Urogenital Flashcards
1
Q
What are five examples of non-malignant scrotal disease?
A
Epididymal cysts Hydrocele Variocele Haematocele Epidiymo-orchitis
2
Q
What is a hydrocele?
A
Fluid in the tunica vaginalis.
3
Q
What is a variocele?
A
Dilated vessels in the pampiniform plexus. ‘bag of worms’
4
Q
What is a haematocele?
A
Blood in the tunice vaginalis.
5
Q
What is epididymo-orchitis?
A
Inflammation of the epididymis and testis.
6
Q
What is the presentation of testicular torsion?
A
Sudden onset testicular pain Inflamed and tender testicle Unilateral Abdominal pain Nausea and vomiting
7
Q
What are the risks of testicular torsion?
A
Cuts off blood supply - ischaemia to the testicle occurs.
Infertility
8
Q
What investigation could be carried out to confirm testicular torsion?
A
Ultrasound - but do not delay treatment.
9
Q
What are the treatment options for testicular torsion?
A
Orchidopexy.
Or if too late orchidectomy.
10
Q
What is the contents of the spermatic cord?
A
3 arteries - testicular artery, cremasteric artery, artery of the vas.
3 nerves - sympathetics, genital branch of genitofemoral, cremasteric.
3 other - lymph vessels, vas deferens, pampiniform plexus.
11
Q
What are the causes of urinary obstruction?
A
Prostatic hyperplasia Urethral structure Urolithiases Tumour Infection
12
Q
What are the symptoms of an acute urinary tract obstruction?
A
LUTS and suprapubic pain
13
Q
What are storage symptoms of LUTS?
A
Frequency
Nocturia
Urgency
Urgency incontinence
14
Q
What are the voiding symptoms of LUTS?
A
Hesitancy Straining Poor/intermittent stream Incomplete emptying Post micturition dribbling
15
Q
What are the signs of a urinary tract obstruction?
A
Distended, palpable bladder
Dull to percussion
+/- large prostate
16
Q
What are the possible complications of urinary tract obstruction?
A
Urinary retention
Interactive obstructive uropathy (damage to the kidneys)
UTIs
17
Q
What is the volume of urine held in acute retention?
A
approx. 600mls
18
Q
What is the volume of urine held in chronic retention?
A
approx. 1.5l
19
Q
What investigations should be carried out for suspected prostatic hyperplasia?
A
Digital rectal exam
PSA (cancer?)
Ultrasound and biopsy - to exclude cancer
Frequency volume chart - to see LUTS
20
Q
What is felt on DRE for prostatic hyperplasia?
A
Smooth
Enlarged
21
Q
What zone of the prostate typically enlarges in BPH?
A
Transitional zone.
22
Q
What lifestyle advice can be offered in BPH?
A
Avoid caffeine and alcohol
‘bladder training’ by progressively increasing time between voiding.
23
Q
What are the pharmacological options available in BPH?
A
Alpha-adrenergic antagonists ie. tamsulosin.
5-alpha reductase inhibitors ie. finasteride
24
Q
What is the action and SEs of alpha-adrenergic antagonists?
A
Reduce smooth muscle tone - symptomatic relief.
Low BP, dry mouth, ejaculatory failure, drowsiness.
25
What is the action and SEs of 5-alpha reductase inhibitors?
Decreases conversion of testosterone to dihydrotestosterone. Acts to shrink prostate size - no immediate effect.
Decreased libido and impotence.
26
What are the surgical options available in BPH?
Transurethral resection of the prostate (TURP)
| Prostatectomy.
27
What are the two types of haematuria found in blood?
Visible
| Non-visible
28
How can haematuria be detected?
Urine disptick
29
What are the causes of haematuria?
```
UTI
Recent catheterisation
Recent vigorous exercise
Bladder cancer
Kidney cancer
Recent sexual activity
```
30
What is the histology of prostate cancer?
