pain
- anti-muscarinic medication
- peripheral neuropathy

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17
Q

What are the clinical features of acute urinary retention?

A
  • acute suprapubic pain
  • inability to micturate

OE palpably distended bladder, with suprapubic tenderness. DRE performed to assess for any prostate enlargement or constipation.

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18
Q

How is acute urinary retention investigated?

A
  • post-void bladder scan
  • routine bloods (e.g. FBC, CRP, U&Es)
  • CSU for microscopy
  • USS to assess for hydronephrosis
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19
Q

How is acute urinary retention managed?

A
  • immediate urethral catheterisation
  • treat underlying causes
  • check CSU for evidence of infection

All men with a palpably large prostate and urinary retention can be started on alpha-blocker, then have TWOC.

20
Q

What are the complications of acute urinary retention?

A

Complications rare if identified and treated early.

If left untreated:
- AKI
- CKD
- UTIs
- renal stones

21
Q

What is chronic urinary retention?

A

The painless inability to pass urine.

As patients have long-standing retention, bladder desensitisation occurs meaning there is minimal discomfort despite extensive bladder distension.

22
Q

What is the most common cause of chronic urinary retention in:

a) males

b) females

A

a) BPH; may also be caused by urethral strictures or prostate cancer.

b) pelvic prolapse (e.g. cystocele, rectocele, uterine prolapse); may also be caused by pelvic masses (e.g. uterine fibroids).

Note neurological causes may also cause chronic urinary retention.

23
Q

What are the clinical features of chronic urinary retention?

A
  • painless retention
  • voiding LUTS
  • overflow incontinence
  • nocturnal enuresis (as sphincter tone reduced)

OE palpably distended bladder, with minimal tenderness. Perform DRE in men to assess for prostate enlargement.

24
Q

What investigations are warranted for chronic urinary retention?

A
  • post-void bladder scan
  • routine bloods (e.g. FBC, U&E, CRP)
  • ultrasound scan to assess for hydronephrosis
25
Q

What is high-pressure urinary retention?

A

Urinary retention causing high intra-vesicular pressures, eventually leading to hydronephrosis and impairing the kidneys’ clearance levels.

Patients present with deranged renal function, renal scarring and CKD.

26
Q

How is chronic urinary retention managed?

A
  • catheterise with long-term catheter
  • intermittent self-catheterisation
27
Q

What is the main complication of catheterisation following chronic urinary retention?

A

Post-obstruction diuresis:

Following resolution, kidneys may over-diurese due to loss of medullary concentration. This can worsen AKI.

Patients producing >2000ml/hr urine should have around 50% of their urine output replaced with IV fluids.

28
Q

What are the common complications of chronic urinary retention?

A
  • UTIs
  • bladder calculi
  • CKD
29
Q

What is the major vessel providing arterial supply to the bladder?

A

Internal iliac artery

30
Q

For a patient presenting with scrotal pain, what key points should be explored during history taking?

A
  • onset
  • course
  • duration of pain
  • associated urinary symptoms
  • sexual history
  • history or previous surgery
31
Q

What investigations are warranted for scrotal pain?

A
  • urinary dipstick / urinalysis
  • urethral swab is STI suspected
  • blood tests (FBC, CRP, U&Es)
  • ultrasound of scrotum to identify structural / inflammatory pathology
32
Q

What are the differential diagnoses of scrotal pain?

A
  • testicular torsion
  • epididymitis
  • testicular cancer
  • Henoch-Schoenlein purpura
  • viral orchitis
33
Q

What is viral orchitis?

A

Inflammation of the tests due to viral infection, most commonly mumps.

Commonly presents with bilateral scrotal pain. Management is conservative with analgesia, with self-limiting symptoms.

34
Q

What are the 6 S’s for inspecting a scrotal lump?

A
  1. Site
  2. Size
  3. Shape
  4. Symmetry
  5. Skin changes
  6. Scars
35
Q

What should be commented upon when palpating a scrotal lump?

Hint: TTT CAMPFIRE

A

Tenderness
Temperature
Transillumination

Consistency
Attachments
Mobility
Pulsation
Fluctuation
Irreducibility
Regional lymph nodes
Edge

36
Q

What are the extra-testicular differentials for scrotal lumps?

A
  • hydrocoele
  • varicocoele
  • epididymal cyst
  • epidymitis
  • inguinal hernia
37
Q

What are the testicular differentials for scrotal lumps?

A
  • testicular tumours
  • testicular torsion
  • orchitis
38
Q

What is a hydrocoele?

A

An abnormal collection of peritoneal fluid between the parietal and visceral layers of the tunica vaginalis, commonly allowed by a patent processus vaginalis.

39
Q

Clinical features of a hydrocoele.

A
  • painless fluctuant swelling
  • transilluminates
  • unilateral / bilateral

NB: men aged 20-40yrs with a hydrocoele should undergo an urgent ultrasound scan, as may be secondary to infection or malignancy.

40
Q

What is a varicocoele?

A

The abnormal dilation of the pampiniform venous plexus within the spermatic cord, most commonly found on the left side.

Left spermatic veins drain into left renal vein, increasing resistance, therefore left more likely to dilate.

41
Q

What are the complications of varicocoeles?

A
  • infertility
  • testicular atrophy
42
Q

Clinical features of a varicocoele?

A
  • bag of worms appearance
  • often left sided
  • disappear when lying flat

NB: red flag signs are right sided varicocoeles, which appear suddenly and persist when lying flat. Require urgent investigation.

43
Q

How are varicocoeles treated?

A

If no red flag signs, can be left to resolve spontaneously.

If red flag signs (right sided, acute, persist when lying flat), surgical management using embolisation.

44
Q

What is epididymitis?

A

Inflammation of the epididymis, presenting with unilateral acute onset scrotal pain and associated swelling.

45
Q

What is the commonest cause of epididymitis?

A

Bacterial in origin, commonly STI-related organisms in sexually active younger males or enteric organisms in older males.

46
Q

How are inguinal hernias differentiated from other scrotal lumps?

A

As inguinal hernias are protrusions of the abdominal contents along the processus vaginalis, OE you cannot ‘get above’ an inguinal hernia.

47
Q

What is the commonest cause of orchitis?

A

Inflammation of the testes, commonly of viral cause.

Most commonly caused by mumps virus.

Year 3 - Surgery (30 decks)

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