Renal and genitourinary Flashcards
1
Q
What is benign prostatic hyperplasia (BPH)
A
Non malignant hyperplasia of stromal (CT) and glandular epithelial cells of the prostate
2
Q
What are the RFs of BPH
A
- Increasing age (over 50)
- FHx
- Non-Asian race - Asian men have smaller prostates at any given age
3
Q
Describe the pathophysiology of BPH
A
- Inner transitional zone of the prostate (muscular, gland) proliferate and narrows the urethra
- More difficult to pass urine
- Accumulation of urine causes bladder to dilate
- Results in bladder hypertrophy and promotes bacterial growth (UTI)
4
Q
Describe the presentation of BPH
A
Usually presents with lower urinary tract Sx (LUTS)
* Storage: frequency, urgency, nocturia, incontinence
* Voiding: Weak stream, terminal dribbling, incomplete emptying, straining, dysuria
5
Q
4 investigations of BPH
A
- DRE - smooth, symmetrical & enlarged
- Prostate-specific antigen (PSA) - raised but not specific
- Urine dipstick - assess for infection and haematuria
- CT/MRI pelvis - prostate size and shape
6
Q
Why is PSA testing an unreliable investigation
A
- Can be raised for several conditions: prostate cancer, BPH, Prostatitis, UTI, vigorous exercise
- High rate of false positives (75%)
- Prostate specific not cancer specific
7
Q
Describe the management of BPH (not including surgery)
A
- May not require intervention if mild & manageable Sx = watchful waiting
Medical: - Alpha blockers (Tamsulosin) - relax bladder neck
- 5-alpha reductase inhibitors (finasteride) - gradually reduce size of prostate
8
Q
When should caution be taken prescribing alpha blockers
A
Patients with postural hypotension or micturition syncope
9
Q
Describe the MOA of 5-ARI in BPH
A
5-ARI blocks the synthesis of dihydrotestosterone and reduce levels of DHT in the prostate leading to a reduction in size
* Takes up to 6 months for effects to result in improved symptoms
10
Q
What is a common side effect of 5-ARI
A
Sexual dysfunction due to reduced testosterone
* e.g. erectile dysfunction, low libido
11
Q
Give 3 complications of TURP
A
- Retrograde ejaculation (mc) - semen goes backwards
- Urethral stricture
- Bleeding
12
Q
Describe the surgical management of BPH
A
<30g:
*Transurethral incision of prostate
30-80g:
* Transurethral resection of prostate (TURP)
* Holmium laser enucleation of prostate (HoLEP)
> 80g:
* Open prostatectomy
* Transurethral electrovaporisation of prostate (TUVP)
13
Q
Define nephrolithiasis
A
- A.k.a renal stones or calculi or urolithiasis
- Hard stones found within urinary tract
14
Q
Give 3 RFs of kidney stones
A
- Dehydration
- HyperPTH/ HyperCa
- Previous kidney stones
15
Q
Explain the pathophysiology of kidney stones
A
- Urine is a combo of water and solutes
- Excess solutes cause supersaturated urine
- Solutes precipitate
16
Q
Describe 5 types of kidney stone
A
- Calcium oxalate (mc) - black/dark brown, radiopaque, envelope shaped
- Ca phosphate - dirty white, radiopaque, wedge shaped
- Uric acid - red/brown, radiolucent, diamond
- Struvite (ammonium Mg phosphate) - infection stones, coffin-lid shaped
- Cystine - yellow/light pink stone, radiolucent, hexagonal
17
Q
RF of struvite stones
A
UTI
18
Q
2 RFs of Ca oxalate stones
A
- HyperCa
- Chron’s
19
Q
Describe the presentation of renal stones
A
- Renal colic:
unilateral loin to groin pain
colicky = fluctuates as stone moves and settles - Moving restlessly
- Haematuria
- N+V
- Fever - sepsis
20
Q
Describe the investigation of kidney stones
A
- GS: Urgent Non-contrast CT kidney ureter, bladder (CT KUB) - calcifications
