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Year 2 > Genitourinary: Part 5 > Flashcards

Genitourinary: Part 5 Flashcards

1
Q

6 Indications for LUTS

A
  1. Retention
  2. UTIs
  3. Stones
  4. Haematuria
  5. Elevated creatinine du eto bladder outflow obstruction
  6. Symptoms deteriorating
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2
Q

What defines benign prostatic hyperplasia

A

Increase in size of prostate without present of malignancy

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3
Q

What proportion of volume of seminal fluid is contributed to by the prostate

A

70%

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4
Q

What age does BPH effect

A

Over 60

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5
Q

What ethnicity does BPH effect

A

Afro-caribbeans more than men (higher levels of testosterone)

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6
Q

Risk factors for BPH

A

Age

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7
Q

What is a protective measure for preventing BPH

A

CASTRATION (removal of testicales)

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8
Q

Does Testosterone cause BPH

A

No, it is a requirement for BPH but doesn’t cause it

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9
Q

When should castration occur for BPH to not manifest

A

Castration prior to puberty or genetic disease inhibiting androgen production

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10
Q

What layers over-proliferate in the prostate in BPH

A

Musculofibrous and glandular layers

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11
Q

BPH vs prostate CARCINOMA histologically

A

Transitional (inner) zone enlarges in contrast to peripheral layer expansion seen in prostate carcinoma

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12
Q

Pathophysiology of BPH

A

Enlarged prostate can block the urethra

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13
Q

Clinical presentation of LUTS

A
  1. Nocturne
  2. Frequency
  3. Urgency
  4. Post-micturition dribbling
  5. Poor stream/flow
  6. Hesitancy
  7. Overflow incontinence
  8. Haematuria
  9. Bladder stones
  10. Delay in initiation of micturition
  11. Incomplete emptying
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14
Q

Diagnosis of LUTS

A
  1. AXR
  2. Digital rectal exam
  3. FBC
  4. ULTRASOUND
  5. BIOPSY and ENDOSCOPY
  6. MID-stream urine sample
  7. Flow rate and residual volume
  8. Frequency volume chart
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15
Q

What would AXR show in LUTS

A

Enlarged BLADDER

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16
Q

What would digital rectla exam accomplish in LUTS

A

Feel prostate is enlarged but SMOOTH

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17
Q

Why is ultrasound done in LUTS

A
  1. Exclude renal damage by obstruction

2. Transrectal ultrasound - size of prostate

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18
Q

What would FBC show in LUTS

A

Serum electrolytes - excludes renal damage

PSA raised

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19
Q

What max flow rate indicates bladder outflow obstruction due to BPH

A

Less than 10ml per second is suggestive

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20
Q

What is the frequency volume chart

A

Measures volume voided and time over MINIMUM 3 days

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21
Q

Why is frequency volume chart important

A

Can indicate if nocturne is present

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22
Q

If symptoms are minimal for BPH what do we do

A

Watchful waiting

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23
Q

Lifestyle changes in BPH

A
  1. Avoid caffeine and alcohol to reduce urgency and nocturne
  2. Relax when voiding
  3. Void twice in a row to aid emptying
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24
Q

First line drug treatment of BPH

A

ORAL TAMSULOSIN

ORAL FINASTERIDE (alternatief(

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25
Q

How does TAMSULOSIN work

A
  1. Relaxes smooth muscle in bladder neck and prostate thereby producing increase in urinary flow rate and improvement in obstructive symptoms
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26
Q

Side-effects of Tamsulosin

A

DDDEE

D - Drowsy
D - Dizzy 
D - Depression 
E - Ejactulatory failure
E - Extra-pyramidal signs

also:
Weight gain and nasal congestion

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27
Q

When do we avoid tamsulosin

A

Postural hypotension

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28
Q

Role of ORAL FINESTERIDE

A

Bolocks conversion of testosterone to dihydrotestosterone - androgen responsible for prostate enlargement

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29
Q

Side-Effects of ORAL FINESTERIDE

A
  1. Decreased Libido

2. Impotence

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30
Q

Surgical intervention for BPH

A
  1. TURP - Transurethral resection of prostate (MAIN)

2. TUIP - Transurethral incision of prostate

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31
Q

When is surgery done for BPH

A

When prostate is too large and isn’t being improved

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32
Q

Indications for BPH

A
  1. Recurrent haematuria
  2. Acute urinary retention
  3. Failed voiding trials
  4. Renal insufficiency
  5. Failure of medical treatment
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33
Q

Complications of BPH if left untreated

A
  1. Bladder calculi
  2. UTI
  3. HAEMATURIA
  4. ACUTE retention
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34
Q

What part of the kidney is effected by RENAL CELL CARCINOMA

A

PCT epithelium

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35
Q

In what gender is renal cell carcinoma caused in

A

Males over females

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36
Q

Average age of renal cell carcinoma presentation

A

55

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37
Q

Risk factors for renal cell carcinoma

A
  1. Smoking
  2. Obesity
  3. Hypertension
  4. Renal failure + haemodialysis
  5. Polycystic kidneys
  6. Von Hippel Lindau syndrome
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38
Q

