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Genitourinary Flashcards

1
Q

where do kidneys lie on the spine level?

A

t11-l3

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2
Q

what is the blood supply for kidneys?

A

renal artery from aorta at L1

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3
Q

at what junction is the reflux of urine prevented by?

A

vesicoureteric junction

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4
Q

what nerves supply the bladder and sphincter?

A
  • Parasympathetic Nerve (pelvic nerve)
    • S2-S4, ACH
  • Sympathetic Nerves (hypogastric plexus)
    - T11 – L2, norad
  • Somatic Nerve (pudendal nerve)
    S2-S4
  • Afferent pelvic nerve
    - Sensory nerve - signals from detrusor muscle
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5
Q

what maintains the guarding reflex in bladder control?

A

onuf’s nucleus

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6
Q

what is responsible for the Micturition reflex?

A

Sacral Micturition Centre

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7
Q

what is responsible for the co-ordination of voiding?

A

pontine micturition centre
PAG

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8
Q

what happen during filling stage in the bladder?

A
  • detruser muscle relaxed - sympathetic/hypogastric stimulated
  • urethra contracted - somatic/pudendal stimulated
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9
Q

how is urine expelled from bladder?

A
  • detruser contraction - Pelvic parasympathetic stimulated
  • external sphincter relaxation - Pudendal nerve inhibited
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10
Q

what are the causes of erectile dysfunction?

A

Multifactorial:
- vascular - hypertension, atherosclerosis, hyperlipidemia, smoking
- neurological - parkinsons, MS
- hormonal - hyperprolactin, thyroid, cushings
- drug-induced - beta-blockers, diuretics
- systemic disease - diabetes, renal failure
- structural - trauma
- psychological

impotence
inflammatory, mechanichal, psych, occlusive, trauma, extra, neuro, chem, endo

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11
Q

what questionnaire asseses erectile dysfunction?

A

International Index of Erectile Function
- 5 questions
- over last 6 months

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12
Q

when is Nocturnal penile tumescence testing (NPT) used?

A

complex/refractory ED
distinguises between organic/psychogenic

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13
Q

what medication is given to help get an erection?

A

Phosphodiesterase-5 inhibitors - sildenafil, vardenafil, avanafil
(can cause priapism)

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14
Q

what autonomic nerves control penis functions?

A

para - produces erection
sympathetic - ejaculation and detumescence

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15
Q

what somatic nerves are in penis?

A

Dorsal Nerve of the Penis from pudendal nerve - sensory
Perineal Nerves - motor & sensory

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16
Q

what part of brain is responsible for erections?

A

medial preoptic area
paraventricular nucleus in hypothalamus

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17
Q

for are the treatment/management options for ED?

A
  • modification of risk factors
  • treat underlying cause
    1ST LINE - PDE-5 inhibitors - sildenafil - short hl, tadalafil - long hl - contraindications are heart attack/arrhythmia
  • alprostadil (increases cAMP) - MUSE
  • caverject - injections
  • psychosexual counselling
  • hormone therapy - testosterone if low
  • surgery - inflatable implants, semirigid rods
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18
Q

what is the definition of ED?

A

an inability to obtain or maintain an erection sufficient for penetration and for the satisfaction of both sexual partners

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19
Q

what are ED at risk of?

A

cardiovascular conditions

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20
Q

what investigations are needed for penile cancer?

A
  • biopsy
  • ct scan/ultrasound assess tumour size
  • MRI (not common) checks for fibrosis
  • CVD risk factors - bloods eg lipids, glucose,BP, bloods for general health
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21
Q

what cell carcinoma is penile cancer?

A

squamous cell carcinoma
kaposi sarcoma

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22
Q

how is penile cancer graded?

A

G1, G2, G3
(cell are graded - normal/abnormal)

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23
Q

what is the T staging of penile cancer?

A

Ta - epithelium
T1 - lamina propia
T2 - spongiosum
T3 - cavernosum
T4 - scrotum/prostate/bone

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24
Q

what is the N staging in penile cancer

A

N0 - no nodes
N1 - up to 2 unilateral inguinal nodes
N2 - 3+ unilateral/bilateral nodes
N3 - pelvic nodes
m1 - metastatic disease

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25
Q

how does penile cancer present?

A
  • hard painless lump
  • can be red patch/ulcer
  • most commonly on glans or prepuce(foreskin)
  • discharge/bleeding
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26
Q

what is important to examine in penile cancer?