Adenocarcinoma
31
Where is the most common location for prostate cancer?
Peripheral zone
32
What are the risk factors for prostate cancer?
Older age
Family history
High levels of testosterone
33
What are the symptoms of prostate cancer?
LUTS - nocturia, hesitancy, poor stream, dribbling.
| Weight loss - suggests mets
34
What does a DRE for prostate cancer show?
Hard
| Irregular
35
What investigations are available for prostate cancer?
```
DRE
PSA
Ultrasound
Biopsy
MRI - staging
```
36
What is PSA?
Prostate-specific antigen
37
What is the function of PSA?
Normally produced by the prostate for semen liquidation.
38
Why may a PSA test be misleading?
It is not specific for cancer - raised in BPE, UTI, prostatitis.
Not all cases of prostate cancer have a raised PSA - can be a false negative.
A positive test may lead to further investigations which can be damaging.
39
Why can a PSA test be beneficial?
Can detect cancer early and allow for more treatment options.
Prostate is the commonest cancer in men with a high mortality so should be detected early.
40
What is the mainstay of diagnosis of prostate cancer from?
Raised PSA
| Ultrasound guided needle biopsy.
41
What system is used to grade prostate cancer?
Gleason grading
42
What are the common sites of metastases for prostate cancer?
Bone
Lung
local structures
43
What are the management options for localised prostate cancer?
Low risk - active surveillance
| Progressing - hormone therapy, prostatectomy, radiotherapy.
44
What are the management options for advanced prostate cancer?
Radiotherapy
Chemotherapy
Hormone therapy
Prostatectomy
45
What is the hormone therapy available in prostate cancer?
GnRH agonists - goserelin
46
What is the most common renal cancer?
Renal cell carcinoma
47
What is the presentation of a renal cell carcinoma?
```
50% are incidental findings.
Haematuria
Loin pain
Abdominal mass
Malaise
Weight loss
```
48
Where are the common sites of metastases for renal cell carcinoma?
Bone
Liver
Lung
49
What investigations should be carried out in renal cell carcinoma?
Bloods - FBC, U&E, LFT, calcium
Urine dipstick and MSU
Ultrasound
MRI - staging
50
What is the management for localised renal cell carcinoma?
Radical nephrectomy
51
What are the management options for metastatic renal cell carcinomas?
Biological therapies
52
What are the types of bladder cancer?
>90% transitional cell carcinoma
Squamous cell carcinoma
Adenocarcinoma
53
What are the risk factors for bladder cancer?
```
Occupation - azo dye exposure, rubber
Schistosomiasis infection
Radiation
Smoking
Male
```
54
What is the presentation of bladder cancer?
Painless haematuria
Recurrent UTIs
Voiding irritability
55
What is the investigations for bladder cancer?
Cystoscopy with biopsy - diagnostic
Urine - dipstick, cytology, microscopy
CT urogram - staging
56
What is the firs lymph node to be affected in bladder cancer?
Para-aortic and iliac nodes.
57
What stages of bladder cancer are non-muscle invasive?
Ta-T1
58
What is the treatment for non-muscle invasive bladder cancer?
Tumour resection
| Chemotherapy
59
What stages of bladder cancer are muscle invasive?
T2-3 (T4 = metastatic)
60
What is the treatment for muscle invasive bladder cancer?
Radical cystectomy
| Radical radiotherapy
61
What are the different types of testicular cancer?
Seminoma (55%)
Non-seminoma
Mixed germ cell
Lymphoma
62
What is the epidemiology of testicular cancer?
Most common cancer in men 20-40
| Undescended testicle = risk factor
63
What is the presentation of testicular cancer?
Painless lump in testicle
Haematospermia
Pain
64
What is the first site of lymph node spread?
Para-aortic lymph nodes.
65
What investigations are carried out in testicular cancer?
Ultrasound
Biopsy
Serum tumour markers
CT/MRI - staging
66
What is the management fo testicular cancer?
