Urinary Flashcards
Which stones are the most radiolucent?
Uric Acid stones and Cystine stones
Which stones are the most dense?
Calcium stones and Struvite stones
What test can be used to differentiate between testicular torsion and epididymo-orchitis ?
Cremasteric reflex. - it is lost in TT.
Stroking of inner thigh to cause the muscle to contract and pull the ipsilateral testicle up into the inguinal canal.
In under 35 males what is the most common cause of epididymo-orchitis?
STI - such as gonorrhoea
In over 35 males what is the most common cause of epididymo-orchitis?
E.coli
A man presents with painful testes. The pain is relieved when the testes are elevated. There is a swelling present which is not transilluminable. What would be the most likely diagnosis?
Epididymo-orchitis
What is the pathophysiology of Benign Prostate Hyperplasia?
Failure of apoptosis to occur therefore unrestricted growth occurs due to dihydrotestosterone
A 80 year old man presents to the GP with nocturia. On history he has other LUTS symptoms including increased frequency, dribbling and hesitation. Based on the most likely diagnosis what would be you next steps, DDx and treatment?
urine dip to exclude a UTI
Rectal - is it smooth and enlarged? and abdominal examination
PSA levels. CRP
DDx = BPH, prostate cancer, prostatitis, tumour.
If is BPH
1st line is alpha blocker = tamsulosin (muscle relaxation)
2nd line is 5-ARI = finasteride
If urgency is occurring then may want a anti-muscarinic (ipratropium) to reduce contractions.
Nocturia treatment = desmopressin - vasopressin analogue (be way of sodium levels)
Can surgery be done for BPH - what surgeries and in what cases?
Patients with high pressure retention
TURP (transurethral resection of the prostate)
Holmium laser enucleation of the prostate (HOLEP)
What are the risks for developing prostate cancer?
Being a black male 50+ age Family history of cancer (BRCA) Increased dietary fat Alcohol Smoking
What does prostate cancer usually present with?
LUTS
frequency, urgency, nocturia, hesitancy, dysuria, dribbling
If more advanced may also occur with haematuria, suprapubic pain.
What are the 2 types of prostate cancer?
Ductal adenocarcinoma
Acinar adenocarcinoma - MOST COMMON
With suspected prostate cancer what investigations are required?
DRE - asymmetry, nodularity, fixed irregular mass
PSA - good but can be raised by other things. PSA density
MRI
What scoring system is used for prostate cancer?
Gleason grade
What is the different treatment options for prostate cancer? Low, intermediate and high risk.
Low = surveillance (repeat tests), prostatectomy, EB radiation, Brachytherapy, Intermediate = Prostatectomy, EB radiation, Brachytherapy High = EBR and brachytherapy and hormones, prostatectomy, hormones only (goserelin - anti GrNh)