A

lymphs in groin

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27
Q

what is the treatment options for penile cancer

A
  • GS: surgery- partial/total penectomy
  • cream - 5-fluorouracil (5-FU) and imiquimod (IQ)
  • chemo/radio (platinum based)
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28
Q

what are risk factors of penile cancer?

A
  • HIV/HPV (multiple sexual partners)
  • tobacco
  • no circumsision
  • Lichen Sclerosus - skin condition, inflammation etc.
  • age - more in over 50
  • geography - asian/african
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29
Q

what is the most common Bladder carcinoma?

A

Urothelial carcinoma - invasion of basement membrane or deeper

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30
Q

what are the risk factors for bladder cancer?

A
  • smoking
  • schistosomiasis infection - parasite
  • chemical exposure - paint, rubber, dye
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31
Q

what is the pathway of development of Urothelial carcinoma?

A
  • papillary lesions - high/low grade
  • flat/in-situ lesions - always high grade
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32
Q

why is PD-L1 expression in urothelial carcinomas significant?

A

more likely to respond to immunotherapy

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33
Q

what are less common forms of bladder cancer?

A

squamous cell carcinoma
small-cell carcinoma
adenocarcinoma

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34
Q

what are the presentations of bladder cancer?

A
  • over 60 years old
  • micro/gross hematuria
  • infection/obstruction
  • less common: painful frequent urination, fatigue, weight loss, pelvic mass
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35
Q

what are the investigations for bladder cancer?

A
  • cystoscopy (+biopsy) - camera - gold standard
  • CT/MRI/ultrasound
  • biopsy- urine cytology - detects cancer cells
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36
Q

what is the treatment for non-muscle-invasive bladder cancer?

A
  • TURBT - removal of cancer + single dose chemo
  • chemo
  • BCG vaccine
  • cystectomy
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37
Q

what is the treatment for muscle-invasive bladder cancer?

A
  • cystectomy
  • radiotherapy
  • chemo
  • immunotherapy if advanced
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38
Q

what is used to stage and diagnose CKD?

A
  • eGFR - less than 60 (for over 3 months) (used with sex and age to calculate stage)
  • ACR - albumin creatinine ratio - over 30 is abnormal
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39
Q

at what eGFR do people need dialysis?

A

5-7 (starts planning at 15)

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40
Q

what most commonly causes CKD?

A

hypertension
diabetes
glomerulonephritis

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41
Q

what are BP targets in CKD for ACR over and under 70?

A

under 70 - 140/90
over 70 - 130/80

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42
Q

how is anemia in CKD treated?

A

EPO
Iron

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43
Q

what is the management of CKD?

A
  • control BP - ACE inhibitors
  • SGLT2 inhibitors - blockglucose reabsorption, reduce proteinuria
  • monitor
  • diet changes - low salt and protein
  • dialysis/transplant for end-stage
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44
Q

what are the stages of CKD?

A

Stage 1: GFR ≥90 mL/min/1.73 m² with evidence of kidney damage.
Stage 2: GFR 60-89 mL/min/1.73 m² with evidence of kidney damage.
Stage 3: GFR 30-59 mL/min/1.73 m².
Stage 4: GFR 15-29 mL/min/1.73 m².
Stage 5: GFR <15 mL/min/1.73 m² or on dialysis (also known as end-stage renal disease, ESRD).

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45
Q

how does CKD effect calcium/parathyroid?

A
  • decreased calcium reabsorption by kidneys/ absorption due to no vit D conversion
  • secondary hyperparathyroidism
  • increased bone turnover
    (increased phosphate levels in blood)
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46
Q

what are the types of dialysis?

A
  • haemodialysis
  • peritoneal dialysis
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47
Q

what is conservative care in CKD?

A
  • no dialysis
  • managing symptoms - fatigue, nausea, itching
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48
Q

what are risk factors for renal cancer?

A
  • hypertension
  • obesity
  • smoking
    (all cause hypoxia)
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49
Q

what is VHL?

A
  • tumour suppressor on chromosme 3
    associated with kidney cancer
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50
Q

how is kindey cancer diagnosed by symptoms ?

A
  • mass (palpable/CT imaging)
  • blood in urine
  • pain
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51
Q

what is the T staging of renal cancer?