- Urinalysis - microhaematuria
- Renal US: pregnancy and under 16 - calcifications and dilation
- Urine pregnancy test - exclude pregnancy and ectopic pregnancy
21
Q
Describe the acute management of nephrolithiasis
A
- IV fluids
- Analgesia: NSAIDS
Ibuprofen/ rectal diclofenac
IV paracetamol if NSAIDs CI - Ab if infection
22
Q
Describe the management of nephrolithiasis <10mm
A
- If stones are <5mm they should pass spontaneously
- Alpha blocker (Tamsulosin) may be given to help passage of ureteric stones between 5-10mm
23
Q
Describe the surgical management of nephrolithiasis
A
- 2nd - Ureteroscopy - retrieve through urethra (higher stone free rate)
- 1st - Shock wave lithotripsy (SWL) - sound waves to break stone into fragments (least invasive)
- 3rd (1st if >20mm): Percutaneous nephrolithotomy (PCNL) - remove stone through incision in back (very invasive)
- Open surgery
24
Q
What are the guidelines on preventing recurrent stones
A
- Increase fluid intake (2.5-3L)
- Add fresh lemon to water
- Maintain normal Ca
- Reduce dietary salt intake
- Limit dietary protein
25
What food should be avoided in calcium stones
Oxalate-rich foods
* Spinach
* Rhubarb
* Nuts
* Black tea
26
Which food should be avoided in uric acid stones
Purine-rich food
* Kidney
* Liver
* Sardines
27
Give 2 complications of nephrolithiasis
* Obstruction and hydronephrosis (swollen) - AKI + RF
* Urosepsis - infected obstructed stone
28
Define acute kidney injury (AKI)
Sudden decline in renal function over hours or days.
29
Describe the classification of AKI (KDIGO)
Kidney Disease: Improving Global Outcomes’ (KDIGO) criteria defines AKI based on one of the following:
- increase in serum creatinine by ≥ 26 micromol/L within 48 hours
- increase in serum creatinine to ≥ 1.5 times baseline within 7 days
- Urine output < 0.5 ml/kg/hr for six hours
30
Prerenal causes of AKI
Due to inadequate blood supply to kidneys (Hypoperfusion):
* HF
* Haemorrhage
* Sepsis
* Hypovolaemia
*Secondary to NSAIDs and ACEi use
31
Intrinsic causes of AKI
Nephron and parenchyma damage:
* Tubular necrosis - mc
* Interstitial nephritis
* Glomerulonephritis
32
Post-renal causes of AKI
Obstruction to outflow:
* Urinary stones
* BPH
* Strictures
* Malignancy - pelvis, abdo
33
6 RFs of AKI
* Over 65
* CKD/ previous AKI
* DM
* HF
* Nephrotoxic drugs - NSAIDs & ACEi
* Multiple myeloma
34
Describe the presentation of AKI
• Pre-renal: Thirst (hypovolaemia) and Hypotension
• Oliguria and haematuria
• LUTS Sx - urgency, frequency
• N+V
• Intrinsic - fever, rash +/- arthralgia
• Post-renal - Palpable bladder
• Fluid overload - swollen ankles, orthopnoea
35
Complications of AKI and how they present
* Hyperkalaemia - arrhythmia
* Hyperuraemia - encephalopathy, bruising, pericarditis
* Fluid overload - oedema
36
Describe the investigation of AKI
* FBC - anaemia, leukocytosis
* U+E - Elevated serum K+
* Urinalysis - nitrates, RBCs, WBCs, proteinuria
* Raised CRP - infection/ vasculitis
* Raised creatinine
* ECG - hyperkalaemia changes
37
Describe management of AKI
* Hypovolaemia - IV fluid
* Hypervolemia - loop diuretics (furosemide)
* Metabolic acidosis - Na bicarbonate
* Hyperkalaemia (>6.5mmol/l) - IV Ca gluconate
* Obstruction - catheter to relieve
* Dialysis for severe cases
38
4 groups of people most affect by UTIs
* Women
* Children
* Elderly
* Hospitalised patients
39
What are the 5 common bacteria that cause UTIs
KEEPS:
* Klebsiella - catheter
* E.coli - mc
* Enterococci
* Proteus mirabilis - renal stones
