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Urological Conditions In Adults Flashcards

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1
Q

What is the commonest histologicall classification of prostate carcinoma?

A

Adenocarcinoma

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2
Q

What is the difference between grading and staging of of a malignancy?

A

Grade = How well/poorly differentiated tumour cells are

Stage = How far the cancer has spread

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3
Q

Haematogenous metastases of prostate ca usually occurs first to which area?

A

Axial skeleton

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4
Q

What are the causes of a raised PSA

A

Prostate Ca

BPH

Prostitis

Prostate biopsy/surgery

Rectal exam

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5
Q

In what part of the prostate does prostate cancer usually start?

A

Peripheral zone

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6
Q

How is prostate Ca diagnosed?

A

Rectal examination

Prostate biopsy

Serum PSA

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7
Q

What are the possible complications of a trans-rectal prostate biopsy?

A

Rectal bleeding

Bacteraemia

Septicaemia

Prostatitis

Cystitis

Epididymo-orchitis

Urinary retention

Haematuria

Haematospermia

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8
Q

How can the complications of prostate biopsy be prevented?

A

Administer prophylactic antibiotics

Monitor for 24hrs for septicaemia

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9
Q

What is the best, first option of treatment in a patient who presents with severe back pain due to metastatic prostate cancer?

A

Hormonal treatment - suppress testosterone:

  • Bilateral orchidectomy
  • Oestrogen
  • Anti-androgens - Ketaconazole
  • LHRH-agonists (GnRH-agoniste) - Buserelin
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10
Q

What are the possible complications and side-effects of bilateral orchidectomy for prostatic carcinoma?

A

Bleeding

Wound sepsis

Psychological trauma of castration

Loss of libido and potency

Hot flushes

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11
Q

What is the treatment of organ confined prostate carcinoma for a patient with >10 years life expectancy?

A

Depends on stage of disease

Radical prostatectomy

External beam radiotherapy

Brachytherapy

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12
Q

How would you treat an older patient with organ confined prostate carcinoma (e.i <10 years life expectancy)?

A

Depends on stage of disease

Conservative management

Watchful waiting

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13
Q

What are the complications of a radical prostatectomy?

A

Intra-operative haemorrhage

Erectile dysfunction

Incontinence

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14
Q

Name 5 possible complications of advanced prostate carcinoma

A

LUTS

  • Hesitancy
  • Weak stream
  • Interrupted stream
  • Feeling of incomplete voiding
  • Post-micturation dribbling

Urinary retention

UTI

Haematuria

Pain

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15
Q

With regard to prostate cancer: In which age group does it occur most commonly?

A

> 45 - 50 years

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16
Q

What are the findings on rectal examination for organ-confined prostate carcinoma?

A

Enlarged prostate with nodule or hard area palpable in 1 or both lobes

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17
Q

What are the findings on rectal examination for advanced prostate carcinoma?

A

Enlarged, hard irregular prostate

Poorly defined edges of prostate

Overlying rectal mucosa is intact

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18
Q

Describe the pathogenesis of BPH

A

Arises from transitional zone

>>Enlarged prostate
> increased urine outflow obstruction
> detrusor hypertrophy
> decompensation
> increased residual volume post micturation
> chronic retention
> hydronephrosis
> renal failure
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19
Q

What are the symptoms of BPH?

A

50% asymptomatic

LUTS

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20
Q

How is BPH diagnosed?

A

Symptom scoring
* IPSS - 7 Q’s - <7 = Mild and >20 = Severe

Rectal examination
* Smooth, non-tender enlarged prostate

Urine flow rate

  • Low flow = <10ml/sec
  • (N) = Bell shaped curve

Bloods
* Serum PSA

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21
Q

How would you manage BPH with a symptom score of <7? Explain your answer

A

IPSS <7 = Mild

Watchful waiting

Because…
50% will remain unchanged
25% will improve
25% will get worse

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22
Q

How would you manage a patient with symptomatic uncomplicated BPH?

