GU/Renal Flashcards
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
Management of BPH
sometimes watchful waiting
first line = alpha blockers = tamsulosin
5a-reductase inhibitors = finasteride
surgery = TURP
involuntary leakage of urine or sudden urge to pass urine
urge incontinence
involuntary leakage on exertion, coughing or sneezing
stress incontinence
involuntary leakage on exertion and sudden urge to pass urine
mixed incontinence
management of urge incontinence
first line = oxybutynin, (alt = tolterodine & darifenacin)
mirabegron in elderly patients
bladder retraining for 6 weeks
management of stress incontinence
duloxetine
pelvic floor muscle training
surgery
management of undescended testes
orchidopexy at 6-18months
= inguinal exploration and mobilise testes
retractile testes
usually appear in warm conditions
surgery usually indicated
soft, non tender swelling
swelling confined to the scrotum
transillumination
difficult to palpate if large
hydrocele
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
painless scrotal swelling - usually left
‘bag of worms’
subfertility
varicolcele
Ix for varicocele
US and doppler studies
management of varicocele
usually conservative
supportive underwear and analgesia for any discomfort
semen analysis if concerned with subfertility
abrupt onset of abdominal pain - mainly in flank/loin
nausea and vomiting
haematuria
some haematuria, dysuria, and straining
nephro/urothialisis = renal stones
black/dark brown stones
radiopaque
acidic urine
calcium oxalate stones
dirty white
radiopaque on X-ray
calcium phosphate
Ix for renal stones
urine dip = exclude infection
non-contrast CT KUB
US if pregnant
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
ureteric obstruction management
urgent decompression surgery
complex renal calculi and staghorn calculi
percutaneous nephrolithotomy
persistent erection lasting over 4 hrs
pain localised to penis
history of trauma to genital/perianal region
priapism
Ix in priapism
cavernosal blood gas analysis
Doppler or duplex ultrasonography
management of priapism
if longer than 4hrs = aspiration/shunt blood from the cavernosa and saline flush
if aspiration fails = phenylephrine
surgical options considered
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
US
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
