GU/Renal Flashcards by Majayda Islam

weak intermittent flow 
hesitancy 
terminal dribbling 
urgency/frequency
nocturia
UTI 
obstruction/retention

typically in older men 50-80yrs, more common in Black and Asian People

Benign Prostate Hyperplasia

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Management of BPH

sometimes watchful waiting
first line = alpha blockers = tamsulosin
5a-reductase inhibitors = finasteride

surgery = TURP

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involuntary leakage of urine or sudden urge to pass urine

urge incontinence

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involuntary leakage on exertion, coughing or sneezing

stress incontinence

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involuntary leakage on exertion and sudden urge to pass urine

mixed incontinence

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management of urge incontinence

first line = oxybutynin, (alt = tolterodine & darifenacin)
mirabegron in elderly patients

bladder retraining for 6 weeks

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management of stress incontinence

duloxetine
pelvic floor muscle training
surgery

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management of undescended testes

orchidopexy at 6-18months

= inguinal exploration and mobilise testes

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retractile testes

usually appear in warm conditions

surgery usually indicated

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soft, non tender swelling
swelling confined to the scrotum
transillumination
difficult to palpate if large

hydrocele

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management of hydrocele

infantile hydrocele are generally repaired if they do not spontaneously resolve by 1-2yrs

adults - take conservative approach - reassurance and scrotal support
usually do an ultrasound to exclude an underlying tumour

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painless scrotal swelling - usually left
‘bag of worms’
subfertility

varicolcele

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Ix for varicocele

US and doppler studies

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management of varicocele

usually conservative
supportive underwear and analgesia for any discomfort
semen analysis if concerned with subfertility

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abrupt onset of abdominal pain - mainly in flank/loin
nausea and vomiting
haematuria
some haematuria, dysuria, and straining

nephro/urothialisis = renal stones

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black/dark brown stones
radiopaque
acidic urine

calcium oxalate stones

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dirty white

radiopaque on X-ray

calcium phosphate

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Ix for renal stones

urine dip = exclude infection
non-contrast CT KUB
US if pregnant

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management of renal stones

NSAID for pain relief - IM diclofenac

conservative = in young/less symptomatic pts with stone <5mm = watchful waiting
if severe = lithotripsy or nephrolithotomy

medical = alpha blocker to facilitate spontaneous passage

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ureteric obstruction management

urgent decompression surgery

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complex renal calculi and staghorn calculi

percutaneous nephrolithotomy

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persistent erection lasting over 4 hrs
pain localised to penis
history of trauma to genital/perianal region

priapism

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Ix in priapism

cavernosal blood gas analysis

Doppler or duplex ultrasonography

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management of priapism

if longer than 4hrs = aspiration/shunt blood from the cavernosa and saline flush
if aspiration fails = phenylephrine
surgical options considered

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non-retractable forekine behind glans penis | forms ring

paraphimosis

management of paraphimosis

manual manipulation | emergency surgical reduction

``` pain is usually severe and sudden onset nausea and vomiting may be present swollen testes, retracted upwards cremasteric reflex is lost Prehn's sign is absent ```

testicular torsion

management of testicular torison

urgent surgical exploration | both testes should be fixed prophylactically

usually gradual onset unilateral testicular pain and swelling prehn's sign positive potential discharge

epididymo-orchitis

management of epididymo-orchitis

If STI related ceftriaxone 500mg IM doxycycline 100mg BD 10-14/7 If enteric organism ofloxacin 200mg BC 14 days OR levofloxacin 500mg OD 10days

painless lump in scrotum possibly with a hydrocele gynaecomastia AFP and LDH elevated commonly in men aged 20-30

testicular cancer/tumour

Ix of testicular cancer

management of testicular cancer

orchidectomy +/- chemo-radiotherapy

penile soreness and itch bleeding from the foreskin with possible odour dysuria/dyspareunia

Balanitis

management of candidal balanitis

topical clotrimazole for 2 weeks

management of bacterial balanitis

oral flucloxacillin OR alternative is clarithromycin if anaerobic organism = metronidazole

management of dermatitis balanitis

topical corticosteroids

management of lichen sclerosis balanitis

topical steroids = clobetasol | and potential circumcision

pain in perineum, penis, rectum or back obstructive voiding symptoms fevers and rigors PR exam reveals a tender, boggy prostate

prostatitis

management of prostatitis

quinolone = ciprofloxacin for 14 days

can be asymptomatic typically present with dysuria +/- urethral discharge

urethritis

Ix for urethritis

urethral swab - NAAT studies

management of urethritis

oral doxycycline 7 days OR oral azithromycin single dose

``` dysuria frequency +/- urgency cloudy/offensive smelling urine lower abdo pain low grade fever malaise ```

