Surgery - Urology Flashcards by B M

What is the best form of imaging for kidney stones?

CT KUB

How well did you know this?

Not at all

Perfectly

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

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

How well did you know this?

Not at all

Perfectly

Which type of kidney stone is associated with urease bacteria?

Triple (struvate) stones

How well did you know this?

Not at all

Perfectly

Which type of kidney stone is associated with hypercalciuria?

Calcium oxalate

How well did you know this?

Not at all

Perfectly

How should kidney stone pain be managed?

PR/IM diclofenac

How well did you know this?

Not at all

Perfectly

Recall one contra-indication to diclofenac

CVS disease

How well did you know this?

Not at all

Perfectly

How should kidney stones be managed depending on size?

<0.5cm: expectant treatment +/- tamsulosin

<2cm: lithotripsy

<2cm and pregnant: uteroscopy

> 2cm (eg staghorn calculi): nephrolithotomy

If hydronephrosis/infection: percutaneous nephrostomy and antibiotics

How well did you know this?

Not at all

Perfectly

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

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

How well did you know this?

Not at all

Perfectly

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

TURP (transurethral resection of the prostate)

How well did you know this?

Not at all

Perfectly

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

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

How well did you know this?

Not at all

Perfectly

When can PSA levels not be done?

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

How well did you know this?

Not at all

Perfectly

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

If PSA is inappropriate or if high chance of Ca

How well did you know this?

Not at all

Perfectly

What is the gold-standard investigation for prostate cancer?

Multiparametric MRI (this has replaced TRUS-guided biopsy)

How well did you know this?

Not at all

Perfectly

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

Conservative with active monitoring
Radical prostatectomy
Radiotherapy (external beam and brachytherapy)

How well did you know this?

Not at all

Perfectly

Recall 3 options for managing localised advaced prostate Ca

Hormonal therapy
Radical prostatectomy
Radiotherapy

How well did you know this?

Not at all

Perfectly

How should metastatic prostate cancer disease be managed?

Hormonal therapy only

How well did you know this?

Not at all

Perfectly

What are the options for hormone therapy in prostate cancer?

Synthetic GnRH agonist + 3w cover of anti-androgen

How well did you know this?

Not at all

Perfectly

Recall 2 types of benign epithelial renal tumour

Papillary adenoma
Renal oncocytoma

How well did you know this?

Not at all

Perfectly

What sort of tumour is an angiomyolipoma?

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

How well did you know this?

Not at all

Perfectly

What is the maximum size for a papillary adenoma?

15mm
If more than this = malignant papillary renal cell carcinoma

How well did you know this?

Not at all

Perfectly

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

Renal oncocytoma

How well did you know this?

Not at all

Perfectly

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

Angiomyolipoma

How well did you know this?

Not at all

Perfectly

Which genetic syndrome predisposes to renal cell carcinoma?

Von Hippel Lindau

How well did you know this?

Not at all

Perfectly

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

Clear cell (70%)
Papillary
Chromophobe

How well did you know this?

Not at all

Perfectly

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

Phaeochromocytoma Neuroendocrine pancreatic Clear cell renal

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

Clear cell renal

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

Papillary renal cell carcinoma

What is Wilm's tumour?

Nephroblastoma

How should high-grade transitional cell carcinomas be managed?

1st: intravesical immunotherapy 2nd: radical cystectomy

How should traumatic urethral injuries be investigated and managed?

Ix: ascending urethrogram Mx: suprapubic catheter

How should traumatic bladder injuries be investigated and managed?

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

What proportion of testicular tumours are germ cell tumours?

95%

What are the subtypes of germ cell testicular tumours?

Seminomas (50%) Non-seminoma (embryonal, yolk sac, teratoma an choriocarcinoma)

What is the biggest risk factor for testicular seminoma?

Cryptochidism

What are the signs and symptoms of testicular cancer?

Painless lump +/- hydrocele, gynaecomastia

How should testicular cancer be investigated?

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

How can testicular cancer be managed?

Orchidectomy +/- chemotherapy +/- radiotherapy

Is the cremasteric reflex pos or neg in testicular torsion?

Neg

What is the cremasteric reflex?

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

What is Prehn's test?

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

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

Neg

What condition is Prehn's test positive in?

Epididymitis

How should testicular torsion be managed?

Surgical exploration + BL orchidopexy

What is an orchidopexy

Surgical procedure that moves undescended testicle into the scrotum

What are the main RFs for ED?

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

How should ED be investigated?

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

How can ED be managed?

1st: PDE4 inhibitors (sildenafil) 2nd line: vacuum devices

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

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

How should UTIs in men be managed?

7 days trimethoprim/nitrufurantoin

When should men be referred to urology for UTI?

If 2 or more uncomplicated UTIs

How should catheterised patients with asymptomatic bacteriuria be managed?

No treatment needed

How should catheterised patients with symptomatic UTI be managed?

7 days trimethoprim/nitrofurantoin

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

E coli

What are the signs and symptoms of prostatitis?

Referred pain Obstructive voiding symptoms Fever and rigors may be present

How should prostatitis be investigated?

DRE --> tender, boggy prostate gland

How should prostatitis be managed?

Quinolone 14/7 STI screening

How should urinary incontinence be investigated?

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)

What is measured by urodynamic testing?

3 pressures measured from inside rectum and urethra: - bladder - detrusor - IAP

How should stress incontinence be managed?

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

How should pelvic floor exercises be done for stress incontinence?

8 contractions, TDS, 3 months

Recall some options for sugical management of stress incontinence

- Burch colposuspension - Autologous rectus fascial sling - Bulking agents

Recall some RFs for stress vs urge incontinence

Stress: age*, children, traumatic delivery, pelvic surgery, obesity* Urge: age*, obesity*, smoking, FHx, DM

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

<65 = <50mLs >65 = <100mLs

How should urge incontinence be managed?

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

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

Falls Can give mirabegron instead

How can urge incontinence be managed surgically?

Botox injection, sacral nerve stimulation, urinary diversion

How should overflow incontinence be managed?

Refer to specialist urogynaecologist 1st line = timed voiding

How should hydrocele be managed?

- Watch and wait - Aspiration for symptomatic relief - Surgical = Lloyd's repair/ Jaboulay's repair

Why does varicocele affect the LHS more than the RHS?

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

What is the best investigation for varicocele?

Doppler USS

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

Renal cell carcinoma

How should varicocele be managed?

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

In a patient with hypercalciuria and recurrent calcium renal stones, what drug can be used as prevention?

Thiazide like diuretics (they decrease urinary calcium)

What should be done before treatment with goserelin for prostate cancer?

Pretreatment with flutamide to avoid initial "flare effect" of goserelin