A

TNM
t1 - completely inside the kidney.
t2 - completely inside the kidney.
t3 - spread to surrounding tissue
t4 - spread to adrenal glands etc

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52
Q

what is the grading of kidney cancer?

A

Grade 1: Nuclei are small and round with little variation in size and shape.
Grade 2: Nuclei are slightly larger with more variation in size and shape.
Grade 3: Nuclei are even larger with noticeably irregular size and shape.
Grade 4: Nuclei are very large and bizarre-looking, with many irregularities.

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53
Q

what are the subtypes of kidney cancer?

A
  • clear cell - most common
  • papillary
  • rare: Chromophobe, collecting duct
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54
Q

what are the treatment options for kidney cancer?

A
  • surgery - nephrectomy (radical/aprital/simple)
  • radiation therapy
  • targeted therapy
  • chemo
  • ablation eg Cryoablation
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55
Q

what is Upper Tract Urothelial Carcinoma?

A

in upper urinary tract - renal pelvis and ureters

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56
Q

what is normal GFR?

A

over 90

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57
Q

what factors decrease GFR?

A
  • Urinary tract obstruction
  • Renal disease, Diabetes mellitus, Hypertension
  • increased Afferent artery resistance - NSAIDs
  • decreased efferent artery resistance - ACEi/ARB
  • decreased renal blood flow - dehydration
  • increased age
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58
Q

what drugs may cause AKI?

A

DAMN
diuretics, ACEi/ARB, metformin, NSAIDs

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59
Q

what is required to measure GFR?

A

plasma and urine creatinine values

(URINE Cr/ PLASMA Cr) * urine flow rate

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60
Q

what is GFR influenced by?

A

Net Filtration Pressure (NFP)
Renal Blood Flow (RBF) - autoregulation
Filtration coefficient (Kf; filter integrity/function)

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61
Q

what is net filtration pressure calculated by?

A

GHP - (BCP+piG) (piG=Glomerular colloid osmotic pressure)

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62
Q

how in BP/volume regulated by kidneys?

A

(Baroreceptor reflexes (medulla) and Osmoreceptor Reflexes (hypothalamus))
- Juxtaglomerular Apparatus & Macula densa (Renin/Angiotensin)
- Tubuloglomerular feedback - GFR
- Negative feedback loops

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63
Q

what is ANP degraded by?

A

Neprilysin

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64
Q

what is the function of anp?

A
  • increases GFR - dilates afferent arterioles and constricts the efferent arterioles
  • inhibits sodium and water reabsorption
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65
Q

what is the most common type of testes cancer?

A
  • germ cell tumor - seminoma and nonseminomatous germ cell tumors
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66
Q

what are risk factors of testicular cancer?

A
  • family history
  • excessive oestrogen in mother
  • scandinavian
  • Undescended Testicle (Cryptorchidism)
  • 15-35
  • Klinefelter syndrome and Kallman syndrome
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67
Q

what is used to diagnose testicular cancer?

A

ultrasound
tumour markers - LDH, AFP, beta HCG

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68
Q

where does testicualr cancer commonly spread to?

A

lymphs in retroperitoneum

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69
Q

how does testicular cancer present?

A

unilateral painless testicular lump
- back pain/weight loss if spread

70
Q

what is the management of testicular cancer?

A
  • CT of plevis/abdo for staging
  • radical inguinal orchidectomy
  • sperm bank/cryopreservation
  • potetnial chemo/radio for late stage
71
Q

What Is Glomerulonephritis?

A

group of parenchymal kidney disease – characteristic of inflammation and damage to glomeruli

72
Q

what can Glomerulonephritis lead to?

A

end stage kidney failure

73
Q

what is the Glomerulonephritis Pathophysiology?

A
  • inflammation of glomeruli
  • immunoglobin deposits
  • can damage basement membrane
74
Q

what are examples of Glomerulonephritis?

A
  • Nephritic syndrome
  • Nephrotic syndrome
  • lupus
  • C3 Glomerulopathy
75
Q

how does Acute Nephritic syndrome present?

A
  • rapid deterioration - AKI
  • haematuria (high) and proteinuria (low-mid)
  • Oliguria
  • hypertension
  • fluid retention - oedema etc
76
Q

what can cause Acute Nephritic syndrome (including pathology)?