* Staph. saprophyticus - young women
40
Why are females more susceptible to UTIs than males
Shorter urethra that is closer to the anus so it is easier for bacteria to colonise
41
What investigations are done for all UTIs
* GS: Midstream urine (MSU) sample to send for culture, microscopy and susceptibility testing
* Urine dipstick
42
Name an upper UTI
Pyelonephritis
43
What is pyelonephritis
Infection of renal parenchyma and renal pelvis/ upper ureter
44
Describe the epidemiology of pyelonephritis
* Females <35
* Associated with significant sepsis and systemic upset
45
What are the routes of infection in pyelonephritis
* Ascending - urethra colonised with bacteria during intercourse
* Haematogenous - s.aureus
46
RFs of pyelonephritis
* Frequent sexual intercourse
* Renal stones
* Catheters
* PKD
* DM
* Hx of UTIs
47
Describe the presentation of pyelonephritis
* Flank/ loin pain
* Fever & myalgia
* Costovertebral angle tenderness
* Pyuria (pus + wbc in urine)
* N+V
48
How is pyelonephritis investigated
* Urine dipstick: leukocytes, nitrates, non-visible haematuria
* Blood culture - bacterial growth
* US - rule out obstruction in upper tract
* Raised ESR and CRP
49
Treatment of pyelonephritis
* Broad spectrum Ab - e.g. co-amoxiclav
* Pregnancy: cefalexin or, if severe, IV cefuroxime
* Drain obstructed kidney
* Analgesia - paracetamol
* Fluid replacement
50
Complication of pyelonephritis
Renal abscess - mc in diabetics
51
Define cystitis
Inflammation of the bladder
* Lower UTI
52
Causes and RFs of cystitis
Cause: E.coli - mc
RFs:
* Urinary catheters
* DM
* Frequent sex
* Hx of UTI
* Post menopause
* Female
53
Presentation of cystitis
* Suprapubic tenderness
* LUTS: Dysuria, frequency, urgency
* Haematuria
54
Investigation of cystitis
MSU sample:
* Urinalysis - +ve nitrates, leukocyte esterase and Hb
* Microscopy - RBC, WBC, bacteria
* Culture + sensitivity - identify infecting organism
55
Treatment of cystitis
Non-pregnant women
* oral nitrofurantoin or trimethoprim for 3 days
Complicated, non-pregnant:
* Ciprofloxacin
Pregnant:
* Amoxicillin or cefalexin
56
Define urethritis
Urethral inflammation
* Can be with or without infectious causes
* mc a sexually acquired disease
57
What are the causes of infectious urethritis
* Gonococcal - Neisseria gonorrhoea (N.G)
* Non-gonococcal (mc) - chlamydia trachomatis (C.T)
58
What causes non-infectious urethritis
trauma
Irritation
Urethral stricture
59
5 RFs of urethritis
* Male to male sex
* Unprotected sex
* multiple sex partners
* Age 15-24
* Female sex
60
Signs and symptoms of urethritis
* Can be asymptomatic
* Dysuria
* Urethral itching and pain
* Urethral discharge
61
Investigation of urethritis
* Nucleic acid amplification test (NAAT) - diagnose N.G or C.T
* Culture of urethral discharge
* Gram stain of urethral discharge: gram -ve diplococcus = gonorrhoea
62
Describe results of a culture of urethral discharge of someone with N.G urethritis
Chocolate agar positive
* grey/ white
63
Treatment of urethritis
* NG - IM ceftriaxone with oral azithromycin
* CT - doxycycline 100 mg twice a day for 7 days (or azithromycin in pregnancy)
64
Complication of urethritis
Reactive arthritis
65
What is acute bacterial prostatitis
Acute infection in the prostate presenting with rapid onset of symptoms
66
RFs and causes of acute bacterial prostatitis
E.coli - mc cause
* UTI ++
* mc in men <50
* Benign prostatic enlargement
* Catheters
67
Presentation of acute bacterial prostatitis
* Fever, chills, malaise
* Tender prostate