Genetic pattern of Von Hippel Lindau syndrome

A

Autosomal dominant

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39
Q

What gene causes VHL syndrome

A

Mutation of chromosome 3 on p arm

Causes loss of both copies of tumour suppressor genes

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40
Q

Characteristic of RCC caused by VHL syndrome

A

Bilateral and multifocal

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41
Q

Where do malignancies spread to in RCC caused by VHL syndrome

A

Renal, pancreatic and cerebellar

42
Q

How does RCC spread

A
  1. Renal vein

2. Lymph or haematogenous (bone, liver and lung)

43
Q

Clinical presentation of RCC

A
  1. Asymptomatic and discovered incidentally
  2. Haematuria, loin/flank pain and abdo mass
  3. Anorexia, malaise and weight loss
  4. Invasion of left renal vein - testicaulr vein compression causing varicocele in left testicular vein
  5. Polycythaemia
  6. Hypertension due to renin secretion
  7. Anaemia due to depression of erythropoietin
  8. Fever
44
Q

Differential diagnosis of RCC

A
  1. Transitional cell carcinoma
  2. WILM’s tumour
  3. Renal oncocytoma
  4. Leiomyosarcoma
45
Q

Diagnostics of RCC

A
  1. ULTRASOUND
  2. CT and abdo contrast
  3. MRI
  4. BP
  5. FBC
  6. RENAL BIOPSY
  7. Bone scan
46
Q

Role of ultrasound in RCC

A

Distinguish simple cyst to complex cyst or tumour

47
Q

Role of CT chest and abdo with contrast in RCC

A
  1. Detects renal mass, involvement of renal vein of inferior vena cava
  2. Kidney function seen by contrast (should be taken up and excreted by wet functioning kidney)
48
Q

Role of MRI in RCC

A

Tumour staging

49
Q

FBC results in RCC

A
  1. Polycythaemia and anaemia as EPO decreased
  2. ESR raised
  3. Liver biochemistry may be abnormal
50
Q

Role of Renal biopsy in RCC

A
  1. Get histology to identify tumour
51
Q

When is bone scan done for RCC

A

Only if there are signs of raised serum ca

52
Q

Treatment of RCC

A
  1. Nephrectomy unless TUMOURS ARE BILATERAL (partial nephrectomy if bilateral)
  2. Ablative techniques
  3. IL-2 and INF-alpha for remission
  • — 2nd line—-
    4. Sunitinib, BEVACIZUMAB and SORAFENIIB
    5. TEMSIROLIMUS - mTOR inhibitor (more effective than INF-alpha)
53
Q

What is WILMS’ tumour

A

Childhood tumour of primitive renal tubules and mesenchymal cells

54
Q

When is WILM’s tumour seen

A

First 3 years of life

55
Q

Clinical presentation of WILMS’ tumour

A

ABdo mass and haematuria

56
Q

Diagnostics of WILMS’ tumour

A

ULTRASOUND, CT and MRI

57
Q

How is WILMS’ tumour treated

A

Nephrectomy, radiotherapy and chemotherapy

58
Q

What carcinoma is bladder ancer

A

Transitional cell carcinoma

59
Q

What structures are lined by transitional epithelium

A 
Calyces
Renal pelvis
Ureter
Bladder
Urethra
60
Q

What gender is TTC more common in

A

Men than female

61
Q

Risk factors for TTC

A
  1. Smoking
  2. Exposure to carcinogens
  3. Exposure to drugs
  4. Chronic inflammation of urinary tract
  5. Greater than 40
  6. Male
  7. Family history
62
Q

What causes chronic inflammation of the urinary tract

A

Schistomiasis - squamous carcinoma

Indwelling catheter

63
Q

What carcinogens can increase risk of bladder cancer

A
  1. Beta-napthylamine, benzidine, azo dyes

2. Workers in PETROLEUM, chemical, cable and rubber industries

64
Q

What drugs can cause bladder cancer

A

CYCLOPHOSPHAMIDE

PHENACETIN

65
Q

Where does bladder cancer spread locally

A

Pelvic structure

66
Q

Lymphatic spread of bladder cancer

A

Iliac, para-aortic nodes

67
Q

Haematogenous spread of bladder cancer

A

Liver and lungs

68
Q

Clinical presentation of bladder cancer

A
  1. PAINLESS HAEMATURIA - pain in clot retention
  2. Any patient over 40 with haematuria presumed tumour
  3. Recurrent UTIs
  4. Voiding irritability
69
Q

Differential diagnosis of TTC

A
  1. Haemorrhagic cystitis
  2. Renal cancer
  3. UTI
  4. Urethral trauma
70
Q

