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Urology / Men's Health > Conditions > Flashcards

Conditions Flashcards

1
Q

Voiding (obstructive) symptoms

A

Hesitancy
Weak stream
Postmicturition dribble
Incomplete emptying
Straining

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2
Q

Storage (irritative) sx

A

Urgency
Urge incontinence
Frequency
Nocturia
Suprapubic pain

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3
Q

History taking for BPH

A

IPSS to evaluate severity and effect on qol
Voiding sx
Storage sx
Bladder diary
Fluid intake
FHx BPH

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4
Q

Physical exam of BPH

A

PR; size, symmetry, nodules, tenderness, constipation
Penis; phimosis, meatal stenosis, balanitis
Neuro; anal tone, sensation, lower limb neuro

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5
Q

BPH Ix

A

Urinalysis; exclude haematuria, proteinuria, infection
Renal function
USS; if mod-severe sx, abnormal renal function, retention

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6
Q

Causes of elevated PSA

A

Cancer
BPH
Exercise
Sex
Prostatitis
PR exam
Recent IDC

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7
Q

PSA screening

A

Not routine
Consider 2 yearly from 50-69yo if family hx
if doubles in 12mo - suspicious for cancer

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8
Q

Mx BPH

A

Cease caffeine/alcohol
Cease acidic/spicy foods
Tx constipation
Reduce nocte fluid intake
Bladder training + pelvic floor exercises
Moderate-severe BPH
- Alpha blockers, 5 alpha reductase inhibitors
Monitor; annual urinalysis + renal function

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9
Q

Alpha antagonists for BPH

A

1st line monotherapy
Prazosin (0.5mg BD) / tamsulosin
ADR; hypotension, retrograde ejaculation, erectile dysfunction

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10
Q

5-alpha-reductase inhibitors

A

Dutasteride / finasteride
Good if prostate vol >4ml / 30cc
ADR; gyno, ED, reduced sperm count, infertility

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11
Q

Indications for urology referral for BPH

A

Urinary retention
Hydronephrosis
Refractory to medical mx
Recurrent UTI
Gross haematuria
Renal insufficiency

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12
Q

Risk factors prostate cancer

A

FHx
African-American
BRCA
Fhx breast-ovarian Ca syndrome
Lynch syndrome

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13
Q

Acute bacterial prostatitis mx

A

Trimethoprim 300mg 2/52
OR keflex 500mg QID 2/52

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14
Q

Chronic bacterial prostatitis mx

A

Ciprofloxacin 500mg BD 4/52

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15
Q

Hydrocoele mx

A

Neonate; monitor until 12/12 - if not resolve by then OR very large at any stage - refer surg
Child; resolve by 2 years - outpatient referral is ongoing after 2 years

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16
Q

Risk factors of Peyronie’s disease

A

DM
Obesity
HTN
HLIPID
Smoking
Pelvic surgery
Dupuytren’s disease

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17
Q

Cause of priapism

A

Idiopathic
Sickle cell
Spinal shock
Penile trauma
Viagra, antiHTN, antidepressants
Gouts
DM

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18
Q

Priapism mx

A

Cold shower
Pseudoephedrine 120mg
Gentle job
Urgent urology input
- Corporal aspiration
- Intracavernous injection phenylephrine

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19
Q

Causes of LUTs

A

UTI
BPH/Prostate Ca/Prostatitis
Urethral stricture
Phimosis
OAB
Parkinson’s disease/MS/CVA
OSA (nocturnal polyuria)

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20
Q

Hx for LUTs

A

Storage sx
Voiding sx
Post-micturition sx
Haematuria
Polyuria/polydipsia
Weight loss
Smoking (risk bladder Ca)
Fhx prostate Ca
caffeine/ETOH
Volume fluid intake

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21
Q

Causes of haematuria

A

Postinfectious GN
IgA nephropathy
PCKD
Stones
Malignancy
Rigorous exercise
Coagulopathy
Sickle cell

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22
Q

Microscopic Haematuria work up

A

Dipstick - 1+ is significant (trace isn’t)
do UMCS to rule out infection
If proteinuria / reduced eGFr -> consider glomerulonephritis - do USS and refer nephrologist
If nil proteinuria/reduced GFR and have malignancy risk factors -> urine cytology x3, USS, refer to urologist for cystoscopy

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23
Q

Risk factors of urological malignancy

A

Male
>40yo
Hx macroscopic haematuria
Smoking
Pelvic irritation
Exposure to occupational chemical dyes or cyclophosphamide

