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Junior Surgery > Haematuria (urology) > Flashcards

Haematuria (urology) Flashcards

1
Q

Define AKI

A

Sudden deterioration in kidney function

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2
Q

NICE specifications for presence of AKI

A
  • urine output <0/5ml/kg for 6 hours
  • > 50% rise in creatinine over 7 days
  • 26 micromol rise in creatinine over 48 hours
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3
Q

Serum creatinine and urine output in AKI stage 1

A

Serum creatinine: 150-200% increase or 25 umol/l increase in 48h
Urine output: <0.5ml/kg/h for 6h

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4
Q

Serum creatinine and urine output in AKI stage 2

A

Serum creatinine: 200-300% increase
Urine output: 0.5 ml/kg/h for 12 h

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5
Q

Serum creatinine and urine output in AKI stage 3

A

Serum creatinine: >300% increase or >350umol/l with acute rise of >45umol/l in 48h
Urine output: <0.3ml/kg/h for 24h or anuria for 12h

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6
Q

What is pre-renal AKI

A

Occurs when the blood supply to the kidney is interrupted
2 causes:
- shock : hypovolemic, cardiogenic, distributive
- renovascular obstruction: aortic dissection, renal artery stenosis, ACEi

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7
Q

What is acute tubular necrosis

A

Prolonged interruption to the blood supply ischaemia leads to necrosis of the cells that line the renal tubules
- leads to porous tubular membranes and also blockage of the tubules by necroses cells
- urine is isotonic with plasma and has high sodium as concentrating powers are lost

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8
Q

What is post renal AKI

A

Occurs when there is obstruction to the outflow of the urinary tract
Leads to back flow of urine, damage to the kidney architecture and resultant organ failure
Blockage is often in the ureters

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9
Q

3 causes / mechanisms of renal AKI

A

Acute tubular necrosis (85%)
Interstitial nephritis (10%)
Glomerular disease (5%)

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10
Q

Causes of acute tubular necrosis

A

Drugs: aminoglycosides, cephalosporins, radiological contrast mediums, NSAIDs
Toxins: heavy metal poisoning, myoglobinuria, haemolytic uraemic syndrome

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11
Q

Pathophysiology of interstitial nephritis

A

Mainly caused by drugs
Damage is not limited to tubular cells and bypasses the BM to cause damage to the interstitium
- mainly caused by abx, diuretics, PPI, allopurinol

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12
Q

Management of interstitial nephritis

A

Withdrawal of the drugs and a short course of oral steroids

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13
Q

Anatomy of the glomerulus

A

3 layers for substances to pass through
1. Fenestrated capillary epithelium
2. BM
3. Visceral layer: formed by interdigitating podocytes

These create a sieve that allows small, charged ions through

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14
Q

Pathophysiology of glomerulonephritis

A

Antibody / T cell mediated immunological attack upon an antigen in the glomerulus which may be primary (always there) or secondary (acquired)

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15
Q

Examinations / investigations in AKI

A

Obs : hypotension = pre renal / hypertension = CKD
OE: palpable bladder = bladder outlet obstruction
Urine dip and MCS
Bloods
VBG /ABG: to assess acid / base status
ECG: hyperkalaemia
Renal USS: to look for post renal causes

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16
Q

Management of AKI

A
  1. Halt any damaging drugs eg ACEi / NSAIDs
  2. Treat pre renal causes with iv fluids
  3. Refer to urology to relieve obstruction
  4. Assess fluid status with volume replacement
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17
Q

Indications for acute dialysis

A

Refractory hyperkalaemia
Refractory acidosis
Pulmonary oedema
Uraemic pericarditis / encephalopathy

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18
Q

Causes of hyperkalaemia

A

AKI / CKD
Drugs: supplements, K sparing diuretics, ACEis, NSAIDs
Acidosis
Others: addisons / tumour lysis syndrome / burns

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19
Q

How does hyperkalaemia present on ECG

A

Tall, peaked T waves
Widened QRS complex
Flattened P waves / prolonged PR interval

