Haematuria Flashcards
What is the definitive way to differentiate between concentrated urine (appearing brown) and visible haematuria?
A urine dipstick test (haematuria will show blood on dipstick, concentrated urine will not).
What are the most common causes of haematuria presenting as brown urine? (3)
Renal stones
Renal inflammatory conditions (such as nephritis)
Benign prostatic hyperplasia (BPH)
What is a normal residual urine volume (post-voiding)?
<100ml
What eGFR is required to safely give a patient contrast prior to an MRI scan?
An eGFR >30ml/min
What investigations should be conducted to investigate an enlarged prostate? (3)
-Prostate-specific antigen (PSA) blood test
-MRI scan (with contrast)
-Prostate biopsies
What is Contrast-Induced Nephropathy (CIN)?
An acute kidney injury caused by the nephrotoxic effects of IV contrast medium given to patients during radiological investigations, particularly iodine-based contrast agents.
How is Contrast-Induced Nephropathy (CIN) defined? (2)
An elevation of serum creatinine of more than 50% of baseline within 48 hours, OR a reduced urine output (<0.5ml/kg/hour) for at least 6 hours.
What is prostate-specific antigen (PSA)?
A serine protease, or protein of the prostate, which functions as part of the semen to help its liquefaction.
Over what level of prostate-specific antigen (PSA) are suspicions for metastatic prostate cancer much higher?
Over 50 mcg/L
What is PIRADS?
A system that rates prostate tissue from 1-5, as to whether it looks normal, or like cancer. (PIRADS score of 5 = presence of cancer is very likely.)
What is Gleason Scoring?
A way of defining the aggressiveness of a prostate cancer, where two scores out of 5 are added together to give a score out of 10 (higher score = more aggressive).
What are Grade Groups in the context of prostate cancer?
A way of simplifying Gleason Scores, where group 1 is the best prognosis and group 5 is the worst prognosis (a Gleason Score of 9 or 10).
What is the difference between active surveillance and watchful waiting?
Active surveillance - regular monitoring tests (PSAs, DREs, MRI and biopsy) but curative treatment only provided if changes occur suggesting progression of disease.
Watchful waiting - also involves waiting to see if symptoms or condition worsen, however check ups are normally done by GP and involve less tests; if treatment does begin at any point, it is usually not curative and just aims to manage symptoms.
How frequently is PSA checked during active surveillance?
Every 3-4 months
When is an MRI scan repeated during active surveillance?
At 12 months after previous scan
What are the treatment options if active surveillance shows worsening disease in prostate cancer? (2)
-Radical prostatectomy
-Radical radiotherapy (given alongside hormone treatments).
What are the classical symptoms of metastatic prostate cancer? (6)
-Tiredness
-Weight loss
-Bony aches and pains
-Loss of sensation/power to legs
-Urinary retention
-Constipation
Describe the difference between prostate cancer and benign prostate hypertrophy (BPH) on a digital rectal exam (DRE).
In prostate cancer, the prostate will feel hard, irregular and asymmetrical on DRE.
In BPH, the prostate may feel enlarged but smooth and elastic on DRE.
What are the ways of achieving androgen deprivation therapy?
-Bilateral orchidectomy
-GnRH analogues/LHRH agonists (given as slow release injections)
-GnRH antagonists/LHRH antagonists
What medication can be given to prevent the symptom flare associated with starting GnRH analogues/LHRH agonists for prostate cancer?
2 weeks of anti-androgen drugs
What is the International Prostate Symptoms Score (IPSS)?
A commonly used questionnaire in Urology clinics, that gives an objective severity grading to a patient’s symptom.
(Used in NICE guidelines on BPH as a threshold for treatments, and helps determine if treatments have improved the score.)
What is nocturnal enuresis?
Involuntary urination whilst asleep (bedwetting).
According to NICE, what medication should a patient with voiding Lower Urinary Tract Symptoms (LUTS) be started on (provided they have a small prostate [<30cc] and a PSA<1.5 if applicable)?
An alpha blocker, such as Tamsulosin.
What is a hydrocele?
A collection of fluid around the testicle.
What is a varicocele?
Abnormal chronic dilatation of the pampiniform plexus.
