UROL Flashcards
What is BPH? RF? Symptoms? IX MX
common condition causing an enlarged prostate and symptoms in men, there is increased activity of 5A reductase which in turn increases the amount of dihydrotestosterone and oestrogen both of which cause hyperplasia of prostate
bph affects the transition zone where as prostate cancer affects the peripheral zone
AGe, FHX, diabetes black
post voidal dribbling, weak stream, incomplete emptyingh
urgency drequency
DRE- smooth but enlarged prostate
URInalysis- pyuria= infection
PSA- raised
Renal tract US
Management
a1 antagonist- tamsulosin -postural hypotension, dizziness, dry mouth, depression
5 A reductase inhibitors- finasteride- reduced libido, erectile dysfunction, reduced ejaculate volume, gynaecomastia
sildenafil
if its bad then we do surgery
Prostate <30 g: transurethral incision of the prostate (TUIP)
Prostate 30-80 g: transurethral resection of the prostate (TURP)
Prostate >80 g: open prostatectomy
What type of prostate cancer. most common? Genes associated? Rf? symptoms? IX scoring Management
Adenocarcinoma, the cancer arises from peripheral zone of the prostate BRCA-1 BRCA-2
Age, fhx. black, obesity, candimum- found in batteries
Frequency hesistancy, nocturia, dribbling
DRE- hard assymetrical irregular prostate
palpable lymphadenopathy
urinary retention
Multiparametric MRI
PSA
GLeason scoring
conservative: active monitoring & watchful waiting
radical prostatectomy
radiotherapy: external beam and brachytherapy
anti androgen therapy
Anti-androgen (hormonal) therapy
Testosterone is mainly produced by the testis and stimulates prostate cancer to grow
Lowering testosterone levels can cause prostate cancers to shrink or grow more slowly over time, but this does not cure prostate cancer
Pharmacological options include anti-androgens (e.g. flutamide) and LHRH agonists (e.g. goserelin; Zoladex), which may be used in combination
Anti-androgens should be given before an LHRH agonist to prevent a rise in testosterone
WHat type of bladder cancer most common? Types of TCC RF features referral pathway IX Management
Transitional epithelium lines renal pelvis, ureter, bladder and urethra, TCC most common arising from the bladder
2 types
Papillary- superficial with finger like projections
FLat against the bladder
AGe, male, fhx, smoking, aromatic amines
Painless haematuria, dysuria, frequency, weigth loss, palpable mass
45+ visible haematuria with no infection
60+ unexplained microscopic haematuria and either dysuria or a raised WCC on a blood test
Consider non-urgent referral for bladder cancer in people aged 60 and over with recurrent or persistent unexplained urinary tract infections.
FLexible cytoscopy
CTAP and CT urogram for metastsisis
urinalysis- haematuria
Trans-urethral resection of bladder tumour with intravesical mitomycin c
Radical cystectomy
Radical chemotherapy and radiotherapy
What is epididymo orchitis?
Causes
features and how to differentiate from torsion
Investigations
Inflammation of the epididymis is referred to as epididymitis, whilst orchitis is inflammation of the testicle. The two may co-exist and this is referred to as epididymo-orchitis.
STI-related: young, multiple partners, unprotected sex
Enteric-related: elderly, bladder outflow obstruction, instrumentation of urinary tract
Tuberculosis: can cause epididymo-orchitis
Unilateral tender, red, and swollen testicle
dysuria
Prehn’s sign positive
Pain relief with lifting the affected testicle
Prehn’s sign is negative in torsion
Cremasteric reflex preserved (unlike torsion)
Urinalysis: first void sample is most useful and should be sent for microscopy and culture. Neisseria gonorrhoeae is a gram-negative diplococcus, whilst chlamydia is difficult to gram stain
Nucleic Acid Amplification Test (NAAT): first void u
can dio a tetsicular ULtra sound if uncertain
First-line for STI [4][5]:
Empirical: ceftriaxone 500 mg IM single dose and doxycycline 100mg BD for 10-14 days
Empirical: fluoroquinolone e.g. Ofloxacin or ciprofloxacin for 10-14 days
what is priapism?
most common causes
IX
Management
persistent, undesired erection lasting greater than 4 hours
sickle cell, haematological malignancy, thalaseemia
recreational drugs
anticoagulatns, antihypertensives, antipsychoticsm alpha blockers
corpus cavernosum blood smapling- po2 less than 4 do soemthing asap
Corporeal aspiration: diagnostic and therapeutic. 10-15ml blood is aspirated and replaced with normal saline,
Sympathomimetic agent: injected into the corpus cavernosum. Phenylephrine, an alpha-1 adrenergic agonist
WHat is pyleonephritis? most common cause RF Features IX Management
infectious inflammation of the renal parenchyma and renal pelvis
E coli= most common, klebsiella species, proteus mirabilis
UTI, unctorlled diabertes, immonocompromised pregnancy
flank pain, suprapubic tenderness, rigors, haematuria, confusion hypotesion
Urinalysis: indicators of infection would include white blood cells and nitrites
Microscopy, culture and sensitivities: to guide antibiotic treatment
Full blood count: to assess for leucocytosis
CRP: as a marker of inflammation
Urea and electrolytes: to assess renal function
USKUB TO EXCLUDE HYDRONEPHROSIS
AND CT KUB TO EXCLUDE RENAL COLIC
MANAGEMENT
Cefalexin: 500mg twice or three times a day (up to 1– 1.5g three or four times a day for severe infections) for 7-10 days
Ciprofloxacin: 500 mg twice a day for 7 days
Intravenous antibiotics (severe disease/sepsis):
Gentamicin: dosage based on body weight (kg) and renal function
Ciprofloxacin: 400mg TDS initially
What is renal cell carcinoma Most common type Endocrine features Features Management
adenocarcinoma arising from the pct
clear cell carcinoma
cushings, polcythaemia, excess renin and hypercalcaemia
triad of flank pain abdo mass and haematuria
varicocele
CT abdomen/pelvis with contrast: the definitive test for diagnosis, with 90% sensitivity and 100% specificity in identifying malignancy
Localised disease [6]:
Partial nephrectomy: standard for T1 tumours (i.e. ≤ 7cm) and performed with curative intent
Radical nephrectomy: standard for T2-T4 tumours (i.e. > 7cm). Local lymph node dissection and adrenalectomy may be considered if these structures are involved
Minimally-invasive procedures: reserved for patients unfit for surgery, e.g. radiofrequency ablation or embolisation
Metastatic disease [6]:
Molecular therapy: Sunitinib and Pazopanib
What are renal stones rf features IX management
renal stones-nephrolithiasisi stones or calculi in renal tract causing loin to groin pain
majority made from calcium oxalate
dehydration, previous kidney stones, crohns, loop directics gout
severe loin to groin pain always exclude aaa
n+V
urgency and frequency
fever
haematuria
Non-contrast CT kidney, ureter, bladder (CT KUB
IV fluids and antiemetics - PR diclofenac
can use tamsulosin
surgery
testicular cancer