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20
Q

What to do if there is >6.5mmol/L potassium or there are ECG changes

A
  1. Start continuous ECG monitoring
  2. 10ml of 10% calcium gluconate IV to stabilise myocardium (repeat at 5min intervals until a max of 3 doses)
  3. 50ml of 50% glucose with 10U ACTRAPID insulin into a large vein over 30mins to decrease K+ conc
  4. Consider 10mg salbutamol neb
  5. If pH <7.2 consider sodium bicarbonate IV if advised by renal reg
  6. Recheck K+ after 2 hours
  7. Calcium resonium can then be given orally / rectally - long term option
  8. Ensure underlying cause is being treated
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21
Q

What is benign prostatic hyperplasia

A

Benign nodular / diffuse proliferation of glandular layers of the prostate, leading to enlargement of the inner transitional zone
Affects 70% of those >70

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22
Q

BPH symptoms

A

Filling: urinary freq (nocturia), urinary urgency

Voiding: hesitancy, poor stream, post void dribbling, strangury, retention with overflow incontinence

Complications: haematuria, UTI, post renal aki

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23
Q

BPB investigations

A

PR: enlarged prostate, typically the sulcus is still palpable
Bloods: FBC, U&E, PSA
Urinalysis
Bladder USS
Transrectal USS

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24
Q

BPH complications

A

UTI
Overflow incontinence
Bladder calculi
Bladder diverticulae
Bilateral hydronephrosis and renal failure

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25
Q

Management of BPH

A

Acute:
- catheter to relieve obstruction (urethral or suprapubic)

Chronic:
- lifestyle: avoid alcohol + caffeine, relax when voiding, void twice in a row to help emptying, bladder retraining therapy

Alpha blockers: reduce SM tone

5a-reductase inhibitors: stop conversion of testosterone to dihydrotestosterone thus decreasing enlargement

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26
Q

Surgical management of BPH

A

Transurethral resection of the prostate
- 10% risk of impotence and 20% need repeat in 10years
- retrograde ejaculation almost universal
- bleeding
- hyponatraemia

Holmium laser prostatectomy
- endoscopic procedure used for very large prostates
- urinary incontinence may occur if too much gland is removed

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27
Q

Epidemiology of PCa

A

2nd most common malignancy in males
Present in 80% of males >80 but only 4% die from it
Slowly progressive malignancy
Mainly adenocarcinomas arising in peripheral prostate

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28
Q

PCa risk factors

A

Age
FH
Black ethnicity
Raised testosterone levels

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29
Q

PCa presentation

A
  • often asymptomatic (found on PR)
  • may present with filling, voiding or complication symptoms
  • weight loss / bone pain suggest advanced metastatic disease
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30
Q

PR findings in prostate examinations

A

Hard ‘craggy’ prostate

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31
Q

PSA levels in PCa

A

> 10mg/ml highly suggestive of tumour
Not a reliable screening method as can be affected by many factors such as cycling, UTI, recent intercourse and catheterisation

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32
Q

Gleason scoring for PCa

A

2 areas of biopsied tissue are graded out of 5 in terms of histological features of aggression to give a combined score out of 10
Gleason grade is vital for prognosis with scores of <6 being low risk and >8 being high risk

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33
Q

What is the D’amico risk stratification

A

Combines gleason score with clinical stage and PSA to give a more accurate prognostic score than gleason score

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34
Q

Management of T1/T2 prostate cancer

A

Patient choice between:
- active surveillance - regular PSA / DRE / biopsy
- curative surgery : radical prostatectomy
- curative radiotherapy / brachytherapy

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35
Q

Management of T3/T4 prostate cancer

A

Choice between radiotherapy or surgery

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36
Q

Management of metastatic prostate cancer

A

Hormonal therapy is first line aiming to decrease the stimulatory effect of testosterone on PCa cell division
- androgen deprivation / blockade

