Urology Flashcards
What level are the kidneys found at
T12-L3
Where do the ureters cross
Pelvic brim at SI joint
Ureter location in relation to the uterine artery and vas deferens?
Ureters are posterior to these
What cell type is the bladder made from?
Transitional cell epithelium
Parasympathetic control contracts the detrusor muscle. T/F
T
Para - contracts
Symp - relaxes
What nerve controls the external urethral sphincter?
Pudendal
Renal Stones Ix (Gold standard)
(non contrast) CT KUB
It is more sensitive than an X-ray and US
What is the most common type of renal stone?
Calcium oxalate
Where are they most commonly found?
VUJ, PUJ, SI joints
VUJ - vesicouterer –> where the ureters meet the bladder
PUJ - pelvic utero –> where the ureters meet the pelvic of the kidney
Mx of stones?
Analgesia - Diclofenac
Usually conservative for small stones
Medical –> Tamsulosin, nifidepine, most pass within 48 hrs
Surgical:
- Less invasive = extracorporeal shockwave therapy
- More invasive = Ureteroscopy
Generally the rule is - if it is smaller than 1cm, use ESWL, if it is bigger than 1cm, use URS
Same rule applies for renal pelvis but the cut off is 2cm
Where does BPH occur in the prostate?
Transition zone
Symtpoms of BPH
Similar symptoms of overflow incontinence - poor stream, hesitancy, incomplete emptying, dribbling
Ix for BPH
PR exam, Urine dip, IPPS
TRUS is also used - US of the prostate
What is IPPS?
Prostate size score: 40-49 - 2.7 50-59 - 3.9 60-69 - 5 70-79 - 7.2
Anything outwith these ranges gives a worse prognosis
Medical Mx of BPH
Tamsulosin
Finasteride
What type of drug is finasteride. How does it work?
5-alpha reductase inhibitor
Reduces peripheral conversion of testosterone
Takes up to 6 months to work
Surgical Mx of BPH
TURP - Trans uretheral resection of the prostate
Can also do laser ablation or a prostatectomy
Causes of incontinence?
DIAPERS D = Delirium I = Infection A = Atropic vaginitis P = Pharmaceuticals - diuretics, anticholinergics E = Endocrine - DM, DI, Hypercalceamia R = Restricted mobility S = Stool impaction
Pathophysiology behind stress incontinence
Weak pelvic floor muscles - common in women who have had children
Pathophysiology behind urge
Detrusor overactivity
medical Mx for stress or urge?
Oxybutynin (<75) or mirabegron (<75)
Scortal swelling:
Involves the testis and is not transilluminable
Testiculuar tumour
Scortal swelling:
You can’t get above the swelling
Inguinoscrotal hernia
Scroatal swelling:
Swelling is seperate from the testis and is a smooth swelling
Epididymal cyst
Varicoceles Mx
Radiological embolization or surgical ligation
Types of renal cancers
Renal cell carcinoma - most common
Occurs in the tubules within the epithelium (outside)
Transitional cell carcinoma
Occurs in the calyces within the uroepithelium
Wilms - cancer in kids
X-ray signs of renal cancer
cannonball mets in the lungs
First line Ix
US
Mx of renal cancer
Surgery - partial or total nephrectomy
7cm is cutoff
What stage of renal cancer is:
Tumour is in major veins or adrenal gland, tumour within Gerota’s fascia or 1 regional lymph node involved
Stage 3
Mx in stage 2+ RCC
Nephrectomy + immunotherapy - INF alpha or IL2 or tyrosine kinase inhibitors
BLadder cancer - what is schistosomiasis?
Squamous cell cancer of the bladder - least common type
main symptom of bladder cancer
painless haematuria
Ix bladder cancer
1st line - urine cytology
Diagnostic - cystoscopy w biopsy
Staging - CT urogram
Mx for superficial non-invasive bladder cancer
TURBT
+/- chemo = mitomycin C
Mx for T2, T3 bladder cancer
Radical cystectomy w ileal conduit
Neoadjuvant chemo
Mx of inoperable locally advanced bladder cancer (T4)
Palliative chemo
Long term catheterization
Follow up from bladder cancer as recurrence rates are HIGH
Regular cystopscopies every 3 months for 2 years
Where is prostate cancer most common?
Adenocarcinoma of the peripheral zone
Diagnostic for prostate cancer
Transrectal/transperineal biopsy + PSA
What score is used for prostate cancer
Gleason score
If prostate cancer is low risk, what is the Mx?
Active surveillance
PSA + DRE every few months
Biopsy at 12 months if concerned
If prostate cancer is medium-high risk
Radical prostacteomy + seminal vesicles + pelvic LNs
External beam RT
If prostate cancer is advanced, what is Mx?
Pelvic EBRT + androgen deprivation
If prostate cancer is metastatic, what is Mx?
Bilateral orchidectomy
Androgen deprovation therapy (goserelin, zoladex) - note S/E flare phenomenon
What is flare phenomenon?
Goserelin = increase of symptoms of prostatic cancer due to increase in LH prior to down regulation
Symtpoms = bone pain, cord compression, acute bladder obstruction, AKI
How to avoid flare phenomenon?
Use anti-androgens such as cryptorone-acetate should be prescribed 3 days before starting gosrelin
Testicular cancer sub types
Germ cell:
1) Seminomas
2) Non-seminoma germ cell tumours (NSGCT)
NSGCT:
a) mixed
b) yolk sac
c) choriocarcinoma
d) embryonal carcinoma
e) Teratoma
Symptoms of testicular cancer
Painless lump
Hydrocele
Loss of testicular sensation
Blood results for testicular cancer
increase bHCG for seminomas and NSGCTs
increase ALP just seminoma
Increase AFP just NSGCTs
Ix testicular cancer
US
Note - NO BIOPSY, diagnosis must be made from total excision and histology
Mx seminomas
Stage 1-2 = inguinal radical orchidectomy + para-aortic LN removal + radiotherapy
Stage 3-4 = all of the above + chemo
chemo drugs = bleomycin, etoposide, cisplatin
Mx NSGCTs
Stage 1 - inguinal orchidectomy
2 - “ “ + chemo + para-aortic LN dissection
3 - IO + chemo
4 - IO with spermatic cord clamping + chemo
Follow up testicular cancer
18-24 months = CT + tumour markers (bHCG, ALP, AFP, LDH)
In testicular torsion, is the cremasteric reflex +ve or -ve
-ve (only if the whole spermatic cord is affected)
Mx of testicular torsion
Inform a senior
NBM, analgesia, pre-op bloods
Surgical mx –> Bilateral surgical orchidopexy (suture testis to scrotum)
Consent for orchidectomy
What investigations do you want to do when someone presents with acute urinary retention?
US renal tract - hydroneprhosis
CT abdo/pelvis - mass?
MRI/CT head - neurological cause
Mx of acute urinary retention
Immediate catheterization
Give Tamsulosin to prepare for TWOC (after 24-72hrs)
Causes of AUR?
DRUGS –> Anticholinergics, CCBs, Opioids,
INFECTIONS –> balanitis, prostatitis, vulvovaginitis, HSV
OBSTRUCTION –> BPH most common, phimosis, prolapse, pelvic mass (uterine fibroid)
and many more!
What is fournier’s gangrene?
Necrotising fasciitis of the perineum
What organisms are likely cause of fournier’s ?
It is polymicrobial:
E. coli, staphs, anerobes
Who is most at risk of fourneir’s?
T2DM, Immunocompromised, alcohol excess
Mx for founier’s
ABCDE + SEPSIS 6
- broad spec abs - gent + taz
- prep for theatre for debridement
