Urology Flashcards
1
Q
Haemospermia may be a presentation of what?
A
- prostate cancer
2
Q
What is non-visible haematuria
A
- microscopic
3
Q
Potential symptoms of non-visual haematuria
A
- LUTS (Hesitancy, frequency, urgency, dysuria)
- UUTS (Renal colic)
4
Q
What does LUTS stand for?
A
- Lower urinary tract symptoms
5
Q
What is important in a history for a patient with haematuria?
A
- smoking
- age > 40yrs
- occupational exposure
- travel (schistoma)
6
Q
Causes of haematuria?
A
- stones
- infection
- malignancy
- trauma
7
Q
What are some infective causes of haematuria?
A
- uretritis
- prostatisis
- cystitis
- pyelonephritis
- glomerulonephritis
8
Q
Tumours of the urinary tract may have what symptoms?
A
- haematuria
- loin pain
- renal colic
- urinary retention
9
Q
Penile cancer symptoms?
A
- itching
- burning
- haematuria
- mass
10
Q
Potential contaminants that may appear like haematuria?
A
- menstural
- food (beetroot, blackberries)
- myoglobin (rhabdomyolysis)
11
Q
Biggest risk factor for bladder cancer?
A
- smoking
12
Q
Schistosoma may lead to what?
A
- chronic cystitis
- squamous cell carcinoma
13
Q
Describe joggers haematuria?
A
- stress - hypoxic damage to nephrons
- no underlying cause
14
Q
Blood visible at the start of urination?
A
- urethra?
15
Q
Blood visible at end of urination?
A
- bladder
- prostate
16
Q
Blood visible throughout urination?
A
- bladder
- kidney
- ureters
17
Q
Investigations for haematuria?
A
- dip stick
- PR examination
- Gold standard = CT urogram
- USS
- MRI
- flexible cytoscopy
18
Q
All patients aged > ____ years with asymptomatic non-visible haematuria should be___
A
- 40yrs
- referred
19
Q
Gold standard investigation for visible haematuria?
A
- CT urogram
20
Q
When might an MRI be done over a CT in a haematuria case?
A
- allergy to contrast dye in CT
21
Q
Causes of a bladder obstruction
A
- benign prostatic hyperplasia
- urethral stricture
- prostatic cancer
- bladder stones
- extrinsic (cystocoele)
- drugs
22
Q
What drugs may cause a bladder outflow obstruction?
A
- anti-cholinergic
- nasal decongestants
23
Q
What is a cystocoele?
A
- prolapsed bladder
24
Q
What composes Hald diagram?
A
- LUTS
- BOO (Bladder outflow obstruction)
- BPE (Benign prostatic enlargement)
25
LUTS can be divided into?
- storage
| - voiding
26
What are some voiding LUTS symptoms?
- hesitancy
- poor flow
- intermittent flow
- sensation of incomplete emptying
- post-micturition dribbling
27
Red flags in urology?
- haematuria
- supra-pubic pain
- recurrent UTI
- Back pain/sciatica
28
What scoring system can be used in bladder obstruction?
- international prostate symptom scale
29
What investigations for bladder outflow obstruction should be conducted?
- frequency-volume chart
- urinalysis
- serum creatinine
- PSA
- Renal USS
- Cytoscopy
- TRUS (Transrectal ultrasound)
30
Surgical treatments of bladder outflow obstructions?
- transurethral resection of prostate gland
| - holmium laser of prostate
31
Medical management of bladder outflow obstruction
- alpha blockers (tamsulosin)
- 5 a reductase inhibitors (testosterone inhibitors)
- anticholinergic
- beta agonist
32
Mainly voiding symptoms suggests?
- bladder outflow obstruction
33
How do alpha blockers work?
- act on smooth muscle of prostate
34
What is the function of 5-alpha reductase inhibitors?
- shrinks prostate
35
Surgical treatment of prostate obstruction to bladder flow
- transurethral resection of prostate gland
36
What is a risk factor for testicular cancer?
- cryptorchidism
37
Main cell type in testicular cancer
- mixed germ cell
38
Investigations for testicular cancer
- USS
- CT chest/abdo
- blood tests (alpha feto protein)
39
Name a testicular cancer tumour marker?
- alpha-feto protein
40
Most common cell type of penile cancer
- squamous cell carcinoma
41
What are risk factors for penile cancer?
- AGE >50YRS
- Asia/africa
- hPV 16 & 18
42
What HPV is associated with penile cancer
16 and 18
43
Most common site for penile cancer
- the glans
44
20% of angiomyolipoma patients may have what condition?
- tuberous sclerosis
45
Appearance of oncocytoma?
