Genitourinal Flashcards
LUTS
Lower urinary tract symptoms
Why males have a stronger bladder neck mechanism than females
Strong bladder neck mechanism in order to prevent reflux of ejaculate into the bladder
LUTS - Types
Storage
Voiding
Post-micturition
LUTS - Storage
Frequency
Urgency
Nocturia
Incontinence
LUTS - Voiding
Slow stream Spitting/spraying Intermittency Hesitancy Straining Terminal dribble
LUTS - Post-micturition
Post-micturition dribble
Feeling of incomplete emptying
Bladder diary
For LUTS patients
Incontinence
Involuntary loss of urine - failure of storage
Urgency incontinence - urgent desire to void which is difficult to defer
Stress incontinence - coughing/straining
Mixed incontinence - stress and urgency
Continuous incontinence- fistula
Overflow incontinence - full bladder
Social incontinence - dementia
Urgency incontinence
OAB - Overactive bladder (urgency with frequency, with or without nocturia, wet or dry)
Urodynamics
Diagnostic - Detrusor overactivity on OAB
OAB - Management
Behavioural - Frequency volume chart, caffeine, alcohol Anti-muscarinics - M2/3 blockers B3 agonists Botox - Potent toxin Surgery - cystoplasty
Stress incontinence
F>M
Females management - Pelvic floor physio, duloxetine, surgery (artificial sphincter)
Male management - Surgery (artificial sphincter)
Voiding problems - Obstructive
BPE - Treat with alpha blockers, phosphodiesterase 5 inhibitor (viagra), last resort is TURP (surgery)
Urethral stricture
Prolapse/mass
Voiding problems - Non-obstructive
Treat with catheter
Spastic spinal cord injury
Supra-conal lesion Lost coordination lost completion of voiding Reflex bladder contractions Detrusor sphincter dyssynergia Diagnostic - urodynamics - raised pressures
Flaccid spinal cord injury
Conus lesion Lost bladder contraction Lost guarding reflex Lost receptive relaxation Areflexic bladder Stress incontinence
Neurogenic bladder - Management
Artificial sphincter
Autonomic dysreflexia
Occurs lesions above T6 Overstimulation of sympathetic NS below level of lesion in response to a noxious stimulus Headache Severe hptn Flushing Management - Catheter drainage
Convene drainage
No indwelling catheter
Basically a condom connected to a bag which drains urine
Suprapubic catheter
Goes through abdo instead of urethra
Bladder problems in MS
OAB syndrome
Prostate cancer - Risks
Increasing age
Family history - 1st-degree relatives
Ethnicity - Afro-carib raised risk, uncommon in far east
Prostate cancer
Histology - majority are adenocarcinoma in peripheral zone
Gleason grading system is diagnostic following DRE
Routes of spread
Haematogenous - spread to bone, lung, lung, liber and kidneys
Lymphatics
Local tissues
Prostate cancer staging
T1-T4 (spread of tumour)
N1 (mets in regional lymph nodes)
M1a,b,c (non-regional lymph nodes, bones, others)
Cancer - General symptoms
Wt loss
Fatigue
Night sweats
Loss of appetite
Prostate cancer - symptoms
Wt loss
Fatigue
Urinary (Voiding and storage) - slow stream, poor stream, frequent, terminal dribbling
Bone pain (indicative of advanced prostate cancer)
Prostate cancer - Examination
DRE - Nodule, asymmetry, the difference in texture, bogginess
Overdistended bladder
Prostate cancer - Investigations - PSA
PSA (Prostate surface antigen)
Glycoprotein produced only by prostate cells which is specific to the prostate but not to prostate cancer
High sensitivity but low specificity
Elevated level suggests prostate cancer
Prostate cancer - Investigations - MRI
MRI prostate
Prior to biopsy
Can identify lesions to target with biopsy
Aids in local staging
Prostate cancer - Investigations - Biopsy
Indicated by a palpably suspicious DRE regardless of PSA
Suspicious lesion on MRI
TRUS or transperineal
Gleason grading on results of biopsy
Prostate cancer - Investigations - Stagibg imaging