* LUTS - dysuria, frequency, weak stream
* Warm/ soft boggy gland
* Perineal pain
68
Investigation of acute bacterial prostatitis
* Urine dipstick - leukocytes and bacteria
* Blood and urine cultures - identify organism
69
Treatment of acute bacterial prostatitis
* Oral ciprofloxacin, levofloxacin
* Sepsis: IV piperacillin, IV cefotaxime
* NSAIDs to relieve pain
70
Define chronic prostatitis
Over 3 months of urogenital pain with or without infection
71
Presentation of chronic prostatitis
* Urogenital pain - may affect perineum, genitalia, rectum
* LUTS - dysuria, hesitancy, frequency
* Sexual dysfunction - Erectile dysfunction, pain on ejaculation
72
Treatment of chronic prostatitis
* Analgesia
* Laxatives
* Alpha blockers (Tamsulosin)
* Ab if infection
73
Complications of acute bacterial prostatitis
* Sepsis
* Prostate abscess
* Acute urinary retention
74
Define epididymo-orchitis
* Epididymitis - inflammation of epididymis
* Orchitis - inflammation of the testes
75
Function of epididymis
Coiled tube that stores sperm and transports it from the testes
76
Causes of E-O
* E.coli
* STIs - N.g, C.t
* Mumps
77
Presentation of E-O
* Unilateral scrotal pain and swelling
* Phren's sign: pain relieved with elevating scrotam
* Cremaster reflex intact
78
Investigation of E-O
* Urinalysis - first void sample
* NAAT (Nucleic acid amplification test)
* Culture of urethral secretions
79
Differential diagnosis of E-O
Testicular torsion
80
How is E-O managed
* Ab depending on organism
* Ceftriaxone and doxycycline
* Analgesia
* Supportive underwear
81
Complications of E-O
* Sub-fertility or infertility
* Abscess
* Reactive arthritis
82
What is complicated vs Non-complicated UTI
* complicated- males, pregnant, children, catheterised, immunocompromised
* uncomplicated - non pregnant women
83
What is polycystic kidney disease
* Genetic disorder where the kidneys develop multiple fluid filled cysts
* Can be autosomal dominant or recessive
84
Which type of PKD is more common
Autosomal dominant PKD
85
What causes ADPKD
* PKD1 (mc and severe) and PKD2 mutations
Type 1 is mc a mutation in chromosome 16
Type 2 = chromosome 4
86
Who is most commonly affected by ADPKD
Males aged 20-30
87
Explain the pathophys of ADPKD
* PKD 1 + 2 code for protein polycystin
* In nephron, urinary filtrate flows by and causes cilia to bend
* Polycystin 1 + 2 allow Ca2+ influx which inhibits cell proliferation
* PKD mutation = no inhibition = cell proliferation = cysts
88
Presentation of ADPKD
* Bilateral flank/back/abdo pain
* Painless haematuria - ruptured cysts
* HTN
* Palpable kidneys
* Headaches associated with stroke
89
Investigation of PKD
* Kidney US - enlarged kidney with cysts
* CT/MRI abdo/pelvis - cystic disease, kidney volume
* CT brain - ruptured aneurysm
* Genetic testing - if other tests are inconclusive
90
Management of PKD
* Vasopressin receptor antagonist (Tolvaptan) - slow development of cysts and progression of renal failure
* HTN - ACEi (Ramipril)
* UTIs and infection- Ab (ciprofloxacin)
* Abdo pain and infected cysts - analgesia (avoid NSAIDs)
* Transplant/ dialysis at end stage RF
91
Complications of PKD
* Ruptured cyst
* Renal stones
* Cerebral aneurysm
* End-stage renal failure
92
Describe autosomal recessive PKD
* Less common than ADPKD but more severe
* Disease of infancy
93
Causes of ARPKD
* PKHD1 mutation of chromosome 6
- makes protein called fibrocystin
94
Presentation of ARPKD
* Oligohydramnios - too little amniotic fluid as foetus doesn't produce enough urine