How is TTC diagnosed

A
  1. Cystoscopy (bladder endoscopy) and biopsy - DIAGNOSTIC
  2. Urine microscopy - STERILE PYURIA (pus in urine) caused in cancer
  3. CT urogram - staging and DIAGNOSTIC
  4. Urinary tumour markers
  5. MRI/Lymphangiogrpahy for pelvic lymph nodes
  6. CT/MRI of pelvis
71
Q

Treatment of TTC

A
  • ——-(non-muscle invasive bladder cancer)———-
    1. SURGICAL RESECTION
    2. CHEMOTHERAPY (with surgery)
  • ——– (localised muscle invasive disease)————-
    3. RADICAL CYSTECOMY (GOLD STANDARD)
    4. RADICAL RADIOTHERAPY (if not fit for surgery)
    5. CHEMOTHERAPY
72
Q

Non-muscle invasive bladder cancer chemotherapy

A

MITOMYCIN
DOXORUBICIN
CISPLATIN - reduces recurrence

73
Q

Post-op chemotherapy after radical cystectomy in Localised muscle invasive disease

A
  1. METHOTREXATE
  2. VINBLASTINE
  3. ADRIAMYCIN + CISPLATIN
74
Q

Chemotherapy in localised muscle invasive disease

A
  1. METHOTREXATE
  2. VINBLASTINE
  3. CISPLATIN
75
Q

Treatment of metastatic bladder cancer

A

Palliative chemotherapy and radiotherapy

76
Q

IN what layer of the prostate is prostatic carcinoma found in

A

Peripheral zone

77
Q

Common metastasis in prostatic carcinoma

A

Bone and lymph

78
Q

What gender is prostatic cancer common

A

Men

79
Q

Why is prostatic cancer more common in black people

A

More testosterone

80
Q

Family history of prostatic cancer

A
  1. 3 or more affected relatives

2. 2 relatives who have developed early onset

81
Q

What gene predisposes you to prostatic cancers

A
  1. HOXb13

2. BRCA2 confers a 5-7 times higher risk

82
Q

Local spread of prostatic cancer

A

Seminal vesicles, bladder and rectum

83
Q

Haematological spread of prostatic cancer

A

Bone (sclerotic bony lesions), brain, liver and lung

84
Q

Clinical presentation of prostatic cancer

A

Signs for LUTS:

  1. Nocturne
  2. Haematuria
  3. Poor stream
  4. Terminal dribbling
  5. Obstruction - bladder outflow problems similar to BPH
85
Q

Presentation of metastatic prostatic cancer

A
  1. Weight loss
  2. Bone pain
  3. Anaemia
86
Q

Differential diagnosis of prostatic cancer

A
  1. BPH
  2. Prostatitis
  3. Bladder tumours
87
Q

Diagnostics of prostatic cancer

A
  1. Digital rectal exam
  2. Trans-rectal ultrasound + biopsy - DIAGNOSTICS
  3. Urine biomarkers
  4. Endorectal coli MRI
88
Q

Urine biomarkers for prostatic cancer

A

PCA3 or gene fusion protein

89
Q

Why is an endorectal coli MRI done for prostatic cancer

A

Locally stage tumour

90
Q

Results of DRE in prostatic cancer

A
  1. Hard, irregular prostate

2. Raised PSA (over 16 ng/ml)

91
Q

Treatment of prostatic cancer if disease is confined to prostate

A
  1. Radical prostatectomy (over 70)
  2. Radiotherapy + hormone therapy
  3. Brachytherapy
  4. Hormone therapy temporarily delays tumour progression
  5. Active surveillance (over 70 and low risk)
92
Q

What is brachytherapy

A

Implantation of radioactive material targeted at tumour

93
Q

Metatstic prostatic carcinoma treatment

A

NOTE: BINDING AT THE ANDROGEN RECEPTOR STIMULATES TUMOUR GROWTH

  1. Orchidectomy (remove testes)
  2. LH receptor hormon agnost:
  3. Androgen receptor blocker
94
Q

Name two LH receptor hormone agonist

A
  1. GOSERELIN

2. SC LEUPRORELIN

95
Q

How do LH hormone receptor hormone

A
  1. Stimulate then inhibit testosterone release from pituitary
96
Q

How is initial surge of pituitary testosterone medicated

A
  1. ORAL CYPROTERONE ACETATE
97
Q

Name an androgen receptor blockers

A

BICALUTAMIDE

98
Q

Side effects of BICALUTAMIDE

A
  1. Weakness
  2. Nausea
  3. Hot flushes
  4. Weight change
99
Q

How are symptoms of Prostatic cancer treated

A
  1. ANALGESIA
  2. HYPERCALCAEMIA

RADIOTHERAPY - bone metastases/spinal cord compression

100
Q

Why should Tamsulosin not be given in postural hypotension

A

It is an alpha-1 antagonist: alpha-1 receptors cause contraction of smooth vascular muscles so if we give during hypotension then BP would get even worse

Year 2 (155 decks)

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