23 y/o male with: - 1cm stone and hydronephrosis? - 1cm stone, no hydronephrosis? - 2.7cm staghorn calculus?

- percutaneous nephrostomy - lithotripsy - percutaneous nephrolithotomy

Management of varicoceles: - mild? - mod or severe?

Mild - conservative Mod-severe: - if asymptomatic and normal semen analysis: semen analysis every 1-2 years - if symptomatic or abnormal semen analysis: surgery

Urology Flashcards by Joe McAuley

Why might someone with haematuria on a background of bladder cancer develop post-renal AKI?
What is the 1st line management of this?

Clot causing urethral blockage

Continuous bladder irrigation via 3-way catheter

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How long must someone abstain from ejaculation/rigorous exercise before getting PSA?

48 hours

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Most common cause of epidydimo-orchitis in males <35 y/o?
If >35 y/o or those who have anal sex?
What may be seen on exam?

<35: chlamydia

> 35: E coli or enterococcus

Erythematous, swollen testicle. Pain is relieved upon elevating the testicle

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28 y/o man has painful testicle that came on 10 hours ago and has been getting worse. He is pyrexial, the testis is tender and there is associated hydrocele?

Acute infective epidydimo-orchitis

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15 y.o boy develops acute pain in left hemiscrotum, O/E the superior pole of the testis is tender and cremasteric reflex is partially marked?

Torsion of testicular appendix (hydatid of morgagni)

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Renal stone with sepsis?

IV antibiotics and renal decompression

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23 y/o male with:

1cm stone and hydronephrosis?
1cm stone, no hydronephrosis?
2.7cm staghorn calculus?

percutaneous nephrostomy
lithotripsy
percutaneous nephrolithotomy

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What can cause acute urinary retention in females?

UTI
Neurogenic
Neoplasm
Fibroids
Constipation

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Management of varicoceles:

mild?
mod or severe?

Mild - conservative

Mod-severe:

if asymptomatic and normal semen analysis: semen analysis every 1-2 years
if symptomatic or abnormal semen analysis: surgery

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2 year old boy with hypertension and right flank mass. CT: non-calcified, irregular lesion affecting apex or R kidney and adrenal gland?

Nephroblastoma

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Communicating hydrocele?
Non-communicating?
What can they develop secondary to?

Communicating:
Patency of processus vaginalis allowing peritoneal fluid to drain down into scrotum. In 5-10% newborns

Non-communicating:
caused by excessive fluid production in tunica vaginalis

Can develop 2 to:

epididymis-orchitis
torsion
tumours

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Ix for hydrocele?

Management?

Ix:
usually a clinical diagnosis (non-tender swelling of hemiscrotum usually anterior and below testicle, can get above, transilluminates)
-> if any uncertainty, USS

Management:

infantile: resolve spontaneously within 1-2 years, rarely don’t resolve and may be fixed
adults: conservative approach if non-severe. Further investigation usually warranted to rule out cancer

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What side are varicoceles most common on?
Presentation?
Ix?
Management?

Left

‘bag of worms’, may be assoc w subfertility

USS with doppler

Management:
Usually conservative
Occasionally surgery if pain or infertility

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Epididymal cyst features?
Assoc w?
Ix?
Management?

Most common cause of scrotal swellings in primary care

Separate from the body of the testicle
Posterior to the testicle

Assoc:

PKD
CF
von hippel-lindau

Ix: may be confirmed by USS if needed

Management:
Supportive
Surgical removal or sclerotherapy may be attempted if larger or symptomatic

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Neuropathic pain:
- if drug is not working, what should you do?
- what can be used for rescue therapy?
- what can be used for localised neuropathic pain e.g. post-herpetic?
If none of this working?

Switch to another one - they are used as mono therapies, don’t add them on top of each other

Tramadol rescue

Localised: capsaicin cream

If not working - refer to pain team

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Types of bladder cancer?
Ix?
Management if superficial (CIS/T1)?
Management of T2+ (invasion into muscle)?

