Urogenital Flashcards
What are non-malignant scrotal diseases?
Epididymal cyst, hydrocele, varicocele, adenomatoid tumour
What are the causes of urinary tract obstruction?
Urinary stones, urothelial tumours, extrinsic compression by abdominal masses, prostatic hyperplasia, urinary tract malformations, strictures
How does obstruction of the urinary tract present?
Pain, impaired renal function, recurrent UTIs
Upper tract obstruction - loin pain radiating to groin
Lower tract obstruction - urinary retention, severe suprapubic pain, urinary frequency, poor stream, terminal dribbling
How is obstruction of the urinary tract diagnosed?
US: hydronephrosis (swelling of the kidney due to a build-up of urine)
CT scan: level of obstruction
How is obstruction of the urinary tract managed?
Upper - nephrostomy or ureteric stent
Lower - urethral or suprapubic catheter
What causes haematuria?
Malignancy, calculi, IgA nephropathy, polycystic kidney disease
What is benign prostatic hyperplasia?
Enlargement of the prostate gland due to an increase in cell number
How does benign prostatic hyperplasia present?
LUTS - frequency, urgency, nocturia, hesitancy, poor flow, terminal dribbling
What are differential diagnoses of benign prostatic hyperplasia?
Overactive bladder, prostatitis, prostate cancer, UTI
How are benign prostatic hyperplasias diagnosed?
Ultrasound, PSA test, biopsy
How are benign prostatic hyperplasias managed?
Lifestyle - avoid caffeine, alcohol to reduce urgency. Void twice in a row to aid emptying
Drugs - alpha blockers 1st line
Surgery - transurethral resection/incision of prostate, prostatectomy
What are the complications of benign prostatic hyperplasia?
Urinary retention, recurrent UTIs, bladder stones, obstructive nephropathy
How do renal carcinomas present?
Painless haematuria, loin pain, abdominal mass, anorexia, malaise, weight loss
How are renal carcinomas managed?
Radical nephrectomy, radio frequency ablation is an option for patients unfit or willing to undergo surgery
What is a Wilm’s tumour?
Nephroblastoma - a malignant childhood renal neoplasm. Present with abdominal mass and haematuria
How do bladder carcinomas present?
Painless haematuria, LUTS, recurrent UTIs, voiding irritability
How are bladder carcinomas managed?
Depends on the stage
T1 - diathermy via transurethral resection
T2-3 - radical cystectomy
T4 - palliate chemo/radiotherapy
How do prostate cancers present?
Majority asymptomatic, LUTS may be present
How are prostate cancers diagnosed?
Needle biopsy performed after a raised serum PSA level is found
DRE - hard, irregular prostate
How are prostate cancers managed?
Prostatectomy, radiotherapy, analgesia, treat hypercalcaemia
What is a seminoma?
Germ cell tumour of the testicle
What is a teratoma?
Non-germ cell tumour of the testicle
How do testicular tumours present?
Painless testis lump, secondary hydrocele, dyspnoea, abdominal mass
How are testicular tumours managed?
Radical orchidectomy, seminomas are radiosensitive, use chemotherapy for teratomas
How are GU tract tumours generally diagnosed?
CT of abdomen and pelvis
CXR, biopsies
Urine cytology
What is urolithiasis?
Urinary tract calculi - the formation of stony concretions in the bladder or urinary tract
What can urinary tract calculi be formed from?
Calcium, phosphate, oxalate, urate
What are the causes of urinary calculi?
Anatomical factors e.g. obstruction
Urinary factors e.g. calcium, oxalate, urine, cystine
Calcium stones associated with hypercalciuria, uric acid stones with hyperuricaemia
How does urolithiasis present?
Triad: fever, vomiting, flank pain.
Nausea, urinary frequency/ urgency, Haematuria, tachycardia
Where would pain be felt if urinary calculi caused obstruction of the kidney?
Loin
What are the 3 most common sites of urinary tract calculi?
Pelviureteric junction, pelvic brim, vesicoureteric junction
What are the risk factors for calculi?
High protein/ high salt intake
Male, white
Obesity, dehydration, medications e.g. antacids
Where would pain be felt if urinary calculi caused obstruction of the bladder or urethra?
Pelvic pain
How is urolithiasis diagnosed?
CT - helps exclude differentials
Urine dipstick - positive for blood
24hr urine sample for stone biochemistry - calcium, phosphate, oxalate, urate
US - hydronephrosis
How is urolithiasis managed?
Acute - NSAIDs, antiemetics, IV fluids
Surgical - nephrostomy, ureteric stent, endoscopic treatment, extracorporeal shock waves
Which clinical syndromes are caused by lower urinary tract infections?
Cystitis, prostatitis, epididymitis, urethritis
Which clinical syndromes are caused by upper urinary tract infections?
Pyelonephritis
What is the main organism that causes UTIs?
Escherichia coli
How are UTIs diagnosed?
Urinalysis - leucocytes/ nitrates
Microscopy
Microbiological culture is gold standard - midstream urine specimen
How are UTIs managed?
Treat with antibiotics
What is prostatitis?
Inflammation of the prostate gland
How does prostatitis present?
Pain, fever, malaise, nausea, urinary symptoms
What is cystitis?
Inflammation of the bladder caused by an infection (usually E.coli)
How does cystitis present?
Frequency, dysuria, urgency, suprapubic pain, polyuria, haematuria
What is pyelonephritis?
Infection of the renal parenchyma and soft tissues of renal pelvis/ upper ureter
How does pyelonephritis present?
Classic triad of loin pain, fever, pyuria
Associated cystitis symptoms
How is pyelonephritis managed?
Fluid replacement, broad spectrum IV antibiotics, drain obstructed kidney, analgesia
What is urethritis?
Sexually transmitted inflammation of the urethra
What can causes urethritis?
Gonorrhoea, chlamydia
How is urethritis managed?
Gonorrhoea - ceftriaxone
Chlamydia - doxycycline
Bacteria - oflaxacin
What is epididymo-orchitis?
Sexually transmitted inflammation of the epididymis +/- testes
What causes epididymo-orchitis?
Chlamydia, E.coli, mumps, gonorrhoea
What are the features of epididymo-orchitis?
Swelling, dysuria, sweats, UTI symptoms, urethral discharge.
Warn of possible infertility
How is epididymo-orchitis managed?
Doxycycline, analgesia, scrotal support, sexual abstinence
What are the male symptoms of STIs?
Urethral discharge, dysuria, genital skin problems, testicular pain/ swelling, peri-anal or anal symptoms
What are the female symptoms of STIs?
Unusual vaginal discharge, vulval skin problems, abdominal pain, unusual vaginal bleeding
