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Surgery - Urology Flashcards

1
Q

What is the best form of imaging for kidney stones?

A

CT KUB

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2
Q

Recall the 4 main types of kidney stone in order of highest to lowest radiointensity

A

Calcium phosphate
Calcium oxalate
Triple (struvite) stones
Uric acid (radiolucent)

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3
Q

Which type of kidney stone is associated with urease bacteria?

A

Triple (struvate) stones

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4
Q

Which type of kidney stone is associated with hypercalciuria?

A

Calcium oxalate

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5
Q

How should kidney stone pain be managed?

A

PR/IM diclofenac

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6
Q

Recall one contra-indication to diclofenac

A

CVS disease

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7
Q

How should kidney stones be managed depending on size?

A

<0.5cm: expectant treatment +/- tamsulosin

<2cm: lithotripsy

<2cm and pregnant: uteroscopy

> 2cm (eg staghorn calculi): nephrolithotomy

If hydronephrosis/infection: percutaneous nephrostomy and antibiotics

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8
Q

Recall 2 options for medically managing BPH and some side effects of each

A
  • alpha-1 antagonists (tamsulosin): postural hypotension, dry mouth
  • 5 alpha reductase inhibitors (finasteride): ED, reduced libido, gynaecomastia, ejaculation problems
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9
Q

What is the main way in which BPH can be surgically managed?

A

TURP (transurethral resection of the prostate)

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10
Q

What is the main complication of TURP to be aware of?

A

TURP syndrome

Hyponatraemia, fluid overload and glycine toxicity caused by over-irrigation

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11
Q

When can PSA levels not be done?

A

Within:

  • 6 weeks of a prostate biopsy
  • 1 week of DRE
  • 4w following a proven UTI/prostatitis
  • 48 hours of vigorous exercise and/or ejaculation
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12
Q

When would a multi-parametric MRI be used to investigate possible prostate cancer?

A

If PSA is inappropriate or if high chance of Ca

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13
Q

What is the gold-standard investigation for prostate cancer?

A

TRUS-guided biopsy

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14
Q

Recall 3 options for managing localised prostate cancer (T1/T2)

A
  • Conservative with active monitoring
  • Radical prostatectomy
  • Radiotherapy (external beam and brachytherapy)
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15
Q

Recall 3 options for managing localised advaced prostate Ca

A
  • Hormonal therapy
  • Radical prostatectomy
  • Radiotherapy
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16
Q

How should metastatic prostate cancer disease be managed?

A

Hormonal therapy only

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17
Q

What are the options for hormone therapy in prostate cancer?

A

Synthetic GnRH agonist + 3w cover of anti-androgen

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18
Q

Recall 2 types of benign epithelial renal tumour

A

Papillary adenoma

Renal oncocytoma

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19
Q

What sort of tumour is an angiomyolipoma?

A

Benign mesenchymal renal tumour composed of thick-walled blood vessels, smooth muscle and fat

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20
Q

What is the maximum size for a papillary adenoma?

A

15mm

If more than this = malignant papillary renal cell carcinoma

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21
Q

What type of renal tumour can be seen in Birt-Hogg-Dube syndrome?

A

Renal oncocytoma

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22
Q

What type of renal tumour can be seen in tuberous sclerosis?

A

Angiomyolipoma

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23
Q

Which genetic syndrome predisposes to renal cell carcinoma?

A

Von Hippel Lindau

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24
Q

What are the 3 main subtypes of renal cell carcinoma, and which is most common

A

Clear cell (70%)
Papillary
Chromophobe

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25
Q

Which tumours are people with Von-Hippel-Lindau predisposed to?

A

Phaeochromocytoma
Neuroendocrine pancreatic
Clear cell renal

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26
Q

Which type of renal cell tumour is associated with loss of 3p?

A

Clear cell renal

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27
Q

Which type of renal tumour is associated with long-term dialysis?

A

Papillary renal cell carcinoma

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28
Q

What is Wilm’s tumour?

A

Nephroblastoma

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29
Q

How should high-grade transitional cell carcinomas be managed?

A

1st: intravesical immunotherapy
2nd: radical cystectomy

30
Q

How should traumatic urethral injuries be investigated and managed?

A

Ix: ascending urethrogram
Mx: suprapubic catheter

31
Q

How should traumatic bladder injuries be investigated and managed?

A

Ix: Intravenous urogram or cystogram
Mx: laparotomy if intraperitoneal, conservative if extraperitoneal

32
Q

What proportion of testicular tumours are germ cell tumours?

A

95%

33
Q

What are the subtypes of germ cell testicular tumours?

A

Seminomas (50%)

Non-seminoma (embryonal, yolk sac, teratoma an choriocarcinoma)

34
Q

What is the biggest risk factor for testicular seminoma?

A

Cryptochidism

35
Q

What are the signs and symptoms of testicular cancer?

A

Painless lump +/- hydrocele, gynaecomastia

36
Q

How should testicular cancer be investigated?