A
  • Immune Complex Formation and Deposition - eg post streptococcal infection & Systemic Lupus Erythematosus
  • anti-glomerular basement membrane antibodies - eg Goodpasture’s disease
  • ANCA associated vasculitis
  • Crescentic IgA nephropathy/ Henoch Schonlein purpura (HSP) (kidney diseases)
77
Q

how is ANCA-Associated Vasculitis treated?

A
  • steroids
  • cyclophosphamide
  • rituximab
    (control immune respone and inflammation)
78
Q

how is ANCA-Associated Vasculitis diagnosed?

A
  • serum ANCA - changes in titre correlate with activity
  • biopsy - lesions/fibrosis/tubular atrophy
79
Q

what are clinical features of ANCA-Associated Vasculitis?

A

inflammatory features eg
- rash, ulcers, Sinusitis, nasal discharge
- kidney and other organ involvement

80
Q

what is considered when ANCA-Associated Vasculitis is life threatening?

A

plasmapheresis - blood plasma exchange

81
Q

what is the most common cause of glomerulonephritis?

A

IgA Nephropathy

82
Q

how is IgA Nephropathy diagnosed?

A

biopsy - mesangial IgA deposits in glomeruli

83
Q

how is IgA Nephropathy managed?

A
  • BP management
  • max tolerated ACE/ARB
  • lifestyle modification
  • asses CVD risk
  • glucocosteroids - limited evidence
  • Budesonide recommended by NICE
84
Q

what is IgA Nephropathy?

A
  • Berger’s disease
  • deposits of IgA in glomeruli causes inflammation and damage
85
Q

how does Systemic Lupus Erythematosus (SLE) present?

A

Rash
arthralgia,
kidney failure
neurological symptoms
pericarditis
pneomonitis

86
Q

how is Systemic Lupus Erythematosus (SLE) treated?

A

steroids
cyclophosphamide
mycophenolate mofetil,
rituximab,

87
Q

how does Henoch Schonlein purpura present?

A
  • purple rash
  • abdominal pain
  • AKI (igA deposits)
88
Q

what is Henoch Schonlein purpura?

A

Systemic form of IgA Nephropathy
- more common in children
- can progress to CHD but often self limiting

89
Q

how is Anti- glomerular Basement Membrane disease (Goodpasture syndrome) treated?

A

plasma exchnage - remove antibodies
steroids/cyclophosphamide - immunosuppression

90
Q

how is Henoch Schonlein purpura treated?

A

supportive measures
steroids

91
Q

how do Nephrotic syndrome present?

A
  • Heavy proteinuria
  • Hypoalbuminaemia
  • oedema
    (- Hypercholesterolaemia
  • Haematuria usually absent or mild)
92
Q

what are primary causes of nephrotic syndromes?

A
  • minimal change syndrome - more in children
  • Focal Segmental Glomerulosclerosis (FSGS)- scaring due to multiple reasons eg HIV/drugs/diabetes
  • membranous - BM thickening
  • Membranoproliferative Glomerulonephritis (MPGN) - (can also be nephritic)
93
Q

what are secondary causes of nephrotic disease?

A
  • Systemic Lupus Erythematosus (SLE)
  • diabetes - 1 earlier, 2 later in life
  • amyloids - proteins
  • infections - HIV/Hep
  • drugs - gold, penicillamine
  • malignancy
94
Q

what investigations are required for Nephrotic Syndrome?

A
  • renal biopsy
  • Serum albumin, creatinine (+eGFR), lipids and glucose, urinalysis
  • protein/creatinine ratio - proteinuria
  • antibodies eg ANA, dsDNA, C3, C4 (lupus), PLA2Rab (membranous, HepdsAg & HepCAb
95
Q

how is nephrotic syndrome treated?

A
  • control fluids - diuretics, ACE/ARBs, spironolactone
  • statins
  • anticoagulation (membranous/amloid - low albumin)
  • prophylactic antibodies in children
96
Q

what is primary vs secondary Membranous Nephropathy?

A

primary - PLA2R antigen - immune system attacks BM

secondary - systemic causes eg viruses, drugs, tumours, other auntominnume conditions

97
Q

how is minimal change disease diagnosed and treated?

A
  • biopsy - podocytes fused
  • steroids
    (2nd= tacrolimus, cyclosporin, cyclophosphamide or rituximab)
98
Q

what is Asymptomatic Urinary abnormalities?

