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1
Q

What does LUTS refer to?

A

any symptoms that affect the quality and control of micturition in the lower urinary tract

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2
Q

most common cause of LUTS in men? and women?

A

BPH

UTI

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3
Q

what lifestyle factors can exacerbate LUTS?

A

drinking excessive fluids late at night

excess caffeinated drinks

excess alcohol

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4
Q

LUTS are divided into two categories - what are they?

A

storage and voiding symptoms

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5
Q

what types of medication can exacerbate LUTS?

A

anticholinergics

antihistamines

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6
Q

Voiding symptoms?

A

Hesitancy

poor flow rate

terminal dribble

feeling of incomplete emptying

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7
Q

storage phase symptoms?

A

frequency

urgency

nocturia

urge incontinence

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8
Q

Initial investigations into LUTS?

A

post-void bladder scan

routine bloods - FBC, U&Es, LFTs, CRP, PSA

Urine frequency and volume chart

urinalysis

urine MC&S

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9
Q

specialist investigations into LUTS?

A

urodynamic studies

cystoscopy

CT or USS

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10
Q

Conservative management of LUTS?

A

pelvic floor exercises

reduced fluid intake

reduced alcohol and caffeine intake

bladder training techniques

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11
Q

Pharmacological management of LUTS?

A

anticholinergics e.g. Oxybutynin for overactive bladder

alpha blockers e.g. Tamsulosin for BPH

loop diuretics have been shown to help with nocturia

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12
Q

most common causes of haematuria ?

A

UTI - most common

Bladder and renal cancer

renal calculi

pyelonephritis

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13
Q

investigations into haematuria ?

A

urinalysis

routine bloods + PSA

CT and USS

Gold standard = flexible cystoscopy

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14
Q

gold standard investigation into haematuria ?

A

Flexible cystoscopy

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15
Q

what is urinary retention ?

A

inability to pass urine

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16
Q

most common cause of acute urinary retention?

A

BPH

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17
Q

potential causes of acute urinary retention?

A

BPH

urethral strictures

neuro (multiple sclerosis)

medication

constipation

prostate cancer

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18
Q

clinical features of acute urinary retention?

A

acute suprapubic tenderness/pain

palpable distended bladder

inability to micturate

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19
Q

investigations into acute urinary retention ?

A

routine bloods + PSA

DRE if indicated

post-void bladder scan

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20
Q

what is high pressure urinary retention ?

A

refers to such high pressures within the bladder that it backs up into the ureters and kidney’s

leading to hydroureter and hydronephrosis

can cause significant AKI and CKD if recurrent

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21
Q

Management of acute urinary retention ?

A

immediate catheterisation

then treat underlying cause

if no evidence of renal impairment try a TWOC

22
Q

what is post-obstructive diuresis?

A

post-catheterisation the kidney over dialyses resulting in excessive solute and water loss

can result in worsening AKI

treated with resus fluids

23
Q

what is the first line of imaging in scrotal lumps ?

A

USS of scrotum

24
Q

what tumour markers can be tested for in testicular cancer?

A

lactate dehydrogenase (LDH)

b-hCG

alpha Fetoprotein (AFP)

25
extra testicular causes of scrotal lumps?
varicocoele hydrocoele epididymitis epididymal cysts inguinal hernias
26
testicular causes of scrotal lumps?
testicular tumours orchitis benign testicular lesions testicular torsion
27
what is hydrocoele ?
abnormal collection of peritoneal fluid between the visceral and parietal layers of the tunica vaginalis enveloping the testis
28
how does hydrocoele present?
painless fluctuant lump transilluminates
29
cause of infant hydrocoele?
patent processus vaginalis
30
what is varicocoele?
distension of the pampiniform venous plexus within the spermatic cord
31
how does varicocoele present?
fluctuant painless lump feels like a bag of worms
32
why are varicocoeles more common on the left side?
the left testis drains via the left renal vein and so is prone to blockage or compression - compared to right testis which drain via the inferior vena cava
33
red flags for varicocoele ?
acute onset right sided present when lying flat
34
how does epididymitis present?
acute onset unilateral scrotal pain some associated swelling and erythema
35
most common cause of acute onset scrotal pain?
epididymitis
36
treatment for epididymitis?
oral antibiotics analgesia
37
how can you determine if a scrotal lump is an inguinal hernia?
you cant get above an inguinal hernia
38
how would a malignant lump in the testis differ from other causes of lumps?
hard and irregular will not transilluminate non-mobile
39
what investigations are required if suspecting a testicular tumour?
urgent USS of testis tumour markers (AFP, b-hCG, LDH)
40
what is testicular torsion?
twisting of the testis around the spermatic cord leading to ischaemia
41
how does testicular torsion present?
severe acute onset unilateral scrotal pain associated nausea and vomiting red swollen
42
what reflex is lost in testicular torsion ?
cremasteric reflex
43
what types of benign testicular lesions are there?
leydig cell tumours sertoli cell tumours lipomas fibromas
44
what is orchitis ?
inflammation of the testis themselves rare in isolation
45
main cause of orchitis ?
mumps virus
46
what facial sign is usually seen before orchitis?
parotid gland swelling
47
what treatment does testicular torsion require ?
urgent testis exploration urgent surgery to prevent permanent damage
48
what full set of investigations would you order if a patient arrived with scrotal pain?
urine dip urine MC&S (if infection indicated) routine bloods USS of testis + tumour markers if malignancy suspected
49
what are the differentials for scrotal pain ?
epididymitis testicular torsion orchitis testicular tumours referred pain
50
What is the main investigative method for lower urinary tract vs upper urinary tract
Lower = flexible cystoscopy Upper = US KUB (non-visible Haematuria) and CT urogram (visible haematuria)

Urology (Surgery) (5 decks)

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