A

1st = USS
2nd = AFP, hCG, LDH
3rd = CT TAP
NO biopsy

37
Q

How can testicular cancer be managed?

A

Orchidectomy +/- chemotherapy +/- radiotherapy

38
Q

Is the cremasteric reflex pos or neg in testicular torsion?

A

Neg

39
Q

What is the cremasteric reflex?

A

Stroking of the skin of the inner thigh causes the cremaster muscle to contract and pull up the ipsilateral testicle toward the inguinal canal

40
Q

What is Prehn’s test?

A

Elevating scrotum and assessing for difference of pain - positive if pain is relieved

41
Q

Is Prehn’s test pos or neg in testicular torsion?

A

Neg

42
Q

What condition is Prehn’s test positive in?

A

Epididymitis

43
Q

How should testicular torsion be managed?

A

Surgical exploration + BL orchidopexy

44
Q

What is an orchidopexy

A

Surgical procedure that moves undescended testicle into the scrotum

45
Q

What are the main RFs for ED?

A

EtOH
Drugs (beta-blockers, SSRI)
CVD RFs (metabolic syndrome, hyperlipidaemia etc)

46
Q

How should ED be investigated?

A 
QRisk score 
Free testosterone (9-11am) --> if low, FSH, LH, prolactin --> if abnormal, refer to endo
47
Q

How can ED be managed?

A

1st: PDE4 inhibitors (sildenafil)

2nd line: vacuum devices

48
Q

How should pregnant women with asymptomatic bacteriuria? UTI be managed?

A

MC&S –> Abx
7 days nitrofurantoin 100mg BD (AVOID AT TERM )
OR
Amoxicillin/cephalexin

49
Q

How should UTIs in men be managed?

A

7 days trimethoprim/nitrufurantoin

50
Q

When should men be referred to urology for UTI?

A

If 2 or more uncomplicated UTIs

51
Q

How should catheterised patients with asymptomatic bacteriuria be managed?

A

No treatment needed

52
Q

How should catheterised patients with symptomatic UTI be managed?

A

7 days trimethoprim/nitrofurantoin

53
Q

What is the causative organism in 95% of cases of prostatitis?

A

E coli

54
Q

What are the signs and symptoms of prostatitis?

A

Referred pain
Obstructive voiding symptoms
Fever and rigors may be present

55
Q

How should prostatitis be investigated?

A

DRE –> tender, boggy prostate gland

56
Q

How should prostatitis be managed?

A

Quinolone 14/7

STI screening

57
Q

How should urinary incontinence be investigated?

A

1st: speculum - exclude prolapse
2nd: Urine dip and MC&S (rule out DM and UTI)
3rd: Bladder diaries (minimum 3 days) - if inconclusive –>
4th: Urodynamic testing (if mixed incontinence)

58
Q

What is measured by urodynamic testing?

A

3 pressures measured from inside rectum and urethra:

  • bladder
  • detrusor
  • IAP
59
Q

How should stress incontinence be managed?

A

1st line: lifestyle advice, WL if BMI>30, pelvic floor exercises
2nd line: duloxetine or surgical treatment

60
Q

How should pelvic floor exercises be done for stress incontinence?

A

8 contractions, TDS, 3 months

61
Q

Recall some options for sugical management of stress incontinence

A
  • Burch colposuspension
  • Autologous rectus fascial sling
  • Bulking agents
62
Q

Recall some RFs for stress vs urge incontinence

A

Stress: age, children, traumatic delivery, pelvic surgery, obesity

Urge: age, obesity, smoking, FHx, DM

63
Q

What is the normal post-void volume for <65 vs >65ys?

A 
<65 = <50mLs
>65 = <100mLs
64
Q

How should urge incontinence be managed?

A

1st line: lifestyle advice, bladder training, avoid fizzy drinks, DM control
2nd line: oxybutynin/tolterodine or desmopressin
3rd line: mirabegron (beta-3 agonist)
4th line: surgical

65
Q

Recall an important side effect of oxybutynin and an alternative option if there is concern

A

Falls

Can give mirabegron instead

66
Q

How can urge incontinence be managed surgically?

A

Botox injection, sacral nerve stimulation, urinary diversion

67
Q

How should overflow incontinence be managed?

A

Refer to specialist urogynaecologist

1st line = timed voiding

68
Q

How should hydrocele be managed?

A
  • Watch and wait
  • Aspiration for symptomatic relief
  • Surgical = Lloyd’s repair/ Jaboulay’s repair
69
Q

Why does varicocele affect the LHS more than the RHS?

A

Left testicular vein:

  • drains into renal vein at 90 degree angle
  • is longer than right
  • often lacks a terminal valve to prevent backflow
  • can be compressed by renal and bowel pathology
70
Q

What is the best investigation for varicocele?

A

Doppler USS

71
Q

If varicocele has a sudden onset, what must be considered?

A

Renal cell carcinoma

72
Q

How should varicocele be managed?

A 
Conservative (scrotal support) 
or surgical (radiological embolisation or operation to expose and ligate vein)

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