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Finals Revision > Urology > Flashcards

Urology Flashcards

1
Q

What level are the kidneys found at

A

T12-L3

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2
Q

Where do the ureters cross

A

Pelvic brim at SI joint

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3
Q

Ureter location in relation to the uterine artery and vas deferens?

A

Ureters are posterior to these

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4
Q

What cell type is the bladder made from?

A

Transitional cell epithelium

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5
Q

Parasympathetic control contracts the detrusor muscle. T/F

A

T
Para - contracts
Symp - relaxes

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6
Q

What nerve controls the external urethral sphincter?

A

Pudendal

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7
Q

Renal Stones Ix (Gold standard)

A

(non contrast) CT KUB

It is more sensitive than an X-ray and US

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8
Q

What is the most common type of renal stone?

A

Calcium oxalate

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9
Q

Where are they most commonly found?

A

VUJ, PUJ, SI joints

VUJ - vesicouterer –> where the ureters meet the bladder
PUJ - pelvic utero –> where the ureters meet the pelvic of the kidney

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10
Q

Mx of stones?

A

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

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11
Q

Where does BPH occur in the prostate?

A

Transition zone

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12
Q

Symtpoms of BPH

A

Similar symptoms of overflow incontinence - poor stream, hesitancy, incomplete emptying, dribbling

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13
Q

Ix for BPH

A

PR exam, Urine dip, IPPS

TRUS is also used - US of the prostate

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14
Q

What is IPPS?

A 
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

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15
Q

Medical Mx of BPH

A

Tamsulosin

Finasteride

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16
Q

What type of drug is finasteride. How does it work?

A

5-alpha reductase inhibitor
Reduces peripheral conversion of testosterone
Takes up to 6 months to work

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17
Q

Surgical Mx of BPH

A

TURP - Trans uretheral resection of the prostate

Can also do laser ablation or a prostatectomy

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18
Q

Causes of incontinence?

A 
DIAPERS 
D = Delirium 
I = Infection 
A = Atropic vaginitis 
P = Pharmaceuticals - diuretics, anticholinergics
E = Endocrine - DM, DI, Hypercalceamia 
R = Restricted mobility 
S = Stool impaction
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19
Q

Pathophysiology behind stress incontinence

A

Weak pelvic floor muscles - common in women who have had children

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20
Q

Pathophysiology behind urge

A

Detrusor overactivity

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21
Q

medical Mx for stress or urge?

A

Oxybutynin (<75) or mirabegron (<75)

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22
Q

Scortal swelling:

Involves the testis and is not transilluminable

A

Testiculuar tumour

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23
Q

Scortal swelling:

You can’t get above the swelling

A

Inguinoscrotal hernia

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24
Q

Scroatal swelling:

Swelling is seperate from the testis and is a smooth swelling

A

Epididymal cyst

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25
Q

Varicoceles Mx

A

Radiological embolization or surgical ligation

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26
Q

Types of renal cancers

A

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

27
Q

X-ray signs of renal cancer

A

cannonball mets in the lungs

28
Q

First line Ix

A

US

29
Q

Mx of renal cancer

A

Surgery - partial or total nephrectomy

7cm is cutoff

30
Q

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

A

Stage 3

31
Q

Mx in stage 2+ RCC

A

Nephrectomy + immunotherapy - INF alpha or IL2 or tyrosine kinase inhibitors

32
Q

BLadder cancer - what is schistosomiasis?

A

Squamous cell cancer of the bladder - least common type

33
Q

main symptom of bladder cancer

A

painless haematuria

34
Q

Ix bladder cancer

A

1st line - urine cytology

Diagnostic - cystoscopy w biopsy

Staging - CT urogram

35
Q

Mx for superficial non-invasive bladder cancer

A

TURBT

+/- chemo = mitomycin C

36
Q

Mx for T2, T3 bladder cancer

A

Radical cystectomy w ileal conduit

Neoadjuvant chemo

37
Q

Mx of inoperable locally advanced bladder cancer (T4)

A

Palliative chemo

Long term catheterization

38
Q

Follow up from bladder cancer as recurrence rates are HIGH

A

Regular cystopscopies every 3 months for 2 years

39
Q

Where is prostate cancer most common?

