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SpC Urology > Prostate and cards > Flashcards

Prostate and cards Flashcards

1
Q

What are the male LUTS?

A

Nocturia, frequency, urgency, post-micturition dribbling, poor stream/flow, hesitency, overflow incontinence

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2
Q

What tests should be done in a male presenting with LUTS?

A

Need to assess impact on life and do PR
MSU, u and e, ultrasound bladder, PSA (prior to PR)
Transrectal ultrasound +/- biopsy

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3
Q

What is the non surgical management for BPH?

A

Lifestyle: avoid caffine/ alcohol as increases urgency, relax when voiding, train the bladder to hold on
Drugs: alpha blockers e.g. tamsulosin decrease smooth muslce tone
5 alpha reductase inhibitors - decreases prostate size over months

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4
Q

What is the surgical management of BPH?

A

transurethral recetion of prostate - may cause impotence, erectile dysfunction and retrograde ejaculation
Transurethral incision of prostate
Retropubic prostatectomy

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5
Q

What advice should be given after a transurethral resection of the prostate?

A

Avoid driving for 2 weeks
Avoid sex for 2 weeks
Reduced semen volume from retrograde ejaculation
Haematuria normal
Initially increased frequency of urination

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6
Q

Where does BPH occur in the prostate vs cancer?

A

BPH centrally, cancer peripherally

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7
Q

What type are most prostate cancers and how do they spread?

A

Most are adenocarcinomas in the peripheral prostate, they spread to the local area via lymph (seminal vesicles, bladder, rectum) or haematogenously to the bone (Spine)

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8
Q

What are some of the symptoms of prostate cancer?

A

Can be asymptomatic or nocturia, heistency, poor flow, terminal dribbling or obstruction
Decreased weight and bone pain suggests mets

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9
Q

How is a diagnosis of prostate cancer made?

A

It is a combination of DRE findings (hard, irregular)
Increased PSA (can be normal)
Transrectal ultrasound/biopsy
CT/MRI

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10
Q

How is staging for prostate cancer done?

A

This is done by MRI

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11
Q

How is prostate cancer treated?

A

In disease confined to prostate:
-Radical prostatectomy
-Radical radiotherapy (external beam or brachytherapy) with neo adjuvant and adjuvant hormonal therapy
-Hormonal therapy alone - delays further tumour growth
Metastatic:
-hormonal therapy can help, radiotherapy for spinal mets

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12
Q

What are the PSA agegroup cutoffs?

A

50-59 years - <3ng/ml
60-69 years - <4ng/ml
Above 70 - <5ng/ml
NICE reccommends over 3 gets referral for all ages

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13
Q

What is the likelihood of a PSA beign accurate?

A

Only one third of those with raised PSA will actually have prostate cancer

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14
Q

What are the features of renal cell cancer?

A 
Often asymptomatic and found incidentally
Haematuria
Loin pain
Abdo mass
Anorexia
Malaise
weight loss
Cancompress left renal vein and cause varicocoele
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15
Q

What are the tests for renal cell carcinoma?

A 
Bloods -FBC polycythaemia from epo, ESR, u and E
BP raised from renin secretion
Urine - RBCs
Imaging - US
MRI - canon ball mets
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16
Q

What is the treatment of renal cell carcinoma?

A

Radical nephrectomy
Can use ablation or cryotherapy for patients not fit for surgery
Generally radio/chemo resistent
For those that have metastasised, try T cell activation therapies

17
Q

Where do transitional cell carcinomas arise?

A

Bladder (50%), ureter or renal pelvis

18
Q

How do transitional cell carcinomas present?

A

With painless haematuria, recurrent UTIs, voiding irritability

19
Q

How is a diagnosis of transitional cell carcinoma made?

A

Cystoscopy with biopsy is diagnostic
CT urogram is both diagnostic and provides staging
MRI can show involved nodes

20
Q

How is transitional cell carcinoma treated?

A

If confined to the epithelium or submucosa:
-Transurethral resection of bladder tumour
-Intravesical BCG immunotherapy can provoke immune attack
If invading:
-Radical cystectomy is gold standard

21
Q

What is a cause of an abdominal mass and haematuria in a child?

A

A nephroblastoma (Wilms tumour)

22
Q

How dos penile cancer present?

A

With chronic fungating ulcer, bloody discharge

50% spread to lymph at presentation

23
Q

What is the treatment fo penile cancer?

A

Radiotherapy if early, amputation and lymph node dissection if late

24
Q

What are some of the prognostic factors to determine treatment in prostate cancer?

A

PSA level pretreatment
TNM
Tumour grade (gleason score)

25
Q

What organisms commonly cause balanitis?

A

Staphs and streps

26
Q

What is the treatment of balanitis?

A

Antibiotics
Circumcision
Hygiene advice

27
Q

What is phimosis?

A

This is when the foreskin occludes the meatus

This caues recurrent balanitis in young boys

28
Q

What is paraphimosis?

A

This is when a tight foreskin becomes retracted and is irreplacable

29
Q

What is the treatment of paraphimosis?

A

Ask the patient to squeeze the glans
Apply 50% glucose soaked swab
Lidocaine and ice packs can be helpful
May require surgery

SpC Urology (7 decks)

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