Transitional - 90%
Squamous - schistosomiasis
Ademocarcinoma - if neobladder formed

Ix: biopsy - cystoscopy
MRI for invasion
CT/PET CT for mets

Superficial - transurethral resection

T2+ - radical cystectomy with ileal neobladder or radical radiotherapy

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High risk AAA rupture, indicating need for surgery?

Preferred treatment?

5.5+cm
Enlarging >1cm/year
Symptomatic

Ideally EVAR, open repair if unsuitable

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AAA size and surveillance?

<3cm, normal

3 - 4.4cm - small, USS every 12 months

5 - 5.4 - medium, USS every 3 months
5+ - large, refer to vascular surgeon within 2 weeks

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Is there screening for AAA?

Yes, single USS scan for males aged 65

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6P’s of acute limb ischaemia?

Pale
Pulseless
Painful
Paralysed
Paraesthetic
Perishing with cold

1 or more suggests acute limb ischaemia

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Initial management of suspected acute limb ischaemia?

USS doppler
Analgesia - IV opioids
IV unfractioned heparin to prevent thrombus propagation
Immediate vascular review

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What suggests thrombus causing limb ischaemia?

What suggests embolus?

Thrombus:

pre-existing claudcation with sudden deterioration
no obvious embolic source
Reduced/absent pulses in contralateral limb as well

Embolic:

sudden onset with no Hx claudication
obvious source e.g. AF, recent MI
contralateral limb fine
evidence of proximal aneurysm (abdo, popliteal)

Management of superficial thrombophlebitis?

Specific to long saphenous vein?

General:
NSAIDs 8-12 days
Compression stockings (after ABPI)
since thrombophlebitis gives a 4% chance of forming clot

Long saphenous:
If proximal, USS to exclude DVT
Consider LMWH/Fondaparinux for up to 45 days

Drugs given to folk with peripheral arterial disease?

Statin

Clopidogrel

Drugs given to folk with peripheral arterial disease?

Statin | Clopidogrel

Management of acute urinary retention?

USS initially to confirm - volume >300ml confirms diagnosis - catheter - if <200ml, not urinary retention - If >400ml, keep catheter in place Reversible cause - UTI, BPH, neuro

What typically causes ABPI >1.2?

Calcification e.g. in advanced age, PAD or diabetes

Where may people be tender with AAA?

Abdo and loin (aorta is right sided)

SE tamsulosin? How long does it take finasteride to work? SE? What does it do to PSA?

Talsulosin: - dizziness, postural hypotension, dry mouth, depression Finasteride: - takes up to 6 months to work - SE: erectile dysfunction, reduced livido, ejaculation problems, gynaecomastia (prevents conversion of testosterone to DHT) - Can raise PSA by up to 50%

