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Urology (Surgery) > Presentations > Flashcards

Presentations Flashcards

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
Q

extra testicular causes of scrotal lumps?

A

varicocoele

hydrocoele

epididymitis

epididymal cysts

inguinal hernias

26
Q

testicular causes of scrotal lumps?

A

testicular tumours

orchitis

benign testicular lesions

testicular torsion

27
Q

what is hydrocoele ?

A

abnormal collection of peritoneal fluid between the visceral and parietal layers of the tunica vaginalis enveloping the testis

28
Q

how does hydrocoele present?

A

painless fluctuant lump

transilluminates

29
Q

cause of infant hydrocoele?

A

patent processus vaginalis

30
Q

what is varicocoele?

A

distension of the pampiniform venous plexus within the spermatic cord

31
Q

how does varicocoele present?

A

fluctuant painless lump

feels like a bag of worms

32
Q

why are varicocoeles more common on the left side?

A

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
Q

red flags for varicocoele ?

A

acute onset

right sided

present when lying flat

34
Q

how does epididymitis present?

A

acute onset unilateral scrotal pain

some associated swelling and erythema

35
Q

most common cause of acute onset scrotal pain?

A

epididymitis

36
Q

treatment for epididymitis?

A

oral antibiotics

analgesia

37
Q

how can you determine if a scrotal lump is an inguinal hernia?

A

you cant get above an inguinal hernia

38
Q

how would a malignant lump in the testis differ from other causes of lumps?

A

hard and irregular

will not transilluminate

non-mobile

39
Q

what investigations are required if suspecting a testicular tumour?

A

urgent USS of testis

tumour markers (AFP, b-hCG, LDH)

40
Q

what is testicular torsion?

A

twisting of the testis around the spermatic cord leading to ischaemia

41
Q

how does testicular torsion present?

A

severe acute onset unilateral scrotal pain

associated nausea and vomiting

red

swollen

42
Q

what reflex is lost in testicular torsion ?

A

cremasteric reflex

43
Q

what types of benign testicular lesions are there?

A

leydig cell tumours

sertoli cell tumours

lipomas

fibromas

44
Q

what is orchitis ?

A

inflammation of the testis themselves

rare in isolation

45
Q

main cause of orchitis ?

A

mumps virus

46
Q

what facial sign is usually seen before orchitis?

A

parotid gland swelling

47
Q

what treatment does testicular torsion require ?

A

urgent testis exploration

urgent surgery to prevent permanent damage

48
Q

what full set of investigations would you order if a patient arrived with scrotal pain?

A

urine dip

urine MC&S (if infection indicated)

routine bloods

USS of testis

+ tumour markers if malignancy suspected

49
Q

what are the differentials for scrotal pain ?

A

epididymitis

testicular torsion

orchitis

testicular tumours

referred pain

50
Q

What is the main investigative method for lower urinary tract vs upper urinary tract

A

Lower = flexible cystoscopy

Upper = US KUB (non-visible Haematuria) and CT urogram (visible haematuria)

Urology (Surgery) (5 decks)

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