* Potter syndrome (uterine wall compresses foetus) - underdeveloped ear cartilage, low set ears, flat nasal bridge, far set eyes, limb deformities
95
Investigation of ARPKD
• Pre/neonatal US - bilaterally large kidneys with cysts and oligohydramnios
• Kidneys later decrease in size as amount of fibrosis increases
96
Define chronic kidney disease (CKD)
* progressive deterioration in renal function
* Issues develop over at least 3 months
97
Describe the G score for classification of CKD
Based on eGFR
* G1: 90+
* G2: 60-89
* G3a: 45-59
* G3b: 30-44
* G4: 15-29
* G5: <15 (ESRF)
98
Which G scores are not classified as CKD unless accompanied with renal damage
G1 and G2
99
Describe the A score
Based on albumin: creatinine ratio (ACR)
* A1 = <3mg/mmol (normal)
* A2 = 3-30mg/mmol
* A3 = >30mg/mmol
100
RFs of CKD
* HTN (2nd mc)
* DM (mc)
* >50
* Childhood kidney disease
* Glomerulonephritis
* Nephrotoxic drugs (NSAIDs)
* Smoking
101
Pathophysiology of CKD
Many nephrons are damaged in CKD which results in low GFR
* Increase in intra-glomerular pressure with glomerular hypertrophy in response to renal injury
* Increased glomerular permeability to macro-molecules
* These result in toxicity to the mesangial matrix, causing mesangial cell expansion, inflammation, fibrosis, and glomerular scarring
* Increased angiotensin 2 causes upregulation of transforming growth factor beta (TGF-beta) which contributes to mesangial (supportive tissue) scarring
102
Presentation of CKD
* Restless legs
* Pruritus (itching) - accumulation of toxic waste
* Oedema
* Fatigue
* Anorexia
* Nausea +/- vomiting
103
Investigation of CKD
* eGFR - <60mL/min1.73m²
* ACR - >3mg/mmol = significant proteinuria
* Urine dip - proteinuria and haematuria
* Renal ultrasound - bilateral kidney atrophy , evidence of obstruction
104
Management of stage 5 CKD
* Dialysis
* Renal transplant
105
Cx of CKD and how each are managed
* Anaemia - erythropoietin and Fe
* CVD - ACEi (e.g. Ramipril) and statins
* Renal bone disease - calcitriol and reduce dietary phosphate (fish, nuts etc)
* Metabolic acidosis - oral sodium bicarbonate
106
Define nephritic syndrome and give identifying characteristics
Caused by inflammation (T3 hypersensitivity) that damages the glomerular basement membrane leading to:
* Haematuria (+ little proteinuria)
* Oliguria (reduced urine output)
* HTN
* Oedema
107
Give 4 disorders that could cause nephritic syndrome
* Post-streptococcal glomerulonephritis
* IgA nephropathy (mc)
* SLE nephropathy
* Goodpasture's syndrome
108
Presentation of IgA nephropathy (3)
* Visible haematuria - ribena/coke colour
* typically presents 1-2 days after upper respiratory tract infection or gastroenteritis
* typically a young male
109
Investigation of IgA nephropathy
* Kidney biopsy:
- immunofluorescence = IgA deposits in mesangial cells
- Light microscopy = glomerular mesangial proliferation
- electron microscopy: immune complexes are seen in the mesangium
110
How is IgA nephropathy managed
* ACEi - BP control
* corticosteroids
111
State the main DDx of IgA nephropathy and how they can be distinguished
* IgA vasculitis (Henoch-Schonlein purpura)
* IgA nephropathy only affects kidneys whereas IgA vasculitis has systemic effects
112
What is post-streptococcal glomerulonephritis (PSGN)
usually an immunologically-mediated (T3 hypersensitivity) delayed consequence of pharyngitis or skin infections caused by streptococcus pyogenes
113
Investigation of PSGN
* Immunofluorescence - IgG, IgM and C3 deposits along glomerular BM and mesangium (starry sky)