UTI/cystitis

management of UTI

nitrofurantoin 3 days (trimethoprim alternative) nitrofurantoin first line in pregnancy but alternatives include amoxicillin and cefalexin (AVOID TRIMETHOPRIM)

loin/flank pain nausea and vomiting fevers white casts in urine can also present with myalgia, flu-like symptoms recent LUTI

pyelonephritis

management of acute pyelonephritis

cefalexin 500mg for 7-10days BD/TDS | other options include co-amoxiclav, trimethoprim and ciprofloxacin

``` flank/loin pain haematuria hypertension palpable/ballotable kidneys bilaterally UTI/pyelonephritis ```

Polycystic kidney disease = PKD

Ix for PKD

abdo ultrasound

management of PKD

vasopressin 2 antagonist = tolvaptan

PKD associated risks

liver cysts | berry aneurysms in brain = SAH risk if ruptured

asymptomatic painless haematuria/proteinuria (frothy urine) can present with oedema

glomerulonephritis

Ix for glomerulonephritis

renal biopsy = spike and dome appearance

management of glomerulonephritis

all patients = ACEi/ARB | severe progressive disease = immunosuppression with cyclophosphamide

proteinuria (<3g/24hr) hypoalbuminemia (<30g/L) oedema ``` Peripheral oedema (more common in adults) Facial oedema (more common in children) Frothiness of urine Fatigue Poor appetite Recurrent infections ```

nephrotic syndrome

``` haematuria hypertension red cell clasts moderate proteinuria ?oliguria ```

nephritic syndrome

``` mainly asymptomatic in early stages lowered urine output (0.5kg/hr/mol) peripheral or pulmonary oedema arrhythmias uraemia - pericarditis/encephalopathy ``` rise in creatinine - 26micromol/L

AKI

Management of AKI

largely supportive - careful fluid balance stop meds = diuretics, ACEi/ARB, metformin or NSAIDs renal replacement therapy if no response to treatment hyperkalemia (and subsequent arrhythmias) = IV calcium gluconate

pre-renal causes of AKI

renal artery stenosis | hypovolemia (due to D&V)

intrinsic/renal causes of AKI

``` glomerulonephritis acute tubular necrosis acute interstitial necrosis rhabdomyolysis tumour lysis syndrome ```

post-renal causes of AKI

``` kidney stones (ureter/bladder) BPH external compression of ureter ```

Immunoglobulin A nephropathy GN diagnosis and management

haematuria, proteinuria, oedema Biopsy BP control with ACEi/ARB

minimal change disease diagnosis and management

nephrotic syndrome Dx = Light microscopy mx = prednisolone

focal and segmental GN diagnosis and management

development of scar tissue ``` Dx= biopsy mx = BP control = ACEi/ARB (corticosteroid if idiopathic) ```

membranous nephropathy diagnosis and management

manifests as nephrotic ``` Dx = anti-phospholipase A2 receptor antibody mx = ACEi/ARB ```

painless macroscopic haematuria | +B symptoms

bladder cancer

management of bladder cancer

superficial lesions managed using TURBT | higher grade/risk = intravesicular chemotherapy

dx of bladder cancer

cytology and biopsies or TUBRT

most common type of bladder cancer

transitional | Squamous cell carcinoma is linked to schistosomiasis

inability to pass urine lower abdo discomfort considerable pain/discomfort acute confusion/altered mental state - esp in elderly

acute urinary retention

management of urinary retention

confirm diagnosis with US - <300cc | decompressing bladder using catheterisation

painless and insidious inability to pass urine

chronic urinary retention

management of chronic urinary retention

patient with chronic urinary retention can be taught to self-catheterise finasteride can take upto 6 months to come into effect

``` haematuria, loin pain and abdo mass pyrexia left varicocele polycythaemia hypercalcaemia ``` middle aged men, smoker, PKD

renal cell carcinoma

management of Renal cell carcinoma

confined disease = partial or total nephrectomy a-interferon/interleukin 2 = reduce tumour size tyrosine kinase inhibitors = sorafenib and sunitinib

often asymptomatic hesitancy, urinary retention haematuria back pain DRE = hard asymmetric, nodular enlargement and median sulcus loss

prostatic cancer/carcinoma

management of prostatic cancer

localised (T1/2) = active monitoring, radical prostatectomy and radiotherapy localised-advanced (T3/4) = radical prostatectomy, radiotherapy + hormonal therapy GnRH agonist - gosrelin metastatic disease = hormonal therapy + GnRH agonist

what scores is used to asses prostate cancer

GLEASON SCORE - grading the cancer (high score = higher grade cancer Likert scale = 3+ - have MRI and if 1-2 discuss pros/cons of biospy

typically in children abdominal mass painless haematuria flank pain anorexia and fevers

Wilm's tumour

management for wilms tumour

usually arrange a paediatric review in 48hrs mx = nephrectomy and chemo if advances = radiotherapy

young male recurrent macroscopic haematuria develops 1-2days after URTI

IgA nephropathy / Berger's disease

non urgent referral for haematuria

above 60yrs with recurrent or persistent UTI

Urgent referral for hematuria

aged 45+ unexplained visible hematuria and no UTI | aged 60+ unexplained microscopic haematuria + dysuria and increased WCC

raised serum creatinine or serum eGFR of less than 60mL/min proteinuria (ACR above 3mg) persistent hematuria after exclusion of UTI urine sediment abnormalities = RBCs/WBCs, granular casts and renal tubular epithelial cells

chronic kidney disease

indications for renal-replacement therapy/

``` acidosis electrolyte disturbance intoxication overload (fluid) urinary complication ```

usually iatrogenic - common in gynae surgery delayed diagnosis may lead to loin pain, fever and urinary leak

ureteric trauma | contrast CT?

management of ureteric trauma

prophylactic stenting