genitourinary path + anatomy Flashcards
What is the danger of someone with LUTS due to prostate Ca undergoing radiotherapy
They might go into retention
Patient with prostate Ca is about to have RT- why should they have a TURP instead of an alpha blocker to relieve sx?
They need a definitive mx- hence TURP instead of tamsulosin
Effect of 5 alpha reductase on the prostate
It converts testosterone into the more active dihydrotestosterone which increases prostate growth
Example of a 5 alpha reductase inhibitor
Dutasteride, finasteride
lymphatic drainage of cervix
obturator nodes
What do the superficial inguinal lymph nodes drain?
anal canal, bladder, vagina
The pectinate line divides the pelvic rectum and the anal canal- what are the lymphatic drainage of the 2
pelvic rectum- external iliac/ common iliac nodes
anal canal- superficial inguinal lymph nodes
nerve supply to
internal
external
anal sphincters
external= pudendal
internal= lower rectal branches of the parasympathetic nerves
What is the other name for the testicular appendix and where does it originate from
Hydatid of Morgagni
Remnant of the Muerllerin duct
What is the remnant of the Wolffian duct called?
epididymal appendix
risk factors for undescended tests
Twins
low birth weight
premature
presenting sx for Wilm’s tumour
abdo mass/ pain
hypertension
haematuria
Epidemiology Wilm’s tumour:
age
race
Fhx
<5 yrs
afro-Caribbean
+ FHx
What is the risk of prolonged TURP surgery
TURP syndrome
Describe the changes seen in TURP syndrome
Fluid overload
glycine toxicity
HTN + reflex bradycardia
dilutional hyponatraemia
reduced plasma osmolality = brain oedema
What are the 5 classifications of undescended testes
retractile
ectopic
atrophic
arterial supply of prostate
prostatic arteries from INTERNAL iliac
venous drainage of prostate
prostatic venous plexus drains into
internal iliac veins
which connect
internal vertebral and Batons venous plexuses
What are the zones of the prostate
4 zones: (middle outwards)
transitional
central (posterior)
peripheral (posterior)
fibromuscular stromal zone (anterior)
transitional, central and peripheral are glandular areas
Which zone does prostate Ca arise in
peripheral zone
Which zone does BPH arise in
transitional zone
How many lobes does the prostate have
4:
anterior
posterior
median
lateral
What are the 3 parts of the urethra (proximal-distal)
prostatic
membranous
spongy
which part of the urethra recieves semen from the ejaculatory ducts
prostatic urethra
2 commonest surgical procedures for the management of hydrocele
Lord’s (plication)
Jabouley’s (excision + eversion of hydrocele sac)
What is a hypospadia
when the urethral meatus is on the VENTRAL aspect of the penis
What are the 3 features of a hypospadia
-ventral meatus
-ventral bend of penis (Chordee)
-doral hooded foreskin
Mx of hypospadia
urethroplasty
At what age are hypospadias corrected and what specifically should parents be counselled not to do until mx has been discussed
Age= 6-18 months
Do not do a circumsition as foreskin maybe vital for reconstruction
What are the 3 classes of hypospadias
Based on location of meatus:
-anterior/ glandular (most common)
-middle (shaft/ penile)
-posterior (penoscrotal/ scrotal/ perineal)
Short/ long term complications post urethroplasty for hypospadia
Short:
bleeding
infection
blocked catheter
bladder spasms
Long:
urethral fistula
urethral/ meatal stenosis/ stricture
urethral diverticula
poor cosmesis
spraying urine
voiding dysfunction
What is cystinuria
An autosomal recessive condition where there excess cystine (amino acid) in the urine that forms stones/ crystals causing renal colic
Hos is cystinuria diagnosed
24hr urine collection
USS/ CT KUB
Urinanalysis
Management of cystinuria
prevent stones forming:
-d penicillamine
-alkalinisation of urine (potassium citrate/ sodium bicarb/ acetazolamide)
-drink water
What is priapism
Sustained painful erection without sexual stimulation lasting >4 HOURS
Types of priapism
Low flow/ ischaemic= painful
High flow/ non-ischaemic= painless
Mx of the types of priapism
Low flow:
1- aspirate blood with 21-gauge cannula from cavernosa
if doesn’t work
2-give alpha-1 adrenoceptor agonist every 5-10mins up to 1 hr
(monitor BP/HR)
if doesn’t work
3-surgery asap
High flow:
conservative mx
risk factors for SCC bladder Ca
Schistosomiasis
long term indwelling catheter
Why is the internal vertebral/ Batsons venous plexus significant in prostate cancer
They ae valveless veins hence allow for metastases
Lymph drainage of testes vs scrotum
testes = para-aortic/ lumbar nodes
scrotal = superficial inguinal nodes
lymph drainage of the uterus
fundus= para-aortic
body + cervix= internal + external iliac + superficial inguinal nodes
what are the muscles/ ligaments that support the uterus
muscle= pelvic floor muscles main support
ligaments=
broad ligament
round ligament
ovarian ligament
cardinal ligament
uterosacral ligament
What is the origin/ insertion/ function of the uterine ligaments
broad
-uterus to lateral pelvic walls
-provides support and keeps in anteverted position
round
-uterine horns to labia majora (through inguinal canal)
-keep correct position
ovarian
-uterus to ovary
-connects uterus to ovary
cardinal
-cervix to lateral pelvic walls
-contains the uterine artery and veins
uterosacral
-cervix to sacrum
-help support + correct position
What are the structures at attach at the perineal body
6 structures:
-superfical +
-deep transverse perineal muscles
-bulbospogiosus
-external anal +
-urethral sphincter
-anterior fibres of levator ani
what are the contents of the superficial perineal pouch
ischiocarvernosus
bulbospongiosus
superficial transverse perineal muscle
what divides the superficial and deep perineal pouches
perineal membrane
what are the contents of the deep perineal pouch
external urethral sphincter
membranous urethra
deep transverse perineal muscle
internal pudendal artery
dorsal nerve of penis/ clitoris
what lies between the deep perineal pouch and the pelvic floor/ levator ani
ischiorectal fossa
what are the muscles that make up the pelvic floor
coccygeous + levator ani
levator ani:
puborectalis
pubococcygeous
iliococcygeous
what does the ilioinguinal nerve give sensory supply to ?
79
common pathogen causing epididymitis in
men <35
older men/ children
> 35= gonorrhoea/ chlamidya
older/children= E.coli
What is a rare, non-infectious cause of epididymitis
amiodarone
Nerve supply of the internal and external anal sphincters
internal= hypogastric plexus
external= inferior rectal nerve
Contents of obturator foramen
obturator
artery
vein
nerve
Structures that pass through the greater sciatic foramen
-above the piriformis
-below the piriformis
above piriformis:
-superior gluteal nerve + artery
below:
-inferior gluteal nerve + artery
-sciatic nerve
-nerve to obturator internus/ quadratus femoris
-posterior femoral nerve
-pudendal nerve
Structures passing through the lesser sciatic foramen into the perineum
-internal pudendal artery + vein
-pudendal nerve
-nerve to obturator internus
-obturator tendon
Organisms causing UTI in:
-sexually active woman
-had recent instrumentation
-no other risk factors
-foreign body present (mesh/ sutures)
-sexually active woman= staphylococcus saprophyticus
-had recent instrumentation= staph aureus
-no other risk factors= E.coli
-foreign body present (mesh/ sutures)= pseudomonas
What do the below renal conditions appear as on a DTPA renogram
-tumour
-renal cyst
-acute tubular necrosis
-transplant rejection
-calculus/ obstruction
-tumour= hypervascular flush/ increased flow
-renal cyst= cold spots (no blood supply)
-acute tubular necrosis= preserved perfusion BUT delayed uptake and excretion of the radioisotope
-transplant rejection= diminished perfusion AND delayed uptake and excretion of the radioisotope
-calculus/ obstruction= affected kidney not draining
Management options for:
-muscle invasive
vs
-non muscle invasive bladder cancer
MIBC:
radical cystectomy/ RT/ RT then radical sugery
NMIBC:
-TURBT
-BCG immunotherapy
-TURBT + post-op mitomycin C chemo
Abx for UTI in pregnant women
cefalexin
nitro + trimethoprim are teratogenic