Study These Flashcards
A

Medical management

Flowmax (alpha a1 adrenergic blocker)
* Causes smooth muscle relaxation of the prostate

Proscar (5 alpha-reductase inhibitor)

  • Causes shrinkage of the prostate
  • Decreases PSA
  • Secreted in semen and can cause hypospadias in a fetus
23
Q

What are the indications for surgery in BPH?

Study These Flashcards
A

Complications of bladder outflow obstruction

Recurrent haematuria due to BPH

Failed/contraindicated medical treatment

Previous prostate surgery

24
Q

What are the surgical options for management of BPH?

Study These Flashcards
A

TURP

Open prostatectomy

25
What are the complications of TURP?
TUR-syndrome * Fluid overload + hyponatraema (esp. when using sterile water) Secondary Haemorrhage Septicaemia Retrograde ejaculation Incontinence Urethral stricture
26
How would you managed a patient with TUR-syndrome?
Stop procedure Furoscemide 40mg IV
27
What is the most common type of bladder cancer?
Transitional cell carcinoma
28
What is the etiology of TCC of the bladder?
Smoking Exposure to aromatic amines Analgesic abuse Cyclophosphamide Pelvic Irradiation
29
What is the clinical presentation of a TCC of the bladder?
Painless macroscopic haematuria (70-90%) Microscopic haematuria Irritative voiding symptoms Suprapubic pain Lower abdominal mass Metastases * Dyspnoea * Bone pain
30
What special investigations would you do for a TCC of the bladder?
FBC Renal function test * Creatinine raised Urine cytology * Urothelium cells * Presence of malignant cells Cystoscopy * visualization of lesion * Can do a TURBT/biopsy of lesion Ultrasound * Bladder mass * Presence/absence of hydronephrosis Excretory urethrogram * Ureteric obstruction * Hydronephrosis * Filling defect on cystogram phase CT scan * Staging
31
List the causes of a filling defect
Bladder tumour Bladder stone Blood clot Prostate middle lobe Foley catheter balloon Overlying bowel gas Foreign body Fungus Ball
32
How would you manage a carcinoma is situ (CIS) of the bladder?
Intravesicular immunotherapy * BCG weekly for 6 weeks If successful: * BCG every 3 months for 3 years If unsuccessful: * radical cystectomy
33
How would you manage a superficial papillary lesion of the bladder?
Complete TURBT Follow-up cystoscopy every 3 months Repeat TURBT if needed (Prognosis = 75-95% 5-year survival)
34
What are the indications for a cystectomy?
Unsuccessful intravesical immunotherapy of CIS Extensive multiple recurrent tumours Evidence of muscle invasion
35
List to types of Renal calculi
Radio-opaque * Calcium oxalate * Struvite (infection) - Staghorn * Cystine Non-opaque * Uric acid * Indinavir
36
Discuss calcium stones
Most common renal calculi (75%) May be associated with metabolic abnormalities * Hypercalcaemia * Hypercalciuria * Hyperoxaluria * Hyperuricosuria * Low magnesium / citrate
37
Discuss struvite (infection) stones
20% of renal calculi Pathogenesis * UTI caused by urease producing organisms - Proteus, pseudomonas, klebsiella * Urea is then broken down into ammonia which causes the urine to become alkalinic * This leads to precipitation of various proteins in urine + pus cells + organisms which makes up the matrix of the stone * The crystalline part of the stone is made up of calcium, magnesium, ammonium and phosphate (CAMP) Rapid stone growth leads to a staghorn configuration * Fills/partially fills the renal pelvis + 2 or more renal calyces
38
What are the factors associated with uric acid stone formation?
Low urine output - Dehydration Low urine pH High red meat intake Chronic diarrhoea - dehydration Hyperuricosuria - Gout
39
What are the complications of renal calculi?
UTIs Obstruction * Hydronephrosis * Renal failure Chronic irritation * Leukoplakia * SCC of renal pelvis
40
What is the presentation of a patient with a renal calculi?
Haematuria Pain * Renal colic * Renal pain Complications Asymptomatic - Infection stones
41