* Light microscope - hypercellular and enlarged glomeruli
* Electron microscope - subepithelial deposits (humps)
114
Presentation of PSGN
* Visible haematuria occurs 1 to 3 weeks after the onset of strep infection
* Proteinuria
* headache and malaise
115
Treatment of PSGN
* Self limiting but can progress depending on age
* Proteinuria - Furosemide
* HTN - Ramipril
* Ab
116
Complication of PSGN
Rapidly progressing glomerulonephritis (RPGN)
117
What is Goodpasture's syndrome
Pulmonary haemorrhage and glomerulonephritis caused by anti-GBM (glomerular BM)
118
Presentation of Goodpasture's
* Haemoptysis (cough up blood), SOB, cough
* haematuria, proteinuria, HTN
* Reduced urine output, lethargy, weight loss
119
Treatment of Goodpasture's
* Prednisolone
* Plasma exchange
120
What is SLE nephropathy
Lupus nephritis secondary to systemic lupus erythematosus
121
Diagnosis of Lupus nephritis
* anti-nuclear antibodies
* anti-double stranded DNA Ab
122
How is lupus nephritis treated
* Corticosteroids
* Immunosuppressants
123
What is the characteristic triad of haemolytic uremic syndrome
* Microangiopathic haemolytic anaemia - physical damage to RBC
* thrombocytopenia
* AKI
124
Causes of HUS
Shiga toxin producing E.coli
125
Tx of HUS
* IV fluids
* Ab with non-E.coli HUS
126
Give identifying characteristics of Nephrotic syndrome
* proteinuria (>3.5g/24h)
* hypoalbuminaemia (<30g/L)
* Peripheral oedema
* Hyperlipidaemia
127
Primary causes of nephrotic syndrome
Due to direct sclerosis of podocytes on the glomerulus
* minimal change disease
* Focal segmental glomerulosclerosis (FSGS)
* Membranous nephropathy
128
Main secondary cause of nephrotic syndrome
Diabetes
129
What is the most common cause of nephrotic syndrome in children
Minimal change disease
130
Investigation of MCD
* Light microscopy - normal glomeruli
* Electron microscopy - Effacement and fusion of podocyte foot processes
131
Causes of Focal segmental glomerulosclerosis
1) Idiopathic
2) Heroin or HIV infection
132
Investigation of Focal segmental glomerulosclerosis
* Light - segmental sclerosis
* Only parts of glomeruli are affected (<50%)
133
Give 3 condition associated with Membranous nephropathy
* infection - HBV, HCV, malaria
* antiphospholipase A2 Ab
* malignancy
134
Investigation of membranous nephropathy
* Light microscopy - thickened GBM caused by subepithelial electron dense deposits
* Electron - Spike and dome appearance - new growth surrounding subpodocytes immune complex deposition
135
How are primary causes of nephrotic syndrome treated
Corticosteroids
* MCD - very responsive
* FSGS - Often resistant, ciclosporin may be used
* MN - corticosteroid + immunosuppressant
136
What is Rapidly progressive glomerulonephritis
50% decline in GFR within 3 months
137
Diagnosis of RPGN
* Light - crescent moon shape in bowman's space
138
What causes RPGN
* Goodpasture's
* Wegener's granulomatosis (GPA)
* Microscopic polyangiitis
139
What 2 conditions can present as both nephrotic and nephritic
* Diffuse proliferative GN
* Membranoproliferative GN
140
What are all testicular lumps assumed to be
Cancer until proven otherwise
141
What is an epididymal cyst
Smooth, extra-testicular sac of fluid above or behind testicle
* Usually harmless
142
Investigation of epididymal cyst
Scrotal ultrasound
143
Signs and Sx of epipidymal cyst
* Palpable lump that will transluminate
* May cause pain if large
* Separate from testicle
144
What is a hydrocele
Painless swelling caused by fluid collection in tunica vaginalis (membrane covering testes)
