GU Flashcards
What are the 3 causes of obstruction hydronephrosis and what is the term nephrolithiasis
- Extrinsic (lymph nodes)
- Intramural (tumour)
- Interior (stones) - think stag horn calculus in middle aged elderly female
-Entire calyces system and pelvises occupied by a single calculus- stag horn
Describe the features of acute pyelonephritis
- Ascending infection
- Blood bourne
- E.Coli
- Loin pain and fever
- Sepsis
- Treatment abx
-Collections of neutrophil polymorphs through renal parenchyma
Describe the features of chronic pyelonephritis
- Repeated infections
- Polar scars - specific features involving the calyx
- Obstructivie/ reflux aetiology
- Thyroidisation of tubules
- Calyces look cystic and renal parenchyma are dilated between calyces
Describe Acute polycystic kidney disease
Name the other congenital/ inherited kidney abnormalities
- Autosomal dominant- presents in 3rd decade, usually hypertension or chronic renal impairment presentation
- Can also have cysts elsewhere eg. on liver and susceptible to berry aneurysms
Horseshoe kidney
Duplex ureters
Agenesis
Discuss the epidemiology of renal tumours
More common in males than females
Occur in 5th decade
Associated with smoking
Risk factors: tuberous sclerosis, VHL disease, renal transplantation, dialysis (papillary cancer due to scarring)
What is the triad of presenting complains in renal cancer and what radiological investigations would you conduct
- Renal mass
- Haematuria
- Flank pain
Radiologu
- Ultrasound
- IVU
- CT/ MRI
What are the features of a clear cells carcinoma
- Genetic 3p deletion
- Yellow/ pale
- Sheets of clear cells with pyknotic (dense) nuclei
What are the features of a papillary carcinoma
- Mutifocal and bilateral
* If they have it on one kidney they might have it on the other*
What is the staging involved in kidney cancer and how do you treat a renal cancer
pT 1-4
pT1: confined to kidney size <7
pT2: Confined to kidney size >7
pT3: renal vein/ vena cava
pT4: spread to adjacent organs
- Radical nephrectomy - remove kidney, ureter, adrenal gland and hilar lymph nodes
- Partial nephrectomy- tumours less than 4cm that don’t invade the collecting system
- Chemotherapy- not too much benefit
Describe the features of transitional cell carcinoma of the kidneys
- Hard to tell apart from renal cell carcinoma
- Commonly in urinary tract- bladder and ureter
- Papillary tumour attached to the wall of the renal pelvis
What is a Wilms tumour
- A paediatric nephroblastoma
- Age 2-4 with abdominal mass
What is the presentation of glomerulonephritis
- Nephrotic syndrome- protein loss in urine
- Nephritic syndrome- Renal impairment
- Acute renal failure
- Chronic renal failure
- Asymptomatic haematuria/ proteinuria
What are the features of nephrotic syndrome
Proteinuria over 3.5g/ 24 hrs
oedema
Hypercholesterolaemia
Hypoalbuminaemia
In children- due to minimal change disease
In adults - drug induced
What are the features of nephritic syndrome
- Haematuria
- Renal impairment
- Hypertension
- Active urine sediment - looking for casts and inflam cells
post strep - lot’s of neutrophil and polymorphs
What are the features of acute renal failure
Pre, renal and post causes
Features Oliguria/ anuria Sudden onset Elevated creatinine HTN
What are the features of chronic renal failure
Vascular disease, T2DM
- Slow onset
- Elevated creatinine
- Irreversible
- Requires dialysis at end stage
What are the causes of primary glomerulonephritis
- IgA nephropathy (very common)
- Minimal change disease (children)
- Membranous glomerulonephritis (adults)
- Post strep GN
- ANCA associated vasculitis
- Good pastures
- Membranoproliferative GN
Gold standard diagnosis is a renal biopsy to determine cause
What are the risk factors for bladder and ureteric tumours
Smoking
Rubber industry
Males
Hydrocarbons
How do bladder and ureteric tumours present
Lower urinary tract symptoms
Haematuria
Identified on cystoscopy, CT or MRI
Biopsy conducted or TURBT
What types of bladder and ureteric tumours are there
Transitional cell carcinoma
Grade 1 - Some enlarged cells , grade 2 - intermediate, grade 3- more aggressive mitotic change
Adenocarcinoma
-Tubular structures formed at the dome of the bladder
Treatment : TURBT +/- BCG therapy
-Partial cystectomy or cystectomy and ill conduit