Chemotherapy - used if relapsed on hormonal therapy

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37
Q

Prognosis of PCa

A

Has a 5 year survival rate of over 95% when diagnosed at stage 1-3
This falls to 49% of those with stage 4

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38
Q

Most common malignancy affecting the urinary system

A

Bladder cancer

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39
Q

What type of cell is mainly affected in bladder cancer

A

Transitional cell

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40
Q

Clinical features of bladder cancer

A

Painless frank haematuria
Lower urinary tract symptoms (frequency, urgency, dysuria)
Symptoms of bladder outlet obstruction (urinary retention / post renal AKI)
Fever
Weight loss
Malaise

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41
Q

Risk factors for bladder cancer

A

Smoking
Aromatic amines: rubber, plastic, dye
Chronic cystitis
Pelvic irradiation

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42
Q

Bladder cancer investigations

A

Urinalysis
Any painless haematuria should be assumed malignant (2WW referral for cystoscopy)
Any suspicious lesion will be biopsied or resected via a transurethral resection of bladder tumour
CT abdo

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43
Q

Treatment for bladder cancer T1 bladder carcinomas

A

Transurethral resection of bladder tumour performed at cystoscopy with intravesical chemotherapy
5 year survival 95%

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44
Q

Treatment of T2-T3 bladder carcinomas

A

Radical cystectomy is gold standard with pre-operative chemo
An ileal conduit is used to leave an urostomy

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45
Q

Treatment of T4 bladder carcinomas (invasion beyond bladder)

A

Palliative care

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46
Q

Risk factors of SCC of the bladder

A

Schistosomiasis
Bladder calculi
Chronic UTI

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47
Q

2 types of renal tumours

A

Vascular tumours that arise from the proximal tubular epithelium (90%)
TCC’s of the renal pelvis

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48
Q

Risk factors for renal cancer

A

Male
Smoking
HTN
Polycystic kidney disease
Chronic haemodialysis

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49
Q

Presentation of renal cancer

A

50% incidental findings
10% present with classic triad: haematuria, loin pain, abdo mass
- constitutional symptoms
- varicocele due to invasion of left renal vein
- polycythaemia

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50
Q

Renal cancer investigations

A

Urine cytology
USS to differentiate between solid and cystic mass
CT / MRI for tumour staging
Cannon ball lung metastases on CXR
Brain metastases also common

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51
Q

Treatment of renal cell carcinomas

A

Radical nephrectomy
Partial nephrectomy (if smaller than 5cm)
Post op immunotherapy
65% 5 year survival for renal disease treated surgically

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52
Q

What is a wilm’s tumour

A

Comprise 20% of childhood malignancies
Undifferentiated mesodermal tumour
Present generally at 3.5yrs with flank pain and abdo mass
Should not be biopsied

Tx:
- nephrectomy and pre-operative chemo

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53
Q

Aetiology of urinary tract calculi

A

Renal calculi form in the collecting ducts of the kidney and may then be deposited anywhere from the renal pelvis to the urethra
Commonly composed of calcium oxalate
15% lifetime risk
Peak age 20-40
M:F 3:1

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54
Q

Presentation of urinary tract calculi

A

Renal colic: excruciating loin to groin spasms with N&V, patient cannot lie still
Occurs if stone is impacted in the ureter

Dull loin pain - if the stone is in a major / minor calyx

UTI - secondary to the partial / complete obstruction

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55
Q

Risk factors for urinary tract calculi

A

Obesity
Dehydration / low fluid intake
FH / personal history of stone disease
Anatomical abnormalities

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56
Q

Investigations for suspected urinary tract calculi

A

Bloods
Urine dip
Urine MCS
Imaging : non contrast CT KUB

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57
Q

Acute management of urinary tract calculi

A

A-E assessment
75mg Diclofenac IM unless contraindicated
Avoid NSAID in the presence of AKI
IM metoclopramide if N&V
IV abx if signs of infection - infected obstructed kidney is surgical emergency

