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September lectures yr 3 (2018) > An introduction to urology > Flashcards

An introduction to urology Flashcards

1
Q

What are some of the key characteristics of the uro-epithelium?

A

3-5 layers thick
Impervious to urine - beneficial because otherwise we would suffer ammonia toxicity
From the calyx to tip of penis

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2
Q

What factors increase the risk of developing a UTI?

A

stagnation, reflux and contamination

- urine is sterile and therefore shouldn’t get infections

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3
Q

What is the normal flow rate of urine production?

A

20ml/min

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4
Q

What are the 7 steps involved in urology diagnoses?

A 
History 
Physical exam
Basic investigations 
Specialist investigations 
Imaging 
Endoscopy
Biopsy
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5
Q

What are the lower urinary tract symptoms (irritative/storage)?

A

Day frequency - up to 7 times - filter 2L of urine a day and void 300ml each time
Night frequency
Urgency
Incontinence - urge, stress, overflow, anatomical

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6
Q

What are the lower urinary tract symptoms (obstructive/voiding)?

A

Hesitancy
Poor stream
Terminal dribbling
Post micturition dribbling

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7
Q

What are the basic principles of the micturition cycle?

A

During bladder filling the detrusor muscles are relaxed, however once the bladder contracts and the sphincter relaxes urine is voided
- both autonomic and voluntary nerves innervate the sphincters

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8
Q

What are the essential investigations and the optional ones when assessing LUTS?

A

Essential

  • symptom score
  • MSU
  • PSA - normal =50
  • bladder scan
  • flow rate
  • freq/vol chart - small amounts means the pathology is in the bladder, whereas large amounts more frequently is indicative of diabetes insipidus, cardiac failure

Optional

  • plain X-ray KUB
  • USS renal tract / CT
  • urodynamics
  • cystoscopy
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9
Q

What are the normal flow rates?

A

> 15ml/sec= normal
10-15ml/sec = equivocal
<10ml/sec = obstructed
Max and mean flow rates decrease with age
Flow rates between 10-15 may be normal for people over 70 years

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10
Q

What are the differential diagnoses for voiding dysfunction ?

A 
Overactive bladder 
bladder outlet obstruction 
UTI 
bladder cancer 
prostate cancer 
gynaecological problem 
bladder stones
fistula
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11
Q

What are the complications of not treating benign prostatic hyperplasia?

A

lead to bladder stagnation and bladder stones which can lead to diverticula formation and renal failure

Every man >40 will have signs of BPH but only about 30% will require symptomatic relief

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12
Q

What is the management plant for LUTS?

A

Conservative= fluid levels advised
Medical therapy - alpha blocker, 5 alpha reductase inhibitor (acts on the size of the prostate gland), anticholinergics
Surgical - Transurethral resection of the prostate, laser prostatectomy, open prostatectomy

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13
Q

What are the different types of incontinence?

A

Overflow: Urethral blockage, bladder unable to empty properly
Stress: relaxed pelvic floor, increased abdominal pressure - common in females because the urethra extends below the sphincter therefore cough causes incontinence
Urge: bladder oversensitivity from infection, neurological disorder

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14
Q

What are the causes of urinary incontinence?

A

1) genuine stress incontinence: congenital weakness of the bladder neck, denervation of sphincter mechanism of pelvic floor (during labour), oestrogen deficiency in menopause
2) detrusor instability
3) retention with overflow incontinence
4) urogenital fistula
5) temporary - UTI, drugs alpha blockers
6) Urethral diverticulum

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15
Q

What is cystometry?

A

put a catheter into the bladder and a measuring line in the rectum to measure the pressure and then fill the bladder up to determine voiding pressure

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16
Q

How do you manage urinary incontinence?

A

conservative - fluid levels advised
urethral catheter for overflow incontinence
anti-cholinergic for urge incontinence
surgical for significant stress incontinence- bulking agents, tapes, mesh, artifical urinary sphincter, or correction of anatomical cause

17
Q

What are the different types of haematuria?