A
  • Incidental finding of dipstick haematuria +/- proteinuria
  • normal kidney function & BP
  • Causes: IgA, Thin membrane disease
99
Q

what is alports syndrome?

A
  • genetic condition - affects type 4 collagen
  • causes kidney disease
100
Q

where does prostate cancer occur?

A

peripheral zone of prostate

101
Q

what is the most common class of prostate cancer?

A
  • Adenocarcinoma - glandular cells
  • Small Cell Carcinoma - less common more aggressive
102
Q

what are risk factors for prostate cancer?

A
  • age - over 50
  • family history
  • african-american men
  • genetics
  • high fat diet
103
Q

what are signs/symptoms of prostate cancer?

A

only present in later stages
- urine changes - frequency, starting/stopping, weak stream
- blood in urine/semen
- pelvic discomfort

104
Q

how is prostate cancer diagnosed?

A
  • lower urinary tract symptoms
  • PSA blood levels
  • PCA3 in urine
  • transrectal ultrasound (TRUS), MRI, bone scan
  • prostate biopsy - gleason grading
  • DRE (posterior and lateral aspects of the prostate gland)
105
Q

when can PSA be elevated?

A
  • prostate cancer
  • UTI
  • prostatitis
106
Q

how is prostate cancer staged using T stage?

A

T1 - no palpable tumour on DRE
T2 - palpable tumour, confined to prostate
T3 - palpable tumour extending beyond prostate

107
Q

how is localised/locally advanced prostate cancer treated?

A
  • surgery
  • radiotherapy
  • adjuvant/neoadjuvant hormones
108
Q

what are risk factors for AKI?

A
  • high BP
  • CKD
  • Diabetes
  • heart/liver problems
  • increased age
  • Nephrotoxic Drugs
109
Q

what is diagnostic criteria for AKI?

A
  • increase in serum creatinine by 0.3 mg/dL or 1.5-1.9 times baseline
  • urine output less than 0.5 mL/kg/h for 6-12 hours
    Stage 1/2/3 based on severity
110
Q

what are pre renal causes of aki?

A

-Decrease in blood volume and blood flow
eg hypovolemia, heart/kidney failure, sepsis, drugs, hyper Ca

111
Q

what are inta renal causes of aki?

A
  • damage to kidneys
    eg ATN Acute tubular necrosis, AIN Acute interstitial nephritis, GN
112
Q

what are causes of post renal AKI?

A
  • obstruction of urine flow causing high pressure
    eg calcus, compression, prostate, medication, tumours
113
Q

what are signs of AKI?

A
  • azotemia - high nitrogen (urea and creatinine)
  • high K, low Ca
  • decreased urine output
  • fluid overload/retention
  • accumulation of drugs
114
Q

what investigations are required for AKI?

A
  • Serum Creatinine
  • FeUrea - pre=low, intra=high
  • urine sodium - pre=low, inta=high
  • Urinalysis - protein/blood - intra
  • urine osmolarity - higher=pre
  • Fractional Excretion of Sodium FeNa - <1% = prerenal, >2% = intra
  • ultrasound - shows kidney stones
115
Q

how is AKI managed?

A
  • treat underlying cause
  • dialysis if severe
  • fluids - when no fluid overload, rarely with dialysis
  • collids - fluids type, anaphylaxis risk
  • blood products eg RBCs
116
Q

how does androgen deprivation/ hormone therapy treat prostate cancer?

A
  • cancer is driven by androgens like testosterone
  • can be surgical - castration
  • LH antagonists or GNrH analogues
117
Q

how is Castration-resistant prostate cancer treated?

A
  • Abiraterone & Enzalutamide - hormone therapy
  • chemo - Docetaxel, Carbazitaxel
  • bisphosphonates - prevent bone comlications
118
Q

what is the classification of UTI?

A

Asymptomatic bacteriuria

Uncomplicated

Complicated

119
Q

what pathogen most commonly causes UTI?

A

E.coli
proteus - associated with renal stones
klebsiella (gut) - catheter associated
Staphylococcus saprophyticus (skin) - younger women - gram +ve cocci

120
Q

what factors contribute to pathogenesis of UTIs?

A
  • obstruction eg stones/tumours
  • low fluid intake
  • increased pH - due to bacteria
  • catheters
121
Q

what are symptoms of an lower UTI?

A
  • dysuria
  • increased frequency and urgency
  • Suprapubic pain
  • Cloudy or strong-smelling urine
122
Q

what are symptoms of an upper UTI?