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58
Q

When should admission be indicated in urinary tract calculi

A

If there is still severe pain at 1hr
Risk of AKI
Signs of shock / infection
Uncertainty over diagnosis

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59
Q

Indications for active treatment in urinary tract calculi

A

Low chance of spontaneous passage
Persistent pain
Ongoing obstruction
Signs of infection
Renal insufficiency

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60
Q

What is extracorporeal shockwave lithotripsy (for urinary tract calculi)

A

Outpatient procedure that focuses shockwaves on the stone to break it up and it can then be passed spontaneously

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61
Q

What is uretoscopy

A

Various energy sources eg laser can be used to break up the stone

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62
Q

What is percutaneous nephrolithotomy

A

Used for renal calculi that do not respond to ESWL

63
Q

Conservative treatment for urinary tract calculi

A

Tamsulosin (a blocker) or nifedipine (CCI) increase rate of spontaneous expulsion

Advise:
- many (80%) of stones will pass naturally
- maintain high fluid intake
- return if there is any increase in pain or infection

Try to pass urine through sieve to collect stone for analysis

64
Q

Aetiology of UTI

A

E. coli is the most common organism involved
- proteus, staphylococcus, streptococcus, klebisella and pseudomonas

65
Q

Clinical presentation of cystitis (lower UTI)

A

Frequency and nocturia
Dysuria
Urgency
Haematuria
Smelly urine
Suprapubic pain / tenderness
Strangury

66
Q

Predisposing factors for cystitis

A

Female sex: due to short urethra
Pregnancy
Menopause
Obstruction / tract malformation
Catheter
Diabetes - reduced host defences

67
Q

Cystitis investigations

A

Urine dip : nitrates and leukocytes indicate infection
Midstream urine MCS: confirm diagnosis if >10^5 pathogenic organisms / ml

68
Q

Management of asymptomatic bacteruria

A

Treat only in pregnancy

69
Q

Management of uncomplicated UTI

A

UTI in healthy non pregnant women
3 days of oral abx as per local guidelines
Drink plenty of fluids

70
Q

Management of complicated UTI

A

Eg males, diabetes, structural anomalies, catheter
5-7 days abx treatment
If systemically unwell initiate the sepsis 6

71
Q

Management of recurrent UTI

A

Consider renal tract imaging
Advise on high fluid intake, frequent voiding (inc after intercourse), avoidance of spermicidal jellies, avoidance of constipation
If this fails, prophylaxis with trimethoprim / nitrofurantoin at night

72
Q

Clinical presentation of pyelonephritis (upper UTI)

A

High fever
Loin pain with tenderness
Rigors, vomiting and oliguria
Signs of sepsis

73
Q

Investigations of pyelonephritis

A

As per lower UTI + bloods
- often markedly raised inflammatory markers

74
Q

Management of pyelonephritis

A

Often systemically unwell and at risk of sepsis so hospital admission for IV abx therapy is generally required

75
Q

What is a urethral stricture

A

A scar of the urethral epithelium which commonly extends into the underlying corpus spongiosum
Fibroblastic activity leads to a shortening of urethral length and narrowing of luminal size

76
Q

Causes of urethral stricture

A

Blunt perineal trauma:
- straddle injury, pelvic fracture

Iatrogenic
- traumatic / long term catheterisation

Infective
- gonococcal

Balanitis xerotica obliterans
- rare, characterised by white atrophic plaques

77
Q

Traumatic causes of urethral stricture

A

Straddle injury
Pelvic fracture

78
Q

Iatrogenic causes of urethral stricture

A

Traumatic / long term catheterisation

79
Q

Infective causes of urethral stricture

A

Gonococcal

80
Q

What is Balanitis xerotica obliterans

A

A rare condition that causes urethral stricture characterised by white atrophic plaques leading to phimosis

81
Q

Presentation of urethral stricture

A

Obstruction voiding symptoms that worsen gradually
- initial frequency / dysuria
- hesitancy / straining
- splayed stream