What can raise PSA levels that's not cancer? (5)

``` BPH Prostatitis/UTI Ejaculation/vigorous exercise in 48 hours prior Urinary retention Catheterisation ```

Age peaks of priapism? | Causes?

Bimodal - 5-10 and 20-50 years Causes: idiopathic, sickle cell, sildenafil, anti-hypertensives, antcoagulants, antidepressants, recreational drugs

Presentation of priapism?

Persistent erection for >4 hours Pain localised to penis If not fully erect/not painful or Hx of trauma this suggests non-ischaemic Ix: - Cavernosal blood gas - differentiate between ischaemic (low O2 and pH) and non-ischaemic - Doppler as alternative to assess blood flow in penis - FBC/toxicology for underlying cause

Management of priapism if ischaemic and non-ischaemic?

Ischaemic is a medical emergency - can lead to permanent damage If >4 hours - aspiration of blood from cavernous - combined with saline flush If this fails - injection of vasoconstrictive agent e.g. phenylephrine Surgery last resort If non-ischaemic - not an emergency - suitable for observation

Ix for intermittent claudication?

Duplex USS 1st line | MR angiography if surgery is planned

What type of renal stones are radio-lucent?

Urate and xanthine - radio-lucent Cystine - semi-opaque (1%) Calcium oxalate (40%), mixed calcium oxalate/phosphate (25%), triple phosphate (struvite - 10%) and calcium phosphate (10%) all radio-opaque

Indications for circumcision? | What must be ruled out before circumcision?

Phimosis Recurrent balanitis BXO Paraphimosis Hypospadias - foreskin used in repair

Intermittent testicular torsion management?

Emergency fixation as prophylaxis

Management options of prostate Ca if T1/T2? Management options for T3/T4? Hormonal options available? (3)

T1/T2: Conserative - watchful waiting, radical prostatectomy or radiotherapy T3/T4: hormonal therapy, radical prostatectomy, radiotherapy Hormonal therapy: - Goserelin (GnRH agonist) - provides negative feedback to ant pit - cover with cyproterone at start - Cyproterone (anti-androgen) - prevents DHT binding to intracytoplasmic protein complexes - orchidectomy

SE of radical prostatectomy? | Of radiotherapy?

Surgery: ED Radio: bladder, colon or rectal cancer

Things that suggest an organic cause of erectile dysfunction?

``` Gradual onset Normal ejaculation Normal libido (unless hypogonadism) Cardio/endocrine/neuro disease Operations/radiotherapy Drug use or PED's Smoking, alcohol ```

Ix for erectile dysfunction?

Free testosterone in morning If low, repeat along with FSH/LH and PRL Refer to endocrinology if abnormal Also calculate QRISK and measure lipids and fasting glucose

Management of ED?

Sildenafil - useful in ED of all aetiologies Vacuum erection device - 1st line in those who don't want viagra Refer to urology if young If keen cyclist tell them to cut down

Obese 77 y/o with T2DM has leg pain at rest, it is worse at night and sometimes improves during the day, no ares of ulceration. What is likely ABPI?

>1.2 | Typical of diabetic ulceration

What is the only testicular/scrotal problem that causes a lump and difficulty conceiving?

Varicocele

Ix for hydronephrosis? Management? Management if hydronephrosis assoc w acute or chronic upper UTI?

1st line - USS IVU - assess position of obstruction If suspected renal colic - CTKUB Management: - remove obstruction - acute upper UTI - nephrostomy Chronic upper UTI - ureteric stent or pyeloplasty

What type of cancer is a renal cell carcinoma? How might it appear under imaging? Ix? Where do they metastasise to?

Adenocarcinoma, most common subtype is clear cell - may appear multifocal, calcified, and/or cystic Ix: - CT CAP 1st line First line for any renal mass as benign masses rare Met: lung, bone, brain

Can hernias transilluminate?

If there is a thin walled bowel rarely they can e.g. in newborn

What are high and low pressure chronic urinary retention?

High pressure - impaired renal function and bilateral hydronephrosis, typically due to bladder outflow obstruction Low pressure - normal renal function and no hydronephrosis

What drugs can cause urinary retention?

``` TCA e.g. amitriptyline Anticholinergics Opioids NSAIDs Disopyramide ```

Complication after relieving acute urinary retention? | Chronic urinary retention?

Acute - post-obstructive diuresis - Kidneys lose medullary concentration gradient so lose ability to concentrate urine - can lead to volume depletion and AKI - fluids - Will re-equilibriate on its own Chronic - decompression haematuria - commonly occurs after catheterisation due to rapid decrease in bladder pressure - Just monitor, requires no further treatment

What can cause intermittent claudication type symptoms of the buttocks?

Iliac stenosis

At what stage will most people with renal cell cancer present?

Stage 4

Test to assess if bladder is leaking after partial cystectomy?

Cystogram

Painful mid-calf ulcer with mild pitting oedema - what type?

Arterial - oedema likely from heart failure