A

Adenocarcinoma of the peripheral zone

40
Q

Diagnostic for prostate cancer

A

Transrectal/transperineal biopsy + PSA

41
Q

What score is used for prostate cancer

A

Gleason score

42
Q

If prostate cancer is low risk, what is the Mx?

A

Active surveillance
PSA + DRE every few months
Biopsy at 12 months if concerned

43
Q

If prostate cancer is medium-high risk

A

Radical prostacteomy + seminal vesicles + pelvic LNs

External beam RT

44
Q

If prostate cancer is advanced, what is Mx?

A

Pelvic EBRT + androgen deprivation

45
Q

If prostate cancer is metastatic, what is Mx?

A

Bilateral orchidectomy

Androgen deprovation therapy (goserelin, zoladex) - note S/E flare phenomenon

46
Q

What is flare phenomenon?

A

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

47
Q

How to avoid flare phenomenon?

A

Use anti-androgens such as cryptorone-acetate should be prescribed 3 days before starting gosrelin

48
Q

Testicular cancer sub types

A

Germ cell:

1) Seminomas
2) Non-seminoma germ cell tumours (NSGCT)

NSGCT:

a) mixed
b) yolk sac
c) choriocarcinoma
d) embryonal carcinoma
e) Teratoma

49
Q

Symptoms of testicular cancer

A

Painless lump
Hydrocele
Loss of testicular sensation

50
Q

Blood results for testicular cancer

A

increase bHCG for seminomas and NSGCTs

increase ALP just seminoma
Increase AFP just NSGCTs

51
Q

Ix testicular cancer

A

US

Note - NO BIOPSY, diagnosis must be made from total excision and histology

52
Q

Mx seminomas

A

Stage 1-2 = inguinal radical orchidectomy + para-aortic LN removal + radiotherapy
Stage 3-4 = all of the above + chemo

chemo drugs = bleomycin, etoposide, cisplatin

53
Q

Mx NSGCTs

A

Stage 1 - inguinal orchidectomy
2 - “ “ + chemo + para-aortic LN dissection
3 - IO + chemo
4 - IO with spermatic cord clamping + chemo

54
Q

Follow up testicular cancer

A

18-24 months = CT + tumour markers (bHCG, ALP, AFP, LDH)

55
Q

In testicular torsion, is the cremasteric reflex +ve or -ve

A

-ve (only if the whole spermatic cord is affected)

56
Q

Mx of testicular torsion

A

Inform a senior
NBM, analgesia, pre-op bloods
Surgical mx –> Bilateral surgical orchidopexy (suture testis to scrotum)
Consent for orchidectomy

57
Q

What investigations do you want to do when someone presents with acute urinary retention?

A

US renal tract - hydroneprhosis
CT abdo/pelvis - mass?
MRI/CT head - neurological cause

58
Q

Mx of acute urinary retention

A

Immediate catheterization

Give Tamsulosin to prepare for TWOC (after 24-72hrs)

59
Q

Causes of AUR?

A

DRUGS –> Anticholinergics, CCBs, Opioids,
INFECTIONS –> balanitis, prostatitis, vulvovaginitis, HSV
OBSTRUCTION –> BPH most common, phimosis, prolapse, pelvic mass (uterine fibroid)

and many more!

60
Q

What is fournier’s gangrene?

A

Necrotising fasciitis of the perineum

61
Q

What organisms are likely cause of fournier’s ?

A

It is polymicrobial:

E. coli, staphs, anerobes

62
Q

Who is most at risk of fourneir’s?

A

T2DM, Immunocompromised, alcohol excess

63
Q

Mx for founier’s

A

ABCDE + SEPSIS 6

  • broad spec abs - gent + taz
  • prep for theatre for debridement

Finals Revision (7 decks)

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