Urology Flashcards
What are the risk factors for prostate cancer?
Increasing age
FH
Black ethnicity
Anabolic steroids
Where in the prostate do most prostate cancers occur in?
Peripheral zone
Where does prostate cancer most commonly metastasise to?
Lymph nodes
Bone
What are the symptoms of prostate cancer?
Asymptomatic Back pain Nocturia Hesitancy Poor stream Terminal dribbling Haematuria Erectile dysfunction Weight loss
Which cells produce prostate-specific antigen (PSA)?
Epithelial cells
What can cause a raised PSA?
Prostate cancer BPH Prostatitis UTIs Exercise Recent ejaculation
How would a benign prostate feel on DRE?
Smooth, soft and central sulcus
How would prostatitis feel on DRE?
Enlarged, tender, warm
How would a cancerous prostate feel on DRE?
Firm, craggy and loss of central sulcus
What is the referral wait time if you suspect prostate cancer?
2 weeks
What investigations can you do to confirm diagnosis of prostate cancer?
Multiparametric MRI