Bone scan (bone mets) CT abdo Look for lymph nodes (obturator region) and mets
Prostate cancer - Treatment
Active surveillance
Radical prostatectomy (curative surgery)
Radiotherapy
Complications of surgery/radio - Urinary incontinence
Hormone therapy - Orchiectomy (surgical removal of both testicles - the main source of testosterone) LHRH agonists - Goserelin, antiandrogens - Flutamide
Chemo - Docetaxel
Bisphosphonates
Prostate cancer
Androgen sensitive
Prostate cancer - Prognosis
Hormone resistance + mets = bad prognosis
Renal cancer - RFs
Smoking Environment - petroleum Occupational - Asbestos Hormonal - obesity Genetic - VHL, BHD
Renal cancer - Presentation
Triad - Mass, haematuria, pain
Mets symptoms if present
Varicocele (rare)
Renal cancer - Bosniak classification
1-4 2F - Septation 4 - Malignant Simple renal cyst- US Complex - CT
Renal cancer - Spread
Local Nodal Renal vein Organs (Local, regional, distant - Host organ, lymph, distant organ(s) )
Renal cell cancer - Genetic causes
VHL - Chromosome 3 mutation
TSC
BHD
Commonest renal cancer
Clear cell RCC
Renal cancer - Treatment
Surveillance Radical nephrectomy Partial nephrectomy Radiofrequency ablation TKIs
Bladder cancer - RFs
M>F Age increasing Occupation (industry) - dyes, rubber, aromatic amines Schistosomiasis endemic areas Smoking Long term catheterisation
Bladder cancer - Presentation
Painless haematuria (painless due to no stimulus for pain) Flank pain Lower limb oedema Pelvic mass Wt loss Bone pain
Bladder cancer - Staging indications
T2 = muscle-invasive
Bladder cancer - Histology
Transitional cell carcinoma
Bladder cancer - Investigations
CT bladder
Cystoscopy
Bladder cancer - Treatment
TURBT Chemo Cystectomy Radio Palliative
Testicular cancer
Adolescence
One of the most curable cancers
RFs - HIV, genetics (1st deg rel)
Testicular cancer - Pathology
Germ cell tumours divided into seminomatous and non-seminomatous
Testicular cancer - Presentation
Scrotal lump
Painless
mets symptoms if present
CNS symptoms
Testicular cancer - Differential diagnosis
Hydrocele Epidydimal cyst Varicocele Tetsicular torsion Indirect inguinal hernia
Testicular cancer - Investigations
US testes
CT brain
Tumour markers (raised) - AFP, HCG, LDH
Testicular cancer - Treatment
Radical inguinal orchidectomy
Radio
Chemo
Stones locations
Anywhere from collecting duct to the external urethral meatus
Idiopathic kidney stone - Causes
Dehydrated, so concentrated urine consisting of calcium, oxalate, urate, cystine
Infection
Calcium oxalate is most common stone
Mechanism of stone formation
Stones form from crystals in supersaturated urine especially when it becomes static
Stones - Prevention
Overhydration Low salt diet Reduce BMI Active lifestyle Normal dairy intake Moderate protein intake
Uric acid stones
Only form in acid urine
Kidney stones - Symptoms
Tend to be asymptomatic Loin pain/kidney pain Haematuria Urgency Frequency Recurrent UTIs N/V
Pain history
SOCRATES Site - Loin, unilateral Onset - Rapid Radiation - Loin to groin etc
Loin pain - Differential diagnosis
Ruptured AAA
Bowel path - diverticulitis, appendicitis
Gynae - ovarian cyst, ectopic preg
Testicular torsion
Kidney stones - Investigation
KUBXR (Kidney, ureter, bladder XR)
NCCT-KUB (CT) = Gold standard
Hydronephrosis - inflammatory renal dilation on imaging
USS - For preg/younger patients
Kidney stones - Management
NSAID Opiates IV fluids Surgical Lithotripsy - shock wave breaks up stones Ureteroscope - ureter stone Endoscope - bladder stone Laser
Pyonephrosis
Combination of infection and obstruction
Basically hydronephrosis where water is replaced with pus
Systemic sepsis leads to septic shock
Treatment - Drainage (nephrostomy) - ureteric stents help dilate ureter
Urosepsis - Consequences
20 digit gangrene
Sepsis 6
ABCDE
Abx
Resus