- stellate scar
46
Genetic link to clear cell carcinoma?
- VHL
47
Commonest renal cancer
- clear cell
48
Treatment of renal cancer less than 4cm
- leave alone
49
Treatment of renal tumour greater than 7cm
- radical nephropathy
50
Causes of acute urinary retention
```
o Prostate infection
o Bladder overdistention
o Excessive fluid intake
o Alcohol
o Prostatic infarction
```
51
Name some triggering events of acute urinary retention?
o Non-prostate related surgery
o Catheterization
o Urethral instrumentation
o Medications - sympathomimetic or anticholinergic
52
What is paraphimosis
- painful swelling of the foreskin distal to phimotic ring
53
When does paraphimosis occur?
- after catheterisation or cystoscopy
54
Treatment of paraphimosis?
- multiple punctures on foreskin
- under penile block, manual compression of glands
- dorsal slit
55
Define priapism
- prolonged unwanted erection >4hrs, painful and not associated with sexual arousal
56
Causes of priapism
- idiopathic
- intracorporeal injection for ED
- Trauma
57
Risk in priapism?
- vascular ischaemia
58
Investigations for priapism
- aspiration of blood from corpus cavernosum
| - colour doppler USS
59
Treatment of priapism
- aspiration
- injection of alpha agonist
- surgical shunt
- non-ischaemic = may resolve spontaneously
60
Define fournier's gangrene
- form of necrotising fasciitis occurring about the male genitalia
61
Predisposing factors for fournier's gangrene
- diabetes
| - local trauma
62
Treatment of fournier's gangrene
- antibiotics and surgical debridement
63
Symptoms of fournier's gangrene
- swelling
- crepitus
- dark purple
64
Treatment of acute urinary retention
- catheter
| - a blockers
65
What organisms are involved in mourners gangrene
- anaerobes and areobes
66
What causes a perinephric abscess
- rupture of an acute cortical abscess into perinephric space
67
What are the blood results for a perinephric abscess
- raised WCC
| - raised creatinine
68
Treatment of perinephric abscess
- CT guided drain and antibiotics
69
Describe emphysematous pyelonephritis
- an acute necrotising parenchymal and perinal infection
70
What organism usually causes emphysematous pyelonpehritis
- e.coli
71
What is seen on CT of emphysematous pyelonephritis
- gas formation
72
Treatment of emphysematous pyelonephritis
- antibiotics
| - potential nephrectomy
73
Causes of an acute renal trauma
- RTA
| - sporting injury
74
Symptoms of renal trauma
- frank haematuria
| - loin pain
75
Investigations of renal trauma
- CT with contrast
76
Bladder trauma is associated with what injury?
- pelvic fractures
77
Symptoms of bladder trauma
- suprapubic tenderness
- lower abdo bruising
- gross haematuria
78
Treatment of bladder trauma
- large bore catheter
- antibiotics
- surgery
79
Urethral trauma is associated with what injury?
- pubic rami fracture
80
Symptoms of urethral trauma
- butterfly haemangioma
| - blood at meatus
81
Treatment of urethral trauma
- suprapubic catheter
| - reconstruction >3mnths
82
Describe post-obrustive diuresis
- prolonged urine production after relief of urinary retention
83
What should be monitored in post-obstructive diuresis?
- fluid balance
84
Blue dot sign?
- torsion of appendage
85
Cremasteric reflex lost?
- torsion of spermatic cord
86
Treatment of torsion of spermatic cord?
- prompt exploration
87
Symptoms of epididymitis
- dysuria
- pyrexia
- cremasteric reflex
88
Treatment of epididymitis?
- analgesia
| - ofloxacin
89
2 main divisions of urinary incontinence
- stress urinary incontinence
| - urge urinary incontinence
90
What causes stress urinary incontinence
- intrinsic sphincter deficiency
| - raised intra abdo pressure - cough sneeze
91
What causes urge urinary incontinence
- bladder overactivity
| - detrusor instability
92
Nocturia incontinence in males may suggest
- chronic high pressure retention
93
Explain post-micturition dribble
- due to urine pooling in bulbar urethra
94
Constant leak of urine consider?
- fistula
95
Investigations for urinary incontinence
- bladder diary
- flow rate and post void residue
- cystometry
96
Treatment of incontinence
- lifestlyle
- pelvic floor muscles
- injection therapy - bulking
- retropubic suspension
- artificial urinary sphincter
97
Symptoms of overactive bladder
- urgency with or without incontinence
| - increased frequency
98
Treatment of an overactive bladder
- pelvic floor exercises
- anticholinergics
- botox
- augmentation ileocytoplasty
99
Last resort for an overactive bladder
- ileal conceit urinary diversion
