Surgery A - Red flag/ 2ww urology referrals

Question 1

75 y/o male

pc: 4 day hx, painless visible haematuria on and off, started on the way back from holiday in Spain
pmh: MI 6months ago, angioplasty. CVD risk factor well controlled with amlodipine, simvastatin and clopidogrel. TURP for BPH ten years ago. smoked since 15.

systemically well currently

which element of the urology 2 week waiting criteria does he meet?

Answer 1

• aged 45 and over
• have visible haematuria
• without UTI

Question 2

when making a 2WW urology referral what are you duties are a referrer?

Answer 2

• make sure patient is aware of suspected cancer diagnosis and what to expect
• make sure patient available for next 4 weeks
• all information electronically sent and complete

Question 3

75 y/o male

pc: 4 day hx, painless visible haematuria on and off, started on the way back from holiday in Spain
pmh: MI 6months ago, angioplasty. CVD risk factor well controlled with amlodipine, simvastatin and clopidogrel. TURP for BPH ten years ago. smoked since 15.

systemically well currently

possible cause of haematuria in this patient?

Answer 3

• bladder/ renal or prostate cancer
• post TURP bleed
• being on clopidogrel

other causes
- uti, renal stone, bah, glomerulonephritis , trauma

Question 4

benign conditions that may discolour the urine

Answer 4

menstruation

jaundice

beetroot

dyes

drugs (rifampicin, metronidazole, nitrofurantoin, warfarin, phenytoin)

Question 5

23 y/o male

pc: left hemiscrotum lump, not painful, otherwise fit and healthy

OE: discreet, hard craggy mass replacing the lower pole of left testis

possible differential?

Answer 5

• concerned about testicular tumour
• most common cancer males 20-40 y/o
• key clinical feature: unilateral, painless testiular lump
• mass typically irregular, firm, fixed, does not transilluminate on examination

Question 6

primary testicular tumours are categorised into:

Answer 6

1. germ cell tumours - 95%
   - -> seminomas
   - -> non-seminomatous
   - -> usually malignant
2. non germ cell tumours - 5%

Question 7

non-germ cell tumours usually comprise of:

Answer 7

• leydig cell tumours

- Sertoli cell tumours

Question 8

non-seminomatous germ cell tumours usually comprise of:

Answer 8

yolk sac tumours

choriocarcinoma

teratoma

often metastasise, worse prognosis than seminomas

Question 9

for patients with suspected case of testicular cancer, what investigations would you od:

Answer 9

• tumour markers
• beta hcg
• AFP
• LDH (tumour volume)
• scrotal USS, then CTPA for staging post confirmation of diagnosis

Question 10

what is the surgical approach for a radical orchidectomy?

why is it used?

Answer 10

• groin approach
• so all cord structures can be removed
• avoid going through scrotal skin which has a different lymph node drainage pattern

Question 11

when should patient with suspected testicular tumour be offered sperm banking?

Answer 11

• before surgery
• before chemo
• consider viral testing, abstaining for 3-4 days

Question 12

treatment options for common types of testicular tumours?

Answer 12

• radical orchidectomy
• surveillance
• chemo, radio therapy, resection of different mets

Question 13

treatment options available for small renal tumours?

Answer 13

• observation
• radioablation
• nephron sparing surgery
• nephrectomy