Passmed Uro Flashcards
Complications of Transurethral Resection
TURP
Tur syndrome
Urethral stricture/UTI
Retrograde ejaculation
Perforation of the prostate
Features of TUR syndrome
1 Hyponatraemia: dilutional
- Fluid overload
- Glycine toxicity
How does rhabdomyolysis cause AKI
Acute tubular necrosis
3 causes of raised PSA
BPH / Ca
Prostatitis / UTI
ejaculation
urinary retention
Gold standard Ix for stones
non-contract CT scan.
Best Ix in bladder Ca
Flexible cystoscopy
Acute upper urinary tract obstruction due to stone mx?
nephrostomy
ESWL is for smaller
2 causes of unilateral / bilat hydronephrosis
Uni - PACT Pelvic-ureteric obstruction (congenital or acquired) Aberrant renal vessels Calculi Tumours of renal pelvis
Bilat - SUPER Stenosis of the urethra Urethral valve Prostatic enlargement Extensive bladder tumour Retro-peritoneal fibrosis
Mx of chronic urinary tract obstruction
Ureteric stent or a pyeloplasty
Renal cell carcinoma usual pres?
Paraneoplastic features?
haematuria
hypertension and polycythaemia
Nephroblastoma vs neuroblastoma on imaging
neuroblastoma is usually calcified
CI to circumscision
hypospadius
Which stones are caused by excessive tissue breakdown ? (they are radiolucent)
Uric acid
A 72-year-old man is diagnosed with prostate cancer and goserelin (Zoladex) is prescribed. Which one of the following is it most important to co-prescribe for the first three weeks of treatment?
cyproterone acetate
[Anti-androgen treatment such as cyproterone acetate should be co-prescribed when starting gonadorelin analogues due to the risk of tumour flare. This phenomenon is secondary to initial stimulation of luteinising hormone release by the pituitary gland resulting in increased testosterone levels.]
Which testie tumour often has normal afp / hcg levels
seminoma
Most common renal malignancy
renal adenocarcinoma
Key comp and Ix to check following acute urinary retention
AKI
Serum creatinine
How long does finasteride take to work/
SEs?
up to 6 months
erectile dysfunction, reduced libido, ejaculation problems, gynaecomastia
2 inherited associations with RCC
von Hippel-Lindau syndrome
tuberous sclerosis
1st line mx for chronic urinary retention
intermittent self catheterisation
1 piece of advice and 2 drug options for noctuira
advise about moderating fluid intake at night
furosemide 40mg in late afternoon
desmopressin
When do you get a bulbar urethral rupture
traddle type injury e.g. bicycles
when do you get a membranous urethral rupture
pelvic fracture
Ix traumatic urethral injury.?
Mx?
Investigation
ascending urethrogram
Management suprapubic catheter (surgical placement)
Eg of an anti androgen used with goserelin to prevent initial rise in testosterone?
flutamide
1 piece of advice and 2 drug options for noctuira
advise about moderating fluid intake at night
furosemide 40mg in late afternoon
desmopressin
A 67-year-old man presents with painless frank haematuria. He recently began complaining of a mild testicular ache and describes his scrotum as a ‘bag of worms’. He is a heavy smoker smoking 60 cigarettes a day for 47 years. On examination he is cachectic. His left testicle appears to have a tortuous texture. His blood reveals anaemia and polycythemia. What is the most likely diagnosis?
RCC of left kidney
A 15-year-old boy develops sudden onset of pain in the left hemiscrotum. He has no other urinary symptoms. On examination the superior pole of the testis is tender and the cremasteric reflex is particularly marked.
Torsion of testicular appendage
The cremasteric reflex is usually preserved when the torsion affects the appendage only.
A 14-year-old boy develops sudden onset severe pain in the left testicle radiating to the left groin. He is distressed and vomits. On examination the testis is very tender and the cremasteric reflex is absent.
torsion of the spermatic cord
The cremasteric reflex is usually absent in torsion.
Eg of an anti androgen used with goserelin to prevent initial rise in tesotsterone?
flutamide
A 19-year-old man attends his GP after noticing a lump in his scrotum while showering. He reports some discomfort in the area but no pain. He is in a long-term relationship with his girlfriend and his last sexual health screen two weeks previously was clear.
On examination, there is a soft mass on the anterior aspect of the left testis that is indistinguishable from the testis itself. It is not tender to touch and transilluminates.
Which of the following is the most likely diagnosis?
Hydrocoele
Hydrocoeles can be differentiated from other testicular lumps as they are not separate to testis and transilluminate
Which stones are radio lucent
urate + xanthine stones