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24
Q

Overactive bladder sx

A

Urgency
Frequency
Nocturia
Urge incontinence

25
Q

Causes OAB

A

Neuro; stroke, MS, diabetic neuropathy
Urothelial carcinoma
Recurrent UTI
BPH
Urethral stricture
Overflow incontinence
OSA
CHF
Diabetes
Diuretics

26
Q

Work up of OAB

A

Urinalysis; exclude infection, blood, glucose
USS and post-residual vol
Bladder diary 3 days
Consider; cytology, urodynamics, cystoscopy etc

27
Q

Mx OAB

A

Reduce fluid intake 6-8 glasses per day
Constipation
Incontinence pads
Topical oestrogen in females
1st line; Bladder retraining/pelvic floor
2nd line; oxybutynin 5mg TDS, mirabegron 25mg daily (beta-3 agonist)
3rd; intravesical botox
4th; bladder augmentation, urinary diversion

28
Q

Nocturia mx

A

Reduce fluid intake
Low Na diet
Lasix 6hr prior to bed
Desmopressin

29
Q

Complications of catheter

A

CAUTI
Catheter obstruction; clots, crystals, biofilms
Catheter bypass (urine bypassing catheter) - due to small IDC size, underflated balloon, constipation, bladder spasms

30
Q

Workup of suspected renal colic

A

Urine dipstick + MCS
bHCG
FBC/CRP/U+E/calcium/uric acid
24hr urine collection volume, calcium, oxalate, uric acid
Stone analysis
CT KUB - gold standard (do with XR KUB)
- if single kidney or renal failure - urgent imaging

31
Q

Renal colic indications for admission

A

Diabetes
eGFR <30
Intractable pain/nausea
Single kidney
Bilateral ureteric obstruction
UTI/sepsis
Anuric renal failure

32
Q

Renal colic

A

Conservative if <=7mm stone
- Panadol
- NSAID 1st line; celecoxib 200mg single dose
- Other; Indomethacin 50mg TDS PRN
Medical expulsive therapy (MET)
- Tamsulosin 400mcg daily

33
Q

Prevention of renal stones

A

Increase fluid intake to ensure 2L UO / day
Increase K+; nuts, beans
Reduce salt/protein intake
Normal calcium intake
Thiazides can reduce Ca excretion

34
Q

Patient instructions for renal colic

A

Safety net red flag; fever, intolerable pain
Strain urine and catch stone - bring in for analysis
Repeat scan 4/52 if not passed stone -> refer urologist if present

35
Q

Causes of testicular lump

A

Cancer
Torsion
Orchitis
Hydrocoele
Varicocoele
Spermatocoele
Epididymal cyst
Epididymitis

36
Q

Varicocele mx

A

Conservative
<=21yo; if assoc atrophy and decreased sperm quality then do surgical ligation
If normal sperm - monitor semen analysis every 2 years

37
Q

Orchitis/epididymitis Ix

A

MSU MCS
Urethral swab or FPU chlam/gonorrhoea if sexually active in last 6/12
Consider USS if suspect tumour, torsion etc

38
Q

Orchitis / epididymitis mx

A

Sexually active tx for chlam + gon (ceftriaxone + doxy)
Not sexually active tx for acute cystitis/acute prostatitis (trimethoprim 300mg 2/52)
No sex 7/7 after tx
No sex w/ partners from last 6/12
Bed rest
Scrotal support
Analgesia
F/u 5/7; tx response, Abx sens, sexual education

39
Q

Risk factors testicular cancer

A

Fhx
Cryptorchidism
Previous tumour
Down syndrome

40
Q

Testicular ca work up

A

USS
BHCG, AFP, LDH

41
Q

Mx testicular ca

A

Discuss sperm banking
Discuss prosthesis
Secondary prevention
- weight, diet exercise
- continued self examination

42
Q

Undescended testes mx

A

Unilateral
- Routine paed surg referral
- Elective repair at 6/12 age
- if impalpable - lap exam + staged procedure
Bilateral
- Palpable; if normal genitalia - routine surg referral. If abnormal genitalia - urgent paed surg referral
- Impalpable; urgent referral

43
Q

Retractile testis mx

A

Annual review to make sure still can be manipulated
If >6yo and retractile or cannot be longer manipulated - urgent referral to surg