145
Presentation of a hydrocele
* Irreducible
* Transillumination
* Smooth and within testicle
146
Investigation of a hydrocele
Testicular US
147
What is a varicocele
Abnormal dilated veins within the pampiniform venous plexus
* most occur of the left side
148
Explain the pathophys of a varicocele
* Pampiniform plexus drain into the testicular veins
* Increased resistance and incompetent valves in testicular veins = backflow to pampiniform plexus
* Left testicular vein is longer and joins left renal vein at a right angle
149
Presentation of a varicocele
* Palpable veins (bag of worms)
* Testicular atrophy on affected side
* Painless swelling
150
Investigation of a varicocele
* Mainly clinical
* Scrotal US - done if physical exam is difficult
151
Treatment of a varicocele
* Conservative - reassurance and observation
* If painful/testicular atrophy - surgery
152
Complication of a varicocele
* Infertility
* Testicular atrophy
153
What is testicular torsion
* Twisting of spermatic cord with rotation of the testicle
* Urological emergency
154
Consequence of delayed treatment for testicular torsion
6 hour window after onset before irreversible ischaemia and necrosis
155
Presentation of testicular torsion
* -ve Phren's sign - not relieved on lifting ipsilateral testicle
* N+V
* Firm swollen and tender testicle
* Lower abdo pain
* Testicular pain - unilateral, sudden onset
* Absent cremasteric reflex
156
Describe the cremasteric reflex
* Swipe upper inner thigh
* Normal reflex contract cremaster muscle, pulling up ipsilateral testis
157
RF of testicular torsion
* Bell clapper deformity - when testicle lies horizontal
* <25y/o (mc 12-18)
* Neonate
158
Investigation of testicular torsion
* Immediate surgical exploration
* US to check testicular blood flow, whirlpool sign
159
Treatment of testicular torsion
* Viable testicle: bilateral orchiopexy - untwisted and fixed to scrotal sac
* Non-viable testicle: ipsilateral orchiectomy (removal) and contralateral orchiopexy
160
Complications of testicular torsion
* Infertility/ subfertility
* Pubertal delay
161
Storage LUTS
Occurs when bladder should be storing urine
* Frequency
* Urgency
* Nocturia
* Incontinence
162
Voiding LUTS
bladder outlet obstructed
* Poor stream
* Terminal dribbling
* Hesitancy
* Intermittency
* Straining
163
What could cause difficulty voiding
* BPH
* Urethral stricture
* Masses
164
What are the types of incontinence
* Urge: detrusor muscle overactivity e.g. frequent urination
* Stress: Urinary leakage with increased intraabdo pressure
* Mixed
165
Investigation of incontinence
* Bladder diary
* Post void bladder scan
* U&E
* Cough stress test
166
What is urinary incontinence
Micturition happens involuntarily
167
Tx of stress incontinence
* Pelvic floor exercises
* Lifestyle: reduce caffeine, weight loss
* pseudoephedrine
168
Tx for urge incontinence
* Bladder training
* Lifestyle changes - weight loss, reduce caffeine
* Anticholinergics - e.g. oxybutynin
169
What is retention
Unable to fully empty bladder:
* Typically seen in males
* AKA overflow incontinence
170
What causes retention
* Obstruction
* BPH
* Stones
171
Treatment for urinary retention
Catheter to drain urine
172
What is a renal cell carcinoma (RCC)
adenocarcinoma most commonly arising from the proximal convoluted tubule epithelium
173
RFs of RCC
* Smoking
* Genetic
* Obesity
* Haemodialysis
* HTN
174
State 2 genetic syndromes that are a RF of RCC
* Von Hippel Lindau - loss of tumour suppression gene