Orchidectomy
Radiotherapy
Chemotherapy
67
What is defined as a urinary tract infection?
Pure growth of >10(5) organisms per ml of MSU
68
What is bacteruria?
Bacteria in the urine
69
What is pyuria?
Leucocytes in the urine
70
What is an uncomplicated UTI?
UTI in a non-pregnant woman.
71
What is a complicated UTI?
Anything else.
| Pregnant, man, catheter, child, recurrent etc.
72
What are the risk factors or a UTI?
```
Female
Intercourse
Pregnancy
Menopause
Immunosuppression
Obstruction
Catheters
```
73
What are the causative agents of a UTI?
E.coli - most common
Proteus mirabilis
Klebsiella pneumoniae
74
What makes the urinary tract resistant to colonisation usually?
Constant flow
| pH
75
What increases the hosts susceptibility to UTIs?
Obstruction - stasis
| Short urethra
76
Which pathogens show virulence factors which help them colonise the urinary tract?
Proteus - produces urase which increases the pH
| E.coli - has fimbrae to adhere to surfaces.
77
What are the symptoms of a UTI?
Frequency changes
Dysuria
Loin/abdo pain
Offensive smelling urine
78
What investigations should be carried out in a UTI?
MSU - microscopy and sensitivities
Urine dipstick - raise nitrites and leucocytes
Bloods
79
In what age demographic is asymptomatic bacteruria common?
>65years old. DO not treat.
80
What is the treatment for an uncomplicated UTI?
Three day course of nitrofurantoin (1st line)
| Advice - fluids, void pre and post intercourse, hygiene.
81
What is the management of a complicated UTI?
Always culture MSU.
Longer antibiotic course (7 days)
Advice - fluids, void pre and post intercourse, hygiene.
82
How to investigate a possible UTI in a catheterised patient?
All catheters will eventually become colonised.
Cultures should be investigated with caution
Do not dipstick - will always be positive
Change catheter before treatment begins.
83
Why do pregnant women require a UTI screen?
Much higher risk of cute pyelonephritis (20-40%)
84
When can nitrofuratoin not be used in pregnancy?
Third trimester
85
What is acute pyelonephritis?
Infection of the renal pelvis
86
What are the symptoms of pyelonephritis?
High fever
Loin pain
Rigors
Nausea and vomiting
87
What is the treatment for pyelonephritis?
```
Fluid replacement
IV antibiotics - borad spec co-amoxiclav/ciprofloxacin
Drain kidney
Analgesia
7-14 day antibiotic course
```
88
What is the most common STI in the UK?
Chalamydia
89
What are the symptoms of chlamydia?
Men - dysuria and discharge
| Female - dysuria, discharge and menstrual irregularity.
90
Why does chlamydia often go undetected?
Asymptomatic in 50% + of cases.
91
How is chlamydia diagnosed?
Female - self collected vaginal swab/first void urine
Male - first void urine
The NAAT
92
What is the treatment for chlamydia?
Doxycycline 100mg for 7 days
| Partner notification
93
What are the symptoms of gonorrhoea?
Dysuria, urethral discharge, menstrual irregularity.
94
How is gonorrhoea diagnosed?
Swab from urethra/endocervix/rectum.
95
What is the treatment for gonorrhoea?
Ceftriaxone IM injection
| Partner notification
96
What is the presentation of syphilis?
Primary chancre - will heal if not treated
| Then a skin rash
97
How is syphilis diagnosed?
Blood serology
98
What is the treatment for syphilis?
Penicillin by injection.
| Partner notification
99
What are primary prevention strategies for STIs?
Awareness campaigns to reduce risk behaviour.
Education in schools
Pre/post-exposure prophylaxis
100
What are secondary prevention strategies for STIs?
Easy access to tests and treatments.
Partner notification
Targetted screening
101
What are tertiary prevention strategies for STIs?