44
Q

Risk factors ED

A

Atherosclerosis; CVD, DM, lipid, HTN, smoking
Neuro; stroke, dementia, parkinsons, DM
Pelvic surgery
Endocrine; thyroid, hypogonadism, HPRL
Obesity
Peyronie’s disease
Stress/relationship issues/depression
Medication; diuretics, beta-blockers, SSRI
Alcohol, cocaine
OSA

45
Q

ED evaluation

A

CVD risk; if high risk stop all sexual activity and refer cardiologist
- High risk; ACS in last 2/52, high risk arrhythmias, severe AS, NYHA IV
BMI
BP
Testes Size
Penile exam
Ix
- Lipid, HbA1c
- Serum testosterone
- Sleep study

46
Q

ED mx

A

Smoking/ETOH cessation
Exercise
Weight loss
Healthy diet
Sildenafil 25-100mg
Urologist
- Intracaversonal injection
- Vacuum erection device
Psychosexual therapy; masturbation retraining, glans stimulation with vibrator, condom with hole in tip

47
Q

Phosphodiesterase type 5 inhibitor for ED

A

Contra; nitrates, MI/CVA in last 6/12, HTN >170/100, unstable angina
ADR; headache, flushing, priapism
Instruction
- empty stomach
- wait 45min prior to sex
- Engage in stimulation prior to sex
- Allow 6-7 attempts with medication for full effect
- Trial on self with masturbation

48
Q

Mx premature ejaculation

A

IELT <1min (primary) or <3min (acquired)
Sexology referral for techniques to control ejaculation, reduce anxiety
Reduce sensitivity; thick condoms, topical EMLA 20min prior to interoucrse
Behaviour
- stop-start, squeeze technique, extended foreplay, cognitive distractions,
Psychosexual
- meditation, relaxation
SSRI
- Dapoxetine
- can combined with viagra

49
Q

Causes of haematospermia

A

Infection; STD
Iatrogenic; prostate biopsy/tx, vasectomy
Cancer; prostate/testis/bladder/urethral
Prolonged intercourse
Prolonged abstinence
HTN
Leukaemia/lymphoma
Coagulopathy
Idiopathic

50
Q

Initial workup of haematospermia

A

UMCS
urine cytology
FBC
Coagulation
+/- STI screen
PSA if >40yo, abnormal DRE or prostate Ca risk factors
Urine and semen AFB/parasites

51
Q

Causes of male infertility

A

HPRL
Hypogonadotrophic hypogonadism
Varicocoele
Radiation
Klinefelter syndrome
Anti-sperm Ab
Retrograde ejaculation

52
Q

Male infertility Ix

A

Serum FSH + morning testosterone
- Low test -> repeat with free test, SHBG, albumin, LH, PRL
Semen analysis; 2-3 abstinence, analysed within 1hr, always repeat abnormal result after 1/12
anti-sperm Abs
Karyotype if severe oligospermia
Scrotal USS; if risk factor for cancer
Post-ejaculatory urine analysis - exclude retrograde

53
Q

General measures for male infertility

A

Cease smoking/alcohol
Weight loss
Reduce scrotal temperature
Avoid drugs
Avoid exposure to vibration/pesticides
Optimal intercourse timing

54
Q

Clinical features Klinefelter

A

Small testis <4ml and firm palpation
Osteoporosis
Gyno
Tall
Reduce facial/body hair

55
Q

Klinefelter long term complications

A

CVD
COPD
osteoporosis
Parkinson-like syndrome
Breast Ca x50 risk
Non-Hodgkin lymphoma
Hashimoto’s
T1DM

56
Q

Klinefelter dx

A

2x morning fasting test low
Raised LH/FSH
Consider
- BMD
- Semen analysis

57
Q

Klinefelter tx

A

Lifelong TRT from mid-puberty
Education risk of osteoporosis/IHD/breast Ca
Discuss fertility +/- IVF

58
Q

Functional hypogonadism

A

Cause; age, overweight, chronic disease
Sx; fatigue, hot flushes, low libido, ED
Serum test - modest reduction 6-10nmol/L
Tx
- 10% weight loss
- Tx depression/OSA
- Remove opioids/steroids

59
Q

Vasectomy patient counselling

A

Ask if tried other contraception
Make sure they know its permanent
Determine whether relationship stable
Ask about future family intent
Not 100% reliable in preventing pregnancy - 1/2000 risk
Need for condoms for STI prevention
Risk; haematoma, infection, pain
Avoid sex for 1 week post-op
Need 3/12 interim contraception and 20 ejaculations with semen analysis prior to being declared sterile

Urology / Men's Health (1 decks)

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