GU Flashcards
what can predispose somone to testicular torsion,
epidemiology
Bell clapper deformity
boys 11-3 is peak age
5-30 is range
what is the presentation for testicular torsion
Sudden onset of unilateral testicular pain
nausea and vomiting
fever
suprapubic abdominal pain
Management of testicular torsion
what’s the optimum operation time
emergency, surgically operate, ask consent for potential orchidectomy
operate and untwist testicle and fixate testicle to back of scrotum
optimum operation time within 6 hours
only do investigation if unsure, Scrotal doppler ultrasound
signs of testicular torsion
inflammation, tender hot and swollen enlargement
High riding testicle
horizontal laying testicle
pain doesn’t go away
in what region does prostatic hyperplasia or carcinoma occur
in the intermittent transitional region of the prostate
symptoms of prostatic hyperplasia
Storing and voiding symptoms
frequency, urgency, bocturia, urgency incontinence
voiding
post void dribble, poor stream, hesitation (Haematuria and dysuria potential symptoms for carcinoma)
what are complications of prostatic hyperplasia
retention, stone or renal disease
what would fever with dysuria indicate
UTI Indicating Pyelonephritis
signs of BPH
prostatic enlargement on DRE
Hard and irregular suggest Carcinoma
smooth and enlarged suggests BPH
abd exam shows palpable bladder
inspect External meatus for signs of STI or UTI
Differential for LUTS voiding and storing
BPH UTI Prostatic carcinoma Bladder cancer Overactive bladder prostatitis
Investigations for BPH
Urinalysis: MSU MS and C. all comes back clear, eliminates UTI
dipstick
DRE
PSA - elevation can suggest carcinoma or BPH
volume chart-
international prostate symptom score questionnaire
Other Ultrasound
CT
Management of BPH
Conservative or in mild symptoms
Mild symptoms- watchful waiting, avoid Alcohol and caffeine. bladder training
Management of BPH
pharamacological
Orchidectomy is ideal however tends to be unwanted. since testosterone is linked to BPH. other cause is prostatic smooth muscle constriction
5 alpha reductase inhibitor - finasteride
Alpha Blockers- Tamsulosin
combination therapy
potentially anticholinergics or phosphodiesterase (PDE) 5 inhibitors
what is treatment for overactive bladder syndrome
Anticholinergics- tolterodine
Indications for surgery in BPH
RUSHES retention UTI recurrent Stones Haematuria elevated creatinine symptoms deterioration (uncontrolled)
Surgery options for BPH
Transurethral resection of prostate (TURP)
Transurethral Incision of Prostate (TUIP)
Prostatectomy
what is 5 alpha reductase inhibitors method of action
Inhibits conversion of testosterone to DHT DiHydrotestosterone (a more potent form of testosterone which can be linked to BPH)
what investigation would you carry out if patient presents with LUTS and haematuria
same as the other: PSA, DRE, Urinalysis, fluid volume
Cystoscopy for all haematuria patients
what are symptoms of urinary retention
Painful confusion fever flank pain LUTS
what can cause urinary retention
any urethral obstruction BPH malignancy from outside stones, urolithiasis Anticholinergics Iatrogenic
treatment of urinary retention
Urethral catheter and treat underlying causes
what is commonest renal tumour in adults
Renal cell carcinoma
what is the renal cell carconoma from
Proximal tubular epithelium
epidemiology risk factors age of onset of RCC
55 y o Smoking obesity hypertension pre existing renal disease renal failure PCKD Von Hippel lindau disease
Clinical features of RCC
presentations and symptoms, cardinal signs
Malaise anorexia weight loss, pyrexia
haematuria and loin pain and palpable mass in flank
patients commonly present with metastasis
decreased EPO causes anemia and polycythemia
tumour secreting renin = hypertension
Investigations and diagnosis of RCC
Ultrasound - shows mass
CT MRI- can be used to stage
Biopsy, use to confirm malignancy
Other investigations:
FBC - anemia , Polycythemia
LFT- can be increased aminotransferases
Creatinine- can be increased
urinalysis - dipstick shocks proteinuria and haematuria
What is Von Hippel lindau disease
autosomal dominant disease where multiple cysts form around the body and predisposes to multiple tumours
Management of RCC
Stage 1 0r 2 - nephrectomy or partial nephrectomy
stage 3 or 4 = temsirolimus, chemo
what are different urethral tumours
state which one is most common
Bladder, commones 50%
urethra
renal pelvis
ureter
what cells do urethral tumors originate from
Transitional epithelium cells lining the Gutract
RFs for urethral tumours
Smoking, exposure to industrial carcinogens, chronic inflammation
Presentation of bladder tumours
Painless haematuria
Other include Dysuria or frequency
presentation of renal pelvis or ureter tumour
Haematuria + loin pain
Investigations for Urothelial tumours
Cystoscopy ( any haematuria presentation do cystoscopy). this can identify presence of mass
then CT/MRI to stage
Management of tumour in renal pelvis or ureter
nephroureterectomy
Management of bladder cancer
if superficial: Transurethral resection + chemo to slow down
if invasive: cystectomy or radical radiotherapy if over 70
What type of cancer is prostate cancer and which cells does it originate from
adenocarcinoma, originating from epithelium of a gland
originates from epithelium in the transitional zone of prostate
prevalence of prostate cancer
Commonest male cancer 80% of those over 80%
where does prostate cancer most often spread to
metastasis to bone and lymph nodes
or spread locally to bladder, seminal vesicles, rectum
Epidimeology assosiations and risk factors of prostate cancer
+ve family history, Age
increased testosterone (Black people)
BRCA2 gene
Presentation of prostate cancer
LUTS, voiding and storing,
+ haematuria, dysuria
Back pain ( also found in prostatitis)
weight loss and anemia
Physical examinations for prostate cancer
DRE shows hard irregular prostate
examination could show enlarged lymph nodes (late stage)
Investigations for Prostate cancer
PSA- Elevated
Transrectal ultrasound and biopsy - diagnostic and graded
CT/MRI used to identify spread.