* Tuberculosis sclerosis
175
Presentation of RCC
Early RCC is asymptomatic
* Varicocele
Classic triad:
* haematuria
* flank pain,
* abdo mass
176
Investigations of RCC
* 1st: kidney ultrasound
* Gold: CT chest/abdo/pelvis
* Biopsy
177
What was previously used as the main staging of RCC
Robson staging
178
Management of RCC
* Radiofrequency ablation or cryotherapy
* Partial/radical nephrectomy
* Palliative - embolisation
179
Give 3 types of RCC
* Clear cell - mc
* Papillary
* Chromophobe
180
Describe the types of bladder cancer
* transitional cell (urothelium) carcinomas - 90%
* Squamous cell carcinoma - associated with schistosomiasis and stones
* Adenocarcinoma - rare with poor prognosis
181
RFs of bladder cancer
* Smoking
* Aromatic hydrocarbons
* Dyes
* Rubber
* Drugs - cyclophosphamide, Thiazolidinediones
182
Presentation of bladder cancer
* Painless haematuria
* LUTS
* Recurrent UTIs
183
Investigation of bladder cancer
* Flexible cystoscopy - quick, direct visualisation
* Urinalysis - haematuria
184
Management of bladder cancer
* Transurethral resection of bladder
* Intravesical chemo (directly into bladder) - mitomycin and Bacillus Calmette-Guérin (reduce progression and recurrence)
* Cystectomy - muscle invasive
185
Describe non-invasive and invasive bladder cancer
* Non-muscle-invasive bladder cancer - superficial, not invading the muscle layer of the bladder
* Muscle-invasive bladder cancer - invading the muscle and beyond
186
Types of testicular cancer
Germ cell - 90%
non-germ cell
187
2 types of germ cell tumours
* Seminoma - mc, made of germ cells that multiply with no differentiation
* Non-seminoma (Teratoma) - contain several types of tissue
188
2 types of non-germ cell tumours
* Leydig cell tumours
* Sertoli
189
RFs of testicular cancer
* FHx
* Infertility
* Caucasian male
* Cryptorchidism - testis don't descend
* Age - mc 20-40
190
Presentation of testicular cancer
* Firm non-tender testicular lump
* Doesn't transilluminate
191
Investigation of testicular cancer
* Urgent doppler ultrasound
* raised Beta-human chorionic gonadotrophin
* raised LDH (non-specific)
* raised alpha-fetoprotein
* CXR is respiratory Sx
192
Treatment of testicular cancer
* Radical inguinal orchidectomy
* Sperm banking
* Neoadjuvant chemotherapy
193
DDx of scrotal mass
* Testicular torsion
* Hydrocele
* Varicocele
* Epididymal cysts
194
What investigations are essential for visible haematuria
* Upper tract imaging
* Flexible cytoscopy
195
What type of cancer are majority of prostate cancers
Adenocarcinomas growing in the peripheral (outermost) zone of the prostate
196
RFs of prostate cancer
* Age - 50+
* Afro-Caribbean
* FHx
* Genetic - BRCA1 and BRCA2
* Anabolic steroids
197
Presentation of prostate cancers
* LUTS
* Systemic cancer Sx - weight loss, fatigue
* Asymmetrical,, hard, nodular prostate with loss of median sulcus
* Bone pain
198
Where does prostate cancer typically metastasise to
Bone (sclerotic lesions) and lymph nodes
199
Investigation of prostate cancer
* PSA and DRE
* MRI
* Transrectal US and biopsy
* Grading using biopsy - Gleason score (>8)
200
Treatment for localised prostate cancer
* Observation
* Radical prostatectomy
201
Treatment of locally advanced prostate cancer
*Radical prostatectomy
* Radiotherapy with anti-androgen therapy
202
Treatment of metastatic prostate cancer
Hormone therapy:
* androgen deprivation therapy + docetaxel chemo
* GnRH agonists - e.g goserelin
* Bilateral orchidectomy
203
mc type of colorectal cancer
Adenocarcinoma