82
Q

Severe presentation of urethral stricture

A

Urinary retention and post obstructive AKI

83
Q

OE of urethral stricture

A

Areas of the penis consistent with periurethral scarring
No prostate abnormalities

84
Q

Investigations for suspected urethral stricture

A

Uroflowmetry
Urethrogram: to determine stricture length, location, calibre and significance
Ureteroscopy

85
Q

Management of urethral stricture

A

Catheterisation is necessary for those presenting in acute urinary retention
(Severe strictures and retention may require suprapubic catheterisation)

1st line is optical urethrotomy
Urethroplasty for those that recur (50%)

86
Q

What is phimosis

A

Narrowing of the preputial orifice
Usually idiopathic
Can be congenital
Can be secondary to chronic Balanitis or forcible retraction of the foreskin

87
Q

Presentation of phimosis

A

In children: ballooning of the foreskin and poor stream during urination
In adults: pain during intercourse and inability to retract foreskin

88
Q

Management of phimosis

A

Topical corticosteroids
Advice to gently try to retract the foreskin nightly in warm baths

Circumcision

89
Q

What is paraphimosis

A

A tight foreskin is pulled over the glans obstructing venous return, leading to a swollen painful glans. As it swells it becomes difficult to replace the foreskin.
This can occur following erection or urethral catheterisation

90
Q

Treatment of paraphimosis

A

Emergency: local anaesthesia and then applying pressure to the glans
If this is unsuccessful incise a slit into foreskin dorsally
Circumcision can be offered to prevent recurrence

91
Q

Luminal causes of bladder outlet obstruction

A

Bladder tumour

92
Q

Mural causes of bladder outlet obstruction

A

Urethral stricture
Congenital abnormalities
Neuropathic bladder

93
Q

Mural causes of bladder outlet obstruction

A

Urethral stricture
Congenital abnormalities
Neuropathic bladder

94
Q

Extramural causes of bladder outlet obstruction

A

BPH
Prostatic carcinoma
Phimosis
Paraphimosis

95
Q

What is priapism

A

Persistent erection of the corpora cavernosa of the penis
Corpora spongiosum remains flaccid

96
Q

What is priapism

A

Persistent erection of the corpora cavernosum of the penis
Corpora spongiosum remains flaccid

97
Q

Causes of priapism

A

Mainly idiopathic
Can be associated with C spine trauma, sickle cell disease and intracavernosal injections for impotence

98
Q

Complications of priapism

A

If prolonged can cause ischaemia
Pain is a good indicator of this

99
Q

Management of priapism

A

Emergency: local ice packs, IV hydration, high flow O2
Many then need needle aspiration of the corpus cavernosum +/- injection of alpha agonists
May need urgent urological review for surgical intervention

100
Q

What is Peyronie’s disease

A

Upwards curvature of the penis when erect affecting 1-3% of all men
Can lead to sexual dysfunction

101
Q

Cause of Peyronie’s disease

A

Fibrous scarring following trauma has been postulated

102
Q

Management of Peyronie’s disease

A

Managing associated psychosocial issues eg depression
Surgical intervention may be indicated if there are issues with penetration

103
Q

Causes of penis carcinoma

A

HPV 16/18
Smokers
Immunosuppression

104
Q

Presentation of carcinoma of the penis

A

Persistent red patch on the penis progressing to an infiltrating ulcer
Never urethral involvement / symptoms

105
Q

What is an epididymal cyst

A

Common condition due to cystic degeneration of epididymal structures
Associated with polycystic kidney disease and CF
Previously termed spermatocele

106
Q

Presentation of epididymal cyst

A

Lump should be clear and transilluminate
Separate from the testes almost always at the upper pole
Contained fluid may be clear or contain sperm and be milky
Painful

107
Q

Management of epididymal cyst

A

Can be excised if cause symptoms but drainage often leads to recurrence

108
Q

What is a hydrocele

A

Collection of peritoneal fluid between the parietal and visceral layers of the tunica vaginalis
Most common cause of scrotal enlargement