carcinoma in situ - full thickness dysplasia found in TCC treated with BCG
Renal pelvis and ureteric tumours can either be
-Transitional cell carcinoma -Squamous cell carcinoma -Adenocarcinoma
What are the four main types of penis tumours
- Squamous cell carcinoma- mostly from keratinising squamous epithelium of penile shaft or non keratinising from the glans and foreskin
- Rarely malignant melanoma
- Spindle cell carcinoma - glans penis
- Adenosquamous carcinoma - mix of glandular and squamous patterns
What are the risk factors for penis cancer
- Poor hygiene
- Uncircumcised
- Phimosis
- HPV
- Smoking
- Pre-neoplastic conditions
- Bowenoid papulosis - before developing carcinoma
- Erythroplasia de queyrat- elderly males- CIS in foreskin or glans
- Bowens disease - dysplasia can affect penis skin
Describe the histology of the testes
Made of seminiferous tubules with germ cells. Lydia cells produce testosterone and sertoli cells give nutritional support
-In a biopsy check for abnormal preneoplastic change in spermatogenesis or intratubular germ cell neoplasia in the testis
Describe the features of testicular torsion
- Testis can go under infarction after portion
- Medical emergency
- Surgical treatment to prevent further torsion - untwist testis and suture it to the scrotal sac to prevent recurrence
What are the features of testicular cancer
- Germ cell tumours of the testis 90%
- Young males 18-55
- Good prognosis
Other types
- Sex cord stromal tumours
- Lymphoma/ leukaemia
What are the 3 main types of germ cell tumours
- Seminoma (most common)
- Non-seminomatous GCTs (teratomas)
- Mixed germ cell tumours ( seminoma + teratoma features)
What are the features of a semimoma
Aged 40-50 Most common Radiosensitive Good prognosis pale tumour expanding out of testis lymphoid storm with granulomas in it, no spermatogenesis in tubules
What are the features of a teratoma
Divided into 4 groups
MTD- Differentiated - can mimic normal structure- skin soft tissue resp bone teeth
MTI- Intermediate - more simple epithelium
MTU- undifferentiated - no mature elements
MTT - trophoblastic - rare
Their are -Malignant teratomas -Embryonal carcinoma
- Choriocarcinoma (associated with haemorrhage) -Yolk sac tumour
- Mixed forms
What diagnosis and treatment is involved in testicular cancer
- Painless testicular mass
- Raised serum markers - AFP , HCG (teratomas) increased LDH (seminoma)
- Mets -lymph node, lung, brain
Treatment
Radical Orchidectomy- done through inguinal canal
Radiotherapy to retroperitoneal lymph nodes in seminoma if involved
Chemotherapy - teratoma after initial surgery
What are the factors that are considered in the prognosis of testicular cancer
- Presence of embryonal carcinoma
- Absence of yolk sac tumour
- Lymphatic invasion
- Vascular invasion
If 2 or more then give chemo
Describe the features of benign prostatic hypertrophy
- Outflow obstruction
- Common with increase in age
- Glandular and stromal increase
- Imbalance in androgens and oestrogen will increase glands and stroma
- Large nodule projecting up into the bladder obstructs urine flow
- All elderly males will partially have this
Treatment
Drugs or TUP (removal of transition and central zone to get chippings that are examined for potential carcinoma)
Discuss the features of prostate carcinoma
- Most common tumour in males
- Increased detection with serum PSA
- May present with bony mets
- Detect with core biopsy using TRUS needle
90% Cases= acinar - prostatic acini on the periphery of the gland
Ductal - around the periurethral zone
Presentation
Haematuria
Abnormal rectal exam
Elevated PSA
What is a TRUS biopsy
Taken if a patient has elevated PSA
Ultrasound through rectum of prostate gland to detect abnormalities - use of ultrasound to direct cores to take biopsy
-Usually 7 core
-Needed for diagnosis
Also need a -TURP -MRI/CT -Bone scan for diagnosis
What is the treatment for prostate cancer
- Radical prostatectomy- not majority due to strict indications - only if PSA is under 15 and Gleason under 7 in males under 65
- Hormonal therapy in poorly differentiated tumours or high gleason score
- Radiotherapy (usually w chemo)
What is the Gleason score
-Scores prostate cancers
Grade 1 = well differentiated grade 5= poorly differentiated (more common
-Score /10 as most prostate carcinomas show more than 1 pattern so scores are combined