A

visual

Non-visual: symptomatic or asymptomatic

18
Q

What investigations are carried out for haematuria?

A

FBC / U&Es, MSU = essential
Endoscopy = essential if you suspect a tumour
Imaging - CT urogram is the most important, US, Retrograde pylogram, MRI
Rarely biopsy

19
Q

What are the different classifications of bladder cancer?

A

pTa - G1-4

  • G1-2= LOW RISK<3CM
  • G3-4 = high risk and will become muscle invasive if not treated

pT1 - G1-4

  • G1-2 = medium risk
  • G3-4 = high risk

pT2, pT3 and pT4 are all muscle invasive

  • 2 = superficial muscle
  • 3 = deep muscle
  • 4 = surrounding are
20
Q

What are the outcomes for bladder cancer?

A

superficial

  • 70% remain superficial and have excellent outcome
  • 30% can become invasive and their outcome depends on treatment offered

Invasive

  • surgery at 6-% 5 yr survival
  • radiotherapy at 40% 5 yr survival
21
Q

How is renal cancer often diagnosed and what are the different types?

A

Often an incidental finding on US or CT scans as it doesn’t necessarily present with haematuria

Tumour types:

  • renal parenchyma (renal cell carcinoma = most common)
  • collecting system (ICC)
  • other rare types
22
Q

What are the important things to consider when there is a renal mass?

A 
is the mass solid or cystic 
- if solid = tumour 
- if cystic need to define whether its simple or complex 
is renal function normal 
is the other kidney normal
is there metastatic disease
23
Q

What is PSA and when is it raised?

A

Prostate specific antigen
-protease enzyme secreted in the seminal fluid
Raised in the blood if:
- enlarged prostate
- prostatitis
- Ca prostate
However all these conditions can have normal PSA

24
Q

What are the normal levels of PSA and if its raised what are the risks of cancer?

A

0-2 ng/ml -1% probability of cancer
2-4 ng/ml - 15% probability of cancer
4-10ng/ml - 25% probability of cancer
>10ng/ml ->50% probability of cancer

25
Q

What are the age specific ranges for PSA?

A

40-49 year olds = 2.5
50-59 year olds = 3.5
60-69 year olds = 4.5
70 and > = 6.5

26
Q

Where do most prostate cancers occur?

A

in the outer most layer, the inner most layer is usually benign

27
Q

What are some of the key symptoms of prostate cancer?

A

sometimes asymptomatic but may have raised PSA / abnormal DRE
lower urinary tract symptoms
backache

On autopsy 80% of men have prostate cancer but didn’t died

28
Q

How can prostate cancer be diagnosed and what techniques can help to stage it?

A

Diagnosis: PSA levels, TRUS (transrectal ultrasound) biopsy, TURP

Staging: DRE, bone scan, CT/MRI

Gleeson scoring = 5 grades

  • 1 = well differentiated (hyperchromatic nuclei, no loss of polarity)
  • 2-4 = moderately differentiated
  • 5 = poorly differentiated

Relevant stages: localised, locally advanced, metastatic

29
Q

If the prostate cancer is localised what is the management plan?

A

Watchful/waiting
Radical prostectomy
DXT - deep x-ray

30
Q

If the prostate cancer is locally advanced what is the management plan?

A

hormone therapy treatment

31
Q

If the prostate cancer is metastatic what is the management plan?

A

hormonal manipulation= increases lifespan by about 42 months
hormonal escapedDs
palliative

32
Q

What are the differences between acute and chronic urine retention

A

Acute - painful, usually vol <1000ml, relief on catheterisation

Chronic - usually painless, vol >1000ml, 2 types: low pressure and high pressure (backpressure effects on the kidney

33
Q

What is the management plan for urine retention?

A 
check bloods before catheterisation 
Type and size of catheter 
record residual vol of urine 
if its chronic renal failure need to closely monitor urinary output 
plan twoc or definitive surgery

September lectures yr 3 (2018) (56 decks)

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