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Year 3 OSCE > Miscellaneous Urology > Flashcards

Miscellaneous Urology Flashcards

1
Q

Acute bacterial prostatitis

A

E. coli

Recent UTI, catheterisation, prostate biopsy

Painful rectum, voiding symptoms, fever, rigors, DRE- tender, boggy prostate

14-day course of quinolone eg. Ciprofloxacin, screen for STI

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2
Q

Causes of acute urinary retention

A

BPH
Urethral strictures, calculi, constipation, pelvis masses (NB- not ureters, we have two, so both need compressing to cause AUR)
Drugs- anticholinergics, TCA, opioids, benzodiazapenes, antihistamines
Neurological- MS, PD, spinal cord lesion
UTI
Postoperative

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3
Q

Features of AUR

A

Inability to pass urine
Lower abdominal discomfort
Considerable pain or distress
Delirium (esp. elderly)

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4
Q

AUR vs CUR

A

Typically painless and overflow incontinence (nocturia)

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5
Q

Investigations for AUR

A

Urinalysis, microscopy culture and sensitivities
UE, FBC, CRP
Bladder USS (volume of greater than 300cc)

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6
Q

Subtypes of CUR

A

High pressure- impaired renal function and bilateral hydronephrosis (due to bladder outflow obstruction)

Low pressure- normal renal function and no hydronephrosis

Decompression haematuria commonly occurs after catheterisation for CUR due to rapid decrease in pressure. Requires no treatment.

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7
Q

Medical indications for circumscision

A

Phimosis
Recurrent balantitis
Balantitis xerotica obliterans
Paraphimosis

NB- must exclude hypospadias prior to circumscion

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8
Q

Epididymal cysts

A

Most common cause of scrotal swelling seen in primary care

Separate from body of testicle
Posterior to testicle

Associated- PKD, CF, Von hippel lindau syndrome

USS diagnosis

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9
Q

Epididymo-orchitis

A

Infection of epididymis or testes resulting in pain and swelling- usually due to spread of infection from genital tract or bladder

20’s and sexually active- chlamydia trachomasis, (Neisseria gonnorhoea less so)
Over 35’s- E coli

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10
Q

Features of EO

A

NB- need to exclude testicular torsion

Unilateral testicular pain and swelling
Urethral discharge

If organism unknown, ceftriaxone 500mg IM once, plus doxycycline 100mg BD for 10-14 days

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11
Q

Factors favouring an organic cause of ED

A

Gradual onset of symptoms
Lack of swelling
Normal libido

NB- vascular are the most common organic causes of ED

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12
Q

Factors favouring a psychogenic cause of ED

A

Sudden onset
Decreased libido
Spontaneous or self stimulated erections
Major life events
Problems or changes in a relationship
Previous psychological problems
History of premature ejaculation

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13
Q

Risk factors for ED

A

Advancing age
CVD- obesity, DM, smoking, dyslipidaemia, HTN
Alcohol use
Drugs- SSRI, beta blockers

NB- vascular are the most common organic causes of ED

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14
Q

Investigations for ED

A

Calculate 10 year cardiovascular risk
Testosterone (between 9 and 11am)

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15
Q

Management of ED

A

PDE5 inhibitors (slidenafil, viagra)
Vacuum erection devices if people cannot take PDE5 inhibitor (ie. recent MI)

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16
Q

Hydrocele

A

Accumulation of fluid in the tunica vaginalis
Communicating- peritoneal fluid enters scrotum (common in newborn males and resolve within first month of life)
Non communicating- excess production

They can develop secondary to- epididymo-orchitis, testicular torsion, testicular tumours

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17
Q

Features and management of hydrocele

A

Soft non tender swelling of the scrotum (anterior and below scrotum usually)
Transillumimates
May be difficult to palpate if hydrocele is large

USS to rule out underlying pathology (although can be clinical)

Children- repaired if don’t resolve by 1-2 years
Adults- conservative. USS to rule out underlying pathology

18
Q

Causes of hydronephrosis

A

Unilateral- PACT

Pelvic ureteric obstruction (congenital or acquired)
Aberrant renal vessels
Calculi
Tumours of renal pelvis

Bilateral- SUPER

Stenosis of urethra
Urethral valve
Prostatic enlargement
Extensive bladder tumour
Retro peritoneal fibrosis

19
Q

Investigation and management of hydronephrosis

A

USS
CT KUB

Remove obstruction and drain urine
Acute- nephrostomy tube
Chronic- ureteric stent or pyleoplasty

20
Q

Renal cell carcinoma

A

Most common is clear cell

Associations- middle aged men, smoking, Von hippel lindau syndrome, tuberous sclerosis, slight increase with ADPKD (not much)

21
Q

Features of renal cell carcinoma

A

Triad- haematuria, loin pain, abdominal mass
Pyrexia of unknown origin
Endocrine effects- EPO (polycythaemia), PTH (hypercalacemia), ACTH
Paraneoplastic hepatic dysfunction syndrome
Varicocele (left sided, tumour suppresses veins)

NB- varicocele can be a testicular tumour or a renal one

Management- nephrectomy, alpha interferon and IL2

NB- patients with a T1 tumour (i.e. < 7cm in size) are typically offered a partial nephrectomy (more= radical nephrectomy)

22
Q

Risk factors for renal calculi

A

Dehydration
Hypercalcuria, hypercalcaemia, hyperparathyroidism
Cystinuria
High dietary oxalate
Rental tubular acidosis
PKD
Drugs- calcium stones: loop diuretics (furosemide, bumetinide), steroids, acetazolamide, theophylline (thiazides (indapamide, bendroflumethazide), prevent calcium stones by causing hypocalcuria)

Urate stones- gout, ileostomy (acidic urine, bicarbonate lost)

23
Q

Potassium sparing diuretics

A

Aldosterone antagonists
Spironalactone, eplenrone

24
Q

Varicocele

A

Abnormal enlargement of testicular veins (associated with infertility)

Commonly on left side
Look and feel like a bag of worms
Subfertility

Diagnose with Doppler

Usually conservative management, occasionally surgery if pain

25
Q

Testicular cancer

A

95% are germ cell tumours (seminomas and non seminomas (embryonal, yolk sac, teratoma etc.)