Bone scan
what is the scoring system for prostate cancer
Gleason scoring system
out of 10
up to 6 is low grade tumour
7 is fast is intermediate grade ( Grade 2 and 3)
8,9,10 is high grade (8 is grade 4 and 9,10 is grade 5)
what can causes Elevated PSA
BPH
adenocarcinoma is PSA is very high
prostatitis
can be falsely elevated by cycling, catheters, ejaculations
Prostate cancer treatment
contained within prostate
radical Prostatectomy + supplementary chemo and radiotherapy
Prostate cancer treatment metastasized
hormone therapy, since prostate cancer very sensitive to hormones
androgen deprivation or orchidectomy
or GNRH Goserelin or LH agonist flutamide , stimulate then inhibits. shrinks tumors
+radiotherapy
lumps in the testicle: after examination, cannot get above the mass
Inguinoscrotal hernia
hydroceles
lumps in the testicle: after examination, feels cystic and is attached to testicle
hydroceles
lumps in the testicle: after examination, feels cystic and is not attached to testicle
epididymal cyst
lumps in the testicle: after examination, feels solid and is not attached to testicle
epididymitis
varicoceles
lumps in the testicle: after examination, feels solid and is attached to testicle
Tumour
orchitis
haematocele
what is a hydroceles
fluid in tunica vaginalis
can be primary due to congenital abnormality or secondary to trauma
aspirate or surgery lords repair
what is an epididymal cyst
cyst, usually asymptomatic but can be if gets large enough and needs removal
what is a varicoceles
dilation of veins in paniform plexus, feels like bag of worms, can cause dull pain, surgically repair
what is a haematocele
collection of blood in Tv, occurs after trauma, may need drainage
what is epididymo-orchitis
inflammation of epididymis, causes by STI, first catch MC and S , chlamydia, mumps, n. gonorrhoea
sudden onset tender swelling dysuria, fever sweats, NO PAIN
Treat with antibiotics plus sexual partners
Testicular cancer prevalence
Commonest malignancy in males age 14-44
RF for testicular cancer
Family History plus undescended testicle
presentation for testicular tumour
painless lump in testicle, often found after trauma or infection Hemospermia effect on hormone If metastasized cough and dyspnea back pain abdominal mass
Investigations and diagnosis for testicular tumour
Ultrasound, Biopsy
CT to assess metastasis
markers and alpha fetoprotein and Beta HCG
Management of Testicular tumours
Radical orchiectomy plus Radiotherapy
Staging system for Testicular tumour
Stage 1 no metastasize
2 spread to infradiaphragmatic
3 supradiaphragmatic
4 involvement into the lungs
what is a complicated and uncomplicated UTI
complicated = men, pregnancy, immunocompromised uncomplicated = non pregnant women
Presentation of UTI
dysuria frequency and urgency Haematuria smelly urine Suprapubic pain and tenderness back and flank pain elderly confusion Fever (indicates pyelonephritis)
causative agent of UTI
and their effects
E Coli, commonest 50%
kelbestia - more likely to occur during hospital stay
proteus- stones
S. Aureus - risk of infective endocarditis
Pseudomonas chlamydia - immunocompromised
Investigations for a UTI
Urinalysis
dipstick - proteinuria, nitrites, pyuria
MSU MC and S increased wcc and bacteria
what is a lower and upper UTI
Lower, cystic (Bladder or urethra) or prostate
Upper, pyelonephritis, urter
what is pyelonephritis
Infection of the renal pelvis by UTI
presentation of pyelonephritis
Same as lower UTI ( dysuria, haematuria, Frequency, suprapubic pain and tenderness)
+ nausea and vomiting , back and flank pain, Loin Pain and tenderness fever and systemic illness
plus sign of costovertebral tenderness
main distingushing differences really is fever, nausea and vomiting. since all other signs also occur in UTI but less frequently
Investigations for pyelonephritis
same as LUTI but also bloods, WCC ESR and CRP
Gram Stain will show e coli or any bacteria
Urinalysis
FBC
ESR CRP
Blood culture
Treatment of UTI: cystic UTI complicated or uncomplicated
Oral Trimethoprim
or IV gentamicin if in patient care
Treatment of UTI: pyelonephritis uncomplicated
Trimethoprim
Treatment of UTI: pyelonephritis complicated
IV Gentamicin
Investigations for Testicular torsion
Scrotal doppler ultrasound
Questionnaire used for BPH investigations
International prostate symptom questionnaire form