109
Q

What is a primary hydrocele

A

Can be idiopathic or due to congenital defects in the processus vaginalis that allows communication between the tunica vaginalis and the peritoneal cavity

110
Q

What is a secondary hydrocele

A

Fluid collects due to underlying inflammation in the epididymis / testes or an underlying cancer

111
Q

OE of hydrocele

A

Fluctuant swelling that transilluminates

112
Q

Management of hydrocele

A

Most are not troublesome and reassurance of its benign nature is suitable treatment
If the swelling is causing problems excision of the hydrocele sac is possible
Aspiration often leads to recurrence

113
Q

What is a varicocele

A

Varicosities of the pampiniform plexus most commonly on the left side
Presents in nearly 10% of men
Dragging sensation and dull ache
Associated with reduced spermatogenesis and subfertility

114
Q

OE of varicocele

A

Feels like a bag of worms on palpation and they may only be palpable in the standing position

115
Q

Why are varicoceles more common on the left side

A

Left testicular vein drains to the left renal vein whereas the right testicular vein drains to the IVC
Valvular incompetency at the junction of the left renal vein is what leads to varicocele

116
Q

Management of varicocele

A

Reassurance of benign nature
Radiological embolisation of the left renal vein
Surgical ligation and division of the testicular veins

117
Q

What is testicular torsion

A

A surgical emergency occurring when the testicle twists upon its pedicel obstructing venous return
Without prompt relief the testicle will be unsalvageable

118
Q

Epidemiology of testicular torsion

A

Predominantly adolescents 12-18
Usually history of mild trauma to the testicle or previous attacks of less severe pain due to partial torsion and spontaneous resolution
Usually due to a congenital abnormality eg testicular maldescent / bell clapper testes

119
Q

Clinical presentation of testicular torsion

A

Sudden onset severe pain in the groin
Pain can sometimes be lower abdominal
Pain often associated with vomitting

120
Q

OE of testicular torsion

A

Unilateral hot, swollen tender testis
Testis may be found lying high and transverse within the scrotum
Cremasteric reflex is absent
Stroking of the skin of the inner thigh normally causes the cremaster muscle to contract and pull the ipsilateral testicle towards the inguinal canal

121
Q

Investigations for suspected testicular torsion

A

Doppler USS show lack of blood supply to testes in equivocal cases
Never delay surgical intervention if torsion is suspected

122
Q

Differentials of testicular torsion

A

Epididymitis
Torsion of the testicular appendage

123
Q

Management of testicular torsion

A

Manual distortion can be attempted under analgesia for temporary pain relief but urgent surgery still required

If testis is still viable:
- untwist and suture to the tunica vaginalis with fixation of the contralateral testicle also

If non viable:
- orchidectomy and fixation of the contralateral testis should occur
- salvage rate of 80% is achievable in patients operated on within 6 hours of initial torsion

124
Q

What is torsion of the testicular appendage

A

Pathology and presentation similar to testicular torsion but it is an embryologically remnant that twists rather than the testicle itself
Less painful
No elevation of the testis
Classically causes a small blue nodule to become visible under the scrotum
Classically occurs at the start of puberty

125
Q

What is epididymitis / epididymis - orchitis

A

Acute infection of the epididymis / epididymis and testicle

126
Q

Aetiology of epididymitis

A

Infections most commonly arise due to ascending infection
- STI
- UTI
- haematogenous eg mumps / TB

127
Q

Presentation of epididymitis

A

Painful swelling of the infected epididymis
- presence of testicular pain, swelling and tenderness suggests spread to the testes also
- history of discharge
- may be a reactive hydrocele
- rare systemically unwell

128
Q

OE of epididymitis

A

Pain and tenderness on palpation of the epididymis
Positive phren’s test
Scrotal elevation relieves pain in epididymitis