Non germ cell tumours include leydig cell tumours and sarcomas

26
Q

Risk factors for testicular cancer

A

Infertility
Cryptorchidism
FH
Kilenfelters syndrome
Mumps orchiditis

(Teratoma-25 years, seminoma- 35 years)

27
Q

Features of testicular cancer

A

Painless lump is most common presentation
Pain in minority
Hydrocele
Gynaecomastia (increased oestrogen to androgen ratio)

Germ cell tumours release hCG

28
Q

Tumour markers

A

Germ cell tumours

Seminoma- hCG elevated
Non-seminomas- AFP/beta hCG elevated
LDH elevated

USS first line

Refer to urology, then chemo, radio, and orchidectomy

NB- non-seminoma is 2 words, so 2 markers are raised

29
Q

Features of testicular torision

A

Pain is severe and sudden onset
Pain may be referred to lower abdomen
Nausea and vomiting may be present
Swollen, tender testis retracted upwards
Red skin
Cremasteric reflex lost
Elevation of testes doesn’t ease the pain (Prehns sign)

Urgent surgical exploration (if tortes testes identified them both testes fixed as condition of a bell clapper testes is often bilateral)- never elective (even if patient has had episodes before and not presented)

NB- USS is imaging modality of choice (whirlpool sign)

30
Q

TURP syndrome

A

Large volumes of glycine absorbed during TURP procedure, causes hyponatrameia, hyper ammonia (get CNS, respiratory and systemic Sx)

31
Q

Causes of urethral stricture

A

Iatrogenic (traumatic placement of indwelling catheter lines)
STI (gonorrhoea)
Hypospadias
Lichen sclerosus

32
Q

Vasectomy

A

More effective than female sterilisation
Contraception until semen analysis reveals azoospermia twice before unprotected sex (usually 16/20 weeks- doesn’t work right away)
Chronic testicular pain, bruising, hameatoma, infection, sperm granuloma

33
Q

Which testicular cancer is associated with cystic lesions containing heterogeneous solid echoes?

A

Teratoma

34
Q

Complication of goserelin treatment (GnRH analogue)

A

During the first stages of treatment, goserelin may cause a transient increase in symptoms of prostatic cancer. This is known as the ‘flare effect’ and is caused by an initial increase in luteinizing hormone production prior to receptor down-regulation.

Flutamide, a synthetic antiandrogen, can be used pre-emptively to attenuate the tumour flare through its antagonistic effects at androgen receptors.

35
Q

Paediatric phimosis

A

In children less than 2 years of age, phimosis (a non-retractable foreskin) is normal and will most likely resolve with time

36
Q

Vesicovaginal fistulae

A

Vesicovaginal fistulae should be suspected in patients with continuous dribbling incontinence after prolonged labour and from a country with poor obstetric services. A dye stains the urine and hence identifies the presence of a fistula.

37
Q

Investigating UTI’s in children

A

All children under 6 months with their first UTI should have an abdominal ultrasound within 6 weeks (or during the illness if there are recurrent UTIs or atypical bacteria)- send for MCUG if recurrent UTI’s under 6 months

Children with recurrent UTIs should have an abdominal ultrasound within 6 weeks

Children with atypical UTIs should have an abdominal ultrasound during the illness

38
Q

Mnemonic for LUTS

A

FUN WISE (storage and voiding)

Frequency
Urgency
Nocturia

Weak stream
Intermittency/hesitancy
Straining
Emptying incomplete

39
Q

PDE5 inhibitors

A

eg. sildenafil (viagra)

Contraindications

patients taking nitrates and related drugs such as nicorandil
hypotension
recent stroke or myocardial infarction (NICE recommend waiting 6 months)

Side effects

visual disturbances ie. blue discolouration/ischaemic neuropathy
nasal congestion
flushing
gastrointestinal side-effects
headache
priapism

NB- blue tablet for blue discoloration

40
Q

Varicocele that doesn’t dimmish when lying down

A

This patient has signs and symptoms consistent with a varicocele (subfertility and a testicular mass similar in feeling to a ‘bag of worms’) that does not diminish when lying down. This should raise suspicion of compression of the renal vein which suggests the presence of an abdominal or retroperitoneal mass, such as malignancy. As well as this, right-sided varicoceles alone are rare and should further raise suspicion of this, therefore necessitating an urgent referral for suspected malignancy. It is important to note that this may be a sign of renal cell carcinoma, and up to 50% of cases are diagnosed incidentally.

41
Q

Preservation of cremaster reflex in testicular torsion

A

The cremasteric reflex is usually preserved when the torsion affects the appendage only.

42
Q

Phimosis management

A

Under 2- conservative

Year 3 OSCE (61 decks)

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