A
  • Fever and chills
  • Nausea and vomiting
  • Malaise and fatigue
  • Dysuria, urgency, and frequency
  • Flank pain
123
Q

what is found on a urinalysis in a UTI?

A
  • nitrates
  • leukocytes
  • blood
124
Q

when is an early morning urine required? (bacteria)

125
Q

what level of bacteria signifies UTI in microscopy?

A

Counts >10^5 cfu/ml

126
Q

what is the first line treatment for UTIs?

A

nitrofurantoin
- Not given in thrid trimester

127
Q

when should UTI not be treated?

A

over 65 asymptomatic

128
Q

what is Pyelonephritis?

A

Infection of the renal parenchyma and soft tissues of renal pelvis /upper ureter
(upper UTI)
- associated with sepsis, fluid depletion

129
Q

what are Pyelonephritis symptoms?

A

Loin pain
Fever
Pyuria - leukocytes

130
Q

what are Pyelonephritis routes of infection?

A
  • Urethra colonised with bacteria - especially female
  • blood - S.aureus/Candida
131
Q

what investigations are done for Pyelonephritis?

A
  • physical examination - tender lion/Renal angle tenderness
  • Bloods including cultures
  • ultrasound scan - rule out obstruction
  • MSU
132
Q

how is Pyelonephritis treated?

A
  • IV antibiotics – eg. Co-amoxiclav +/- Gentamicin
  • fluid replacement
  • catheter
  • analgesia
  • draining obstructed kidney
133
Q

what are complications of Pyelonephritis?

A
  • Renal abscess (common in diabetics)
  • Emphysematous pyelonephritis (gas accumulation - Rare)
134
Q

what are lower urinary tract (LUTS) symptoms?

A
  • Frequency
  • Nocturia
  • Urgency
  • Hesitancy/Straining
  • Poor/intermittent stream
  • Incomplete emptying
  • Post micturition dribbling
135
Q

what cell is increased in benign prostatic hyperplasia?

A

epithelial and stromal cell numbers in the periurethral area of the prostate

136
Q

what is International Prostate Symptom Score (IPSS) ?

A

8 questions to asses LUTS
8-19 = mild
20-35 = severe

137
Q

what is physically examined in LUTS?

A
  • Abdominal - bladder distension
  • External genitalia - urethra narrowing/ cancer
  • Digital rectal examination (DRE) - prostate cancer
  • neurological examination - dementia/MS
  • lower limbs/peritoneum - sensory/motor
138
Q

what investigations are done for LUTS?

A
  • urinanalysis
  • imagings
  • TRUS - prostate
  • cystoscopy - if haematuria
  • urine frequency charts - flow rate/urine output
  • PSA
139
Q

what medication is used in prostate enlargement?

A
  • Alpha-Blockers - relax the muscles in the prostate and bladder neck
  • 5-Alpha Reductase Inhibitors - shrink the prostate over time, inhibits conversion of testosterone
140
Q

what surgical intervention is used in benign prostate enlargement?

141
Q

how is long term Interactive obstructive uropathy treated?

A

(urine isnt drained/blockage)
TURP
Long term catheter

142
Q

where are upper urinary tract vs lower urinary tract stones found?

A

upper - renal and Ureteric
lower - bladder, prostatic, urethral

143
Q

what may cause stones in urinary tract?

A
  • anatomical - eg horseshoe
  • obstruction
  • trauma
  • calcium, oxalate, urate, cystine
  • infection
  • dehyrdration
144
Q

what is the Nucleation theory for stone formation?

A

stones form from crystals in supersaturated urine

145
Q

how are stones prevented?

A
  • overhydration
  • low sodium diet
  • reducing BMI
  • active lifestyle
  • healthy protein intake
146
Q

what are symptoms of stones in urinary tract?

A
  • Asymptomatic
  • Loin pain
  • “Renal” colic
  • UTI symptoms- dysuria, strangury, urgency, frequency
  • Recurrent UTIs
  • Haematuria
147
Q

what is gold standard for diagnosing stones?

A
  • non-contrast CT of kidneys, ureters and bladder (KUB)
148
Q

what is a compliaction from stones in the urinary tract?

149
Q

what are the treatment options for stones?