129
Q

Investigations for epididymitis

A

First catch urine MCS and STI screen
Scrotal USS to rule out other diagnoses

130
Q

Management of epididymitis

A

Oral abx
NSAIDs
Scrotal elevation
Empiric abx are based on whether the man is high risk for STI and should always be reviewed once the STI / UTI screen is back

131
Q

Risk factors for testicular cancer

A

Undescended / ectopic testes
Infertility
Hypospadia
Family / personal history

132
Q

Pathophysiology of seminoma (testicular tumour))

A

Arise from the semineferous tubules
Classically seen in 30-40yr olds
Have a solid appearance macroscopically
Microscopically can range from well differentiated spermatocyte cells to undifferentiated round cells

133
Q

Pathophysiology of non-seminomatous germ cell tumours (NSGCTs)

A

Including teratomas, yolk sac tumours and choriocarcinomas
Arise from totipotent germ cells classically seen in 20-30yr olds
Have a cystic appearance macroscopically and variable cell types microscopically

134
Q

Clinical presentation of testicular cancer

A

Painless lump in the testes
Hydrocele
Haematospermia
Symptoms of metastases (abdo swelling or breathlessness) - first palpable node is likely to be supraclavicular
Can rarely present as gynaecomastia due to paraneoplastic hormone production

135
Q

Testicular cancer investigations

A

Scrotal USS - can reveal a solid tumour in the presence of hydrocele

Tumour markers
- NSGCTs usually produce AFP, some bHCG
- seminomas - never produce AFP, 10% produce bHCG

CT CAP

136
Q

Management of testicular cancer

A

Early surgical intervention
Retroperitoneal lymph node dissection
Adjunctive chemo +/- radiotherapy
Sperm banking due to the risks of infertility

137
Q

Prognosis of testicular cancer

A

Node negative cases have nearly 100% 5 year survival
Overall 5year survival is >90%

138
Q

Indications for urinary catheterisation

A

Acute urinary retention
A need for precise urine output monitoring eg AKI, sepsis, major surgery
For bladder irrigation
For patients requiring epidural anaesthesia

139
Q

Contraindications of urinary catheterisation

A

Known abnormalities of the urethra
Recent urological surgery

140
Q

Alternatives to urinary catheterisation

A

If the patient is able to void into bottles this can provide accurate urine output monitoring
For those requiring long term catheters, suprapubic catheterisation is preferred

141
Q

Complications of urinary catheterisation

A

Introduction of infection
Traumatic insertion - haematuria, false passage creation, urethral strictures
Bladder stones / bladder malignancy

142
Q

Red flags for bladder cancer

A

Patient >60
Unexplained, non visible haematuria
Dysuria or raised white cell count on blood test

143
Q

First line analgesia for renal colic

A

IM Diclofenac

144
Q

What is decompression haematuria

A

Occurs commonly after catheterisation for chronic urinary retention due to the rapid decrease in the pressure in the bladder

145
Q

Management of overactive bladder

A

Antimuscarinic agent eg tolterodine or oxybutynin

146
Q

What is a radical nephrectomy

A

Removal of the kidney, perinephric fat and local lymph nodes
Used for renal cell carcinoma invading renal capsule or >7cm

147
Q

When is a partial nephrectomy done

A

RCC
Patients with a T1 tumour <7cm in size

148
Q

What is the classic triad of renal cell carcinoma

A

History of haematuria
Flank pain
Palpable renal mass

149
Q

Management of congenital hydrocele in a newborn baby

A

Reassurance and observation initially
If it doesn’t resolve then elective surgery in 1-2 years

150
Q

What can acute urinary retention cause in older patients

A

Delirium

151
Q

Side effects of alpha 1 adrenergic receptor antagonist eg tamsulosin

A

Dizziness + postural hypotension as it can cause systemic vasodilation

152
Q

What is bladder voiding measured by

A

Urodynamic studies

153
Q

What is the most common site affected in ischaemic colitis

A

Splenic flexure

X-ray will show thumbprinting

Junior Surgery (6 decks)

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