How would you investigate a patient with suspected renal calculi?
Urine dipstick * Haematuria Urine MCS AXR * Able to visualize an radio-opaque stone * Calcium - Round, irregular border * Struvite - Staghorn * Cystine - Ground glass appearence IVP * site of stone * degree of obstruction * kidney function Metabolic evaluation * Primary hyperparathyroidism - serum levels * 24 hour urine - recurrent stone formers Stone analysis
42
What is the surgical treatment of a renal calculi?
General measures * High fluid intake * low salt, low red meat diet * do not restrict calcium intake Surgical Treatment * PCNL * ESWL - small stones <2cm * Pyelolithomy - removed from renal pelvis * Nephrolithotomy - removed through renal parenchyma * Combined treatment * Chemolysis * Nephrectomy Long term follow up
43
What is the etiology of bladder calculi?
Primary * Children Secondary * Bladder outflow obstruction * Foreign bodies * Stasis and infection - neuropathic bladder/ bladder diverticulum * Stone from upper tract * Primary hyperparathyroidism
44
What is the clinical presentation of a patient with a bladder calculi?
Suprapubic pain Dysuria Haematuria Intermittent interruption of bladder stream Symptoms of bladder outflow obstruction Irritative symptoms
45
How do you diagnose a patient with a bladder calculi?
US AXR * 50% non-opaque Cystoscopy * Usually done for bladder outflow obstruction
46
What is the treatment of a patient with a bladder calculi?
Endoscopic cystolithopaxy Open cystolithopaxy * Multiple stones * If open prostatectomy needed TURP * For treatment of bladder outflow obstruction if present
47
What are the components of the posterior urethra?
Prostatic urethra Membranous urethra
48
What are the components of the anterior urethra?
Penile urethra Bulbar urethra Glanular urethra
49
What are the inflammatory causes of Urethral strictures in males?
Gonorrhoea urethritis - Most common cause in SA Chlamydial urethritis Balanitis xerotica obliterans (lichen sclerosis)
50
Discuss how a catheter can cause a urethral stricture in a male
1. Previous indwelling urethral catheter 2. Premature inflation of catheter balloon in the urethra 3. Submeatal/Bulbar stricture
51
What are the clinical features of urethral strictures?
Previous history... * Urethritis * Catheterisation * Perineal trauma * Pelvic radiotherapy * Urinary difficulty - thin stream/spraying Examination... * Meatal/submeatal stricture * Palpable bulbar urethra thickening * Palpable urethral mass - carcinoma Local complications * peri-urethral abscess * necrotising fasciitis Complications of bladder outflow obstruction * urinary retention * epididymitis * chronic renal failure
52
How would you investigate a patient with a urethral stricture?
Urine dipstick Urine MCS Ascending Retrograde Urethrogram * Foleys catheter inserted through the EUM and balloon inflated just enough to prevent leakage * Contrast injected upwards through the EUM under x-ray screening * Info about penile and bulbar urethra Descending retrograde urethrogram * Patient already has a suprapubic catheter in place * Bladder is filled with contrast via surprapubic catheter * Patient voids under x-ray screening
53
What is the managemnet of urethral strictures in males?
Inital - Suprapubic catheterization Dilation of urethra Optical Urethrotomy * short <2cm strictures in bulbar urethra * Cystoscope with small knife at tip * indwelling transurethral catheter 1-3 days Intermittent self dilatation * Used with urethral dilatation and optical urethrotomy coz of stricture recurrencce Urethral stent * Expensive Urethroplasty - Treatment of choice * Excision and end to end urethroplasty - <2cm * Substitution urethroplasty
54
What are the treatment complications of urethral strictures?
Periurethral abscess Necrotising fasciitis of perineum Urethrocutaneous fistula Proximal diversion

Urology (5 decks)

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