Genitourinary Flashcards
Name 3 types of stones. Which is the most common?
- Calcium oxalate (70%)
- Uric acid
- Magnesium ammonium phosphate
What are some risk factors for ureteric stone development?
Dehydration
Diet high in animal protein &salt
What are the initial investigations for a suspected stone?
- FBE, UEC
- Serum calcium & uric acid
- MSU
- CT-KUB and plain KUB
What are some indications for intervention for a ureteric stone?
- Infection/sepsis
- Renal impairment
- Bilateral obstructions
- Solitary kidney
- Inability to control symptoms
- Prolonged obstruction
- Unlikely to pass spontaneously
What organism usually causes obstructive pylonephrosis?
E. coli
What is the management of obstructive pylonephrosis?
- IV Abs (gentamicin?)
- Urgent decompression
- Supportive care (fluids, monitoring)
What are some medical treatments for ureteric stones?
- a-blockers, eg. Tamsulosin 0.4mg OD for 2 weeks
- calcium channel blockers & steroids not as effective
What are the surgical options for a ureteric stone?
- JJ stent & delayed management
- Ureteroscopy & lithotrospsy
- Shock wave lithotripsy
What is the likely make-up of a radiolucent stone?
- Uric acid (or cystine)
- Form in acidic urine
What are some strategies to prevent stone recurrence?
- Adequate fluid intake
- Dietary modification
- Urinary alkalinization
- Medical therapy - allopurinol, thiazide diuretics
- Cystinuria
What are 5 causes of urological haematuria?
- Obstructive uropathy
- Carcinoma of the prostate
- Nephritis
- Trauma
- Tumour
- TB
- Thrombosis
- Haematological
- Infection/inflammation
- Stones
Which common drugs can make the urine beetroot red?
- Pyridium
- Nitrofurantoin
- Rifampin
- Ibuprofen
- Phenytoin
- L-DOPA
- Chloroquine
What is the acute work-up for haematuria?
- Bloods: Hb, clotting, creatinine
- MSU -> M/C/S
- Upper tract imaging: CT-IVP, U/S
- Cystoscopy
- Others: urine cytology, PSA, urinalysis
What are the obstructive urinary symptoms?
Poor flow, hesitancy, intermittency, terminal dribbling
What are the irritative urinary symptoms?
Frequency, urgency, nocturia, incontinence
What are the 3 most common causes of obstructive urinary symptoms?
- BPH
- Prostate cancer
- Stricture
What are 5 causes of irritative urinary symptoms?
- UTI
- Secondary to obstruction
- Bladder cancer
- Stone
- Diabetes
- TB
What is your work-up for lower urinary tract symptoms?
- MSU
- UEC
- PSA
- Bladder diary
- Voiding flow rate
- US - residual urine, hydronephrosis
Which drugs can be used in lower urinary tract symptoms?
- Alpha blockers
- 5-alpha reductase inhibitors
What are the surgical options for treatment of lower urinary tract symptoms?
- TURP
- BNI (bladder neck incision)
- Open prostatectomy
What is acute urinary retention?
Sudden and PAINFUL inability to pass urine
What are some painless causes of urinary retention?
- Neurogenic
- Longterm voiding detrusor dysfunction
- Ageing
What can precipitate acute urinary retention?
- Medication (anticholinergics)
- UTI
- Diuresis (esp. ALCOHOL)
- Postoperative
What are common causes of acute urinary retention in females?
- Urethritis/UTI
- Meatal stenosis/stricture
- Tumour
- Urethral diverticulum
- Urethral stone
- Extrinsic compression - prolapsed uterus or pelvic mass
What are the appropriate size catheters for: men, women & haematuria?
Men: 12-14F
Women: 14-16F
Haematuria: 22-24F
What is the management of obstructive nephropathy?
- Admit
- Monitor urine hourly
- Replace urine volume with 1/2 volume 0.9% NaCl
- Monitor UECs regularly
- Replace magnesium & phosphate as required
What are the treatment options for AUR?
- Alpha-blocker & TOV
- Surgery: TURP, laser, open
- Long-term IDC
Differential diagnosis of a painless scrotal lump?
Hydrocoele, epididymal cyst, varicoele, benign tumour, idiopathic scrotal oedema, testicular cancer, lymphoma, inguinal hernia, ascites
What 3 serum markers might be elevated in testicular cancer?
- alpha-fetoprotein
- beta-HCG
- LDH
Which lymph nodes do the testicles drain to first?
Retroperitoneal lymph nodes (require CT abdomen & pelvis for staging)
What are the treatment options for testicular cancer?
- Inguinal orchidectomy
- Chemotherapy (BEP)
- Retroperitoneal lymph node dissection
What are the main investigations for suspected testicular cancer?
- Serum tumour markers
- Urgent scrotal U/S
What 2 places does testicular cancer commonly metastasize to first?
- Retroperitoneal lymph nodes
- Chest
What are the differentials for an acute scrotum?
- Testicular torsion
- Trauma
- Epididymo-orchitis
- Testicular appendage torsion
- Acute indirect inguinal hernia
What conditions can predispose to testicular torsion?
- Cryptorchidism
- Bell clapper deformity
What are the physical findings in testicular torsion?
- Tender, firm, high-riding testicle with a horizontal lie
- Absent cremasteric reflex
- Epididymis not posterior to testis
What are the common causative bacteria in epididymo-orchitis?
Men 35: E. coli & other GNBs
What are the risk factors for epididymo-orchitis?
- IDC
- Chronic retention
- Structural abnormality
- Instrumentation
What are the physical examination findings in epididymo-orchitis?
- Swollen, tender testis
- Fever
- Hydrocoele
What investigations should be ordered in suspected epididymo-orchitis?
- U/S - to rule out torsion
- Urinalysis & MSU
- Urine/urethral swab for PCR
Which antibiotics should be used in epididymo-orchitis?
GNB coverage: trimethoprim, cephalexin, augmentin or norfloxacin for 2 weeks
-give ampicillin & gentamicin via IV until afebrile
STI coverage: ceftriaxone & azithromycin & doxycycline
What are the macroscopic & microscopic features of papillary bladder cancer in situ?
- Cytologically malignant cells
- Lack of cohesiveness
- Mucosal reddening, granularity or thickening
What conditions predispose to carcinoma of the bladder?
- Smoking
- Industrial exposure to arylamines
- Schistosomiasis
- Long-term use of analgesics
- Long-term exposure to cyclophosphamide
What are the histological features of a testicular seminoma?
Large cells with distinct borders, pale nuclei, prominent nucleoli & sparse lymphocytic infiltrate
What are the 3 broad classifications of testicular neoplasms?
- germ cell tumours
- sex cord stromal tumours
- lymphoma
What are common germ cell tumours of the testicles?
- Seminoma
- Embryonal carcinoma
- Yolk sac tumour
- Choriocarcinoma
- Teratoma
- Mixed tumours
In which region of the prostate does hyperplasia typically arise?
Transitional zone
In which region of the prostate does carcinoma typically arise?
Peripheral zone
What does a Gleason score confer?
Degree of differentiation of cells (GRADE)
What are first-line antibiotics in uncomplicated UTI?
Trimethoprim (but NOT in pregnancy)