Anti-retrovirals to HIV.
102
Name five types of incontinence.
```
Urgency
Stress
Mixed
Overflow
Continuous
```
103
What is the cause of urgency incontinence?
Detrusor overactivity usually.
104
What is urgency incontinence?
Incontinence associated with the urgent desire to void which is almost unstoppable.
105
What are the lifestyle changes that can be made in urgency incontinence?
Stop caffeine and alcohol
Bladder training
Weight loss
106
What are the pharmacological option available in urgency incontinence?
Anti-muscarinic agents - decrease parasympathetic activity.
Beta-2 agonists - increase sympathetic
Botox - blocks neuromuscular junctions.
107
What is stress incontinence?
Involuntary emission of urine when pressure in the abdomen increases suddenly - ie. cough or laugh.
108
What is the anatomical association to stress incontinence?
Urethral sphincter deficiency.
109
Why is stress incontinence more common in women?
Only one sphincter
| Can occur secondary to pregnancy or birth.
110
What is the management for stress incontinence?
1 - Pelvic floor exercises.
| 2 - surgery sometimes
111
What is mixed incontinence?
A mixture of stress and urgency incontinence.
112
What is overflow incontinence?
Involuntary leakage of urine from an overfull bladder as a result of retention.
113
What nerves causes controls the detrusor muscle?
Sympathetic - relaxation
| Parasympathetic - contraction
114
What nerve control the external sphincter?
Pudendal nerve (S2-4)
115
Describe the storage phase of micturition.
Bladder fills gradually - slow pelvic nerve firing - sympathetic stimulation - pudendal stimulation - receptive relaxation and external sphincter contraction.
116
What nerve feeds information from the bladder back to the spinal cord?
Pelvic nerve
117
Describe the voiding phase of micturition.
Fast pelvic nerve firing - parasympathetic stimulation - pudendal nerve inhibited - detrusor contraction and external sphincter relaxation.
118
What is the guarding reflex?
Voluntary control of micturition inhibits the micturition reflex.
119
Where is the guarding reflex controlled from?
Pontine micturition centre.
120
What is erectile dysfunction?
Persistent inability to attain and maintain an erection sufficient to permit satisfactory sexual performance.
121
What are the causes of erectile dysfunction?
```
Psychological
End artery damage - CVD
Shunt artery-vein
Neurological damage
Low testosterone
Alcohol
Smoking
Diabetes
```
122
What is the mechanism that generates an erection and how does it work?
In flaccidity - penile smooth muscle is contracted, arteries are constricted and veins are open.
In erection - smooth muscle is relaxed, arteries are dilated, veins are compressed against tunica albuginea and venous outflow is blocked.
123
What stimulates an erection?
Parasympathetic supply releases NO - causes conversion of GTP to cGMP - stimulates PKG to open potassium channels and close calcium channel - less internal calcium - smooth muscle relaxation. cGMP inactivated by phosphodiesterase.
124
What symptoms may indicate a psychological cause of erectile dysfunction?
Sudden onset
Good nocturnal and morning erection
Situational
Younger patient
125
What investigations are carried out in erectile dysfunction?
Clinical exam
DRE
Fasting glucose
Morning testosterone
126
What is the lifestyle advice given for erectile dysfunction?
Quit smoking
Less alcohol
Weight loss
127
What is the pharmacological therapy available and its mechanism of action for erectile dysfunction?
PDE5 inhibitors - sildenafil (viagra), tadalafil. Inhibit Phosphodiesterase so less cGMP broken down, so erection lasts longer.
128
Why may PDE5 inhibitors not work?
Failure of adequate stimulation , NO still needs to be stimulated to release.
Only effective 30-60 minutes after being taken - need to wait.
129
What are the other options available for erectile dysfunction?
Intracavernous injections
Vacuum devices
Prosthesis
130
What is a priapism?
4 hour + long erection - emergency as a risk of tissue death.