A
  • conservative
  • mediaction to dissolve stone eg potassium citrate
  • Percutaneous Nephrolithotomy (PCNL) - incison in back - larger stones/ renal
  • Ureteroscopy - laser
  • drainage - Ureteric stones
  • endoscopy - bladder stones
  • ESWL
150
Q

what is Hydronephrosis?

A

Dilation of the renal pelvis or calyces

151
Q

what is Supravesical obstruction vs Infravesical obstruction

A

supra - above bladder
infra - below bladder

152
Q

what is cystitis?

A

bladder infection
upper uti

153
Q

what bacteria most commonly causes Urethritis

A

Neisseria gonorrhoeae
Chlamydia trachomatis.
- sti

154
Q

what investigations are needed for urethritis?

A
  • Gram stain culture of urethral discharge and/or urine sediment
  • nucleic acid amplification tests (NAAT) - for bacteria
155
Q

what are symptoms/signs of urethritis?

A
  • presence of risk factors
  • urethral discharge
  • urethral irritation or itching
  • dysuria
156
Q

what are symptoms of Epidydmo-Orchitis/Epididymitis?

A

Pain and swelling in one or both testicles
Fever and chills
Nausea and vomiting
Discharge from the penis
A feeling of heaviness in the affected testicle
Dysuria (painful urination)
Urgency and frequency of urination
Erythema and edema of the scrotum

157
Q

what causes Epidydmo-Orchitis?

A

chlamydia
gonorrhea
mumps
UTIs

158
Q

what investigations are needed for Epidydmo-Orchitis?

A
  • physical examination - swelling, pain, thickening, UTI symptoms.
  • Positive Prehn’s sign, Cremasteric reflex present
  • Urinalysis and Urine Culture: To identify bacterial infections
  • ultrasound - rule out testicular torsion
  • sti test
159
Q

how does Varicocele present?

A
  • pain uncommon
  • scrotal swelling usually left side
  • ‘bag of worms’
  • infertility
  • small testes if growth arrest
160
Q

what investigations are required for varicocele?

A
  • clinical examination - basis of diagnosis
  • ultrasound with doppler imaging - to confirm
  • semen analysis, FSH and testosterone levels to assess testes function
161
Q

what are treatment options for varicocele?

A
  • observe if asymptomatic
  • surgery if high grade - Varicocelectomy
162
Q

what is Testicular torsion?

A
  • twisting of the spermatic cord within the scrotum
  • occulusion of venous return and compramise of arterial suuply
  • leads to ischaemia of the testis
163
Q

when is peak age for Testicular torsion?

164
Q

what are risk factors of Testicular torsion?

A

Cryptorchidism (undescended testes)
Pubertal changes (increase in testicular volume)
Testis with a horizontal lie
Previous testicular tumour
Bell-clapper deformity
Recent strenuous exercise
Previous testicular torsion
Family history of testicular torsion

165
Q

what are symptoms of Testicular torsion?

A
  • Sudden onset, severe unilateral testicular pain
  • Lower abdominal pain
  • Nausea and vomiting
166
Q

what are examination finding of Testicular torsion?

A
  • swollen/tender
  • bell-clapper position - horizontal testes
  • Absent cremasteric reflex: stroke thigh = scrotal contents move up
  • negative Prehn’s sign - pain relief on elevation - not specific
  • permatic cord may be palpated in early not severe
167
Q

what are investigations for Testicular torsion?

A
  • mainly clinical - treatment should not be delayed
  • doppler ultrasound
  • urinalysis - UTI
168
Q

what is the management of Testicular torsion?

A
  • Manual Detorsion - while waiting, temporary
  • orchidopexy (fixation) and orchidectomy (removal)
169
Q

what is hydrocele?

A

a fluid-filled sac surrounding a testicle that results in swelling of the scrotum
- more common in infants or over 40
- uncomfortable but not usually painful

170
Q

what investigations are required for hydrocele?

A
  • Transillumination of the testis
  • ultrasound
  • urine culture and dipstick - excludes uti
  • presence of the cremasteric reflex
171
Q

what is the management for hydrocele?

A
  • observation - infants usually resolve
  • treat underlying causes
  • scrotal support eg supportive underwear
  • draining - may refill
  • surgery if symptomatic and severe
172
Q

what causes hydrocele?

A
  • uknown causes mainly
  • may be infection, inflammation, trauma, tumours
  • fluid retention

2A (9 decks)

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