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Uro Flashcards

1
Q

7Cs of bladder cancer risk factors

A

Cigarettes
Catheter
Chronic nsaid
Cyclophosphamide
Chemicals
Chemo
Chronic cystitis

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2
Q

Functional causes of bladder obstruction

A
  1. Detrusor under activity
  2. Diabetes
  3. Spinal pathologies spinal bifida cauda equina
  4. Trauma
  5. Transverse myelitis
  6. Multiple sclerosis
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3
Q

Methods for acutely decompressing obstructive uropathy

A
  1. Percutaneous nephrostomy then anterograde stenting
  2. DJ stenting retrograde
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4
Q

Where the ends of a Double J stent sit

A

Proximal in renal pelvis, distal in bladder

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5
Q

Definition of testicular torsion

A

Twisting of the spermatic cord leading to ischemia and infarction of the testes

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6
Q

Presenting Sx and sign of testicular torsion

A
  1. Scrotal pain
  2. Epigastric pain
  3. N/V
  4. Scrotal swelling and tenderness

Loss of cremasteric reflex and high riding testis

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7
Q

Cutoff for surgical Mx of testicular torsion

A

6hrs

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8
Q

Surgical Mx of testicular torsion

A
  1. Open surgery
  2. Untwist spermatic cord
  3. Increased oxygenation to check if viable->orchidectomy
  4. Orchidopexy including prophylactic of contralateral testes
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9
Q

Sonographic sign for testicular torsion

A

Whirlpool sign

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10
Q

Pus in renal pelvis vs pus in renal parenchyma

A

Pyonephrosis vs renal abscess

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11
Q

Package of gross hematuria workup

A
  1. CT Urogram
  2. Flexible cystoscopy
  3. Urine culture and cytology
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12
Q

RCC TNM staging

A

T1:limited to kidney <7cm
T1a: Tumor =<4cm
T1b: 4cm=<x<7cm
T2:limited to kidney >7cm
T2a: 7cm<x<10cm
T2b: >10cm limited to kidney
T3a: Tumor extends into renal vein/perinephric tissue/fat
T3b: extends into IVC below diaphragm
T3c: extends intowall of IVC or IVC above diaphragm
T4: Beyond Gerota’s fascia, including ipsilateral adrenal gland

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13
Q

Epnymous name for appendicovesicostomy

A

Mitrofanoff procedure

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14
Q

Score for grade of prostate cancer

A

Gleason

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15
Q

Sx of prostate Ca

A
  • Gross hematuria
  • Anemia Sx
  • Urinary storage symptoms: Dysuria, Urgency
  • Urinary Voiding symptoms: Hesitancy, Weak stream, straining, terminal dribbling, need for double voiding
  • Incontinence
  • Retention of Urine
  • Constitutional symptoms: LOA, LOW
  • Cachexia
    -Sx of metastasis
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16
Q

Sx of prostate Ca

A
  • Irregular, craggy, hard and enlarged prostate on DRE
    Palpable tumor is stage T2 minimum
  • Hematuria on urine sample
  • Palpable/Percussible bladder if urinary obstruction
  • Ballotable kidneys if severe hydronephrosis
  • Vertebral tenderness from spinal mets
  • Neurological signs from spinal mets eg weakness, positive babinski’s
17
Q

RFs

A

Non modifiable
Familial prostate cancer
Age

Modifiable
Smoking
Exposure to industrial chemicals
High fat diet that increases testosterone levels
Radiation/RT

18
Q

Cx of prostate Ca

A
  1. Local
    - Acute Retention of Urine(rare)
    - Urinary stasis leading to
    UTis
    Urolithiasis
  2. Regional
    - Obstructive Uropathy/ Hydronephrosis
  3. Systemic
    - Neurological symptoms from spinal mets eg Cauda Equina Syndrome
    - Anemia from hematuria
    - Other mets sx
19
Q

Biochemical invx for prostate Ca

A
  1. Prostate Specific antigen for prognosis and recurrence
    >4 is elevated
    >10 is worrying
    2.FBC for anemia, TWs
  2. RP for renal function, scans
    4.PFO bloods PT/PTT and GXM
    5.Urine studies
    - Dipstick
    - Culture and sensitivity
    - Cytology
    - UFEME
20
Q

Imaging for prostate Ca

A

1.Ultrasound KUB
- Often a hypoechoic lesion
- Urinary retention
- Bladder tumors
- Hydroureteronephrosis
2. CT TAP for delineating tumor and for staging
3. MRI Prostate
4.Bone Scan
5. XR KUB for stones

21
Q

Procedures for diagosing prostate ca

A

TRUS bx: Trans Rectal Ultrasound and biopsy (Clean contaminated? Give gentamicin prophylaxis)
Trans Perineal Ultrasound and biopsy(Clean)

22
Q

Classification for grading of prostate Ca

A

Gleason’s

23
Q

Factors for deciding b/w watchful monitoring and surgery for prostate Ca

A

Patient factors
- Age above/below 70
- Life expectancy >10years
- Fitness for surgery
Disease factors
- Tumor grade(Gleasons)
- Local invasion
- Metastatic disease
-PSA levels

24
Q

Components of watchful monitoring of prostate ca

A

PSA surveillance, repeat DRE and repeat biopsy

25
Q

Curative surgery for prostate Ca

A

Radical Prostatectomy KIV Pelvic lymphadenectomy

26
Q

Adjuvants for prostate cancer Mx

A
  • Radiotherapy
    1. External Beam RT(EBRT) for T3/4
    2. Brachytherapy
    3. Radium 223 for mets

Androgen Deprivation Therapy
- Surgical: Orchidectomy
- Medical
1.LHRH/GnRH agonists or antagonists
2. Anti androgen( if LNRH/GnRH agonist given)
3.Bisphosphonates for bone mets
4. Estrogen therapy(historical)

Locally advanced: EBRT + Adjuvant ADT

27
Q

Cx of prostatectomy

A

Subfertility/ Erectile dysfunction
Urinary incontinence
Lymphocele
Injury to rectum or ureters

GS (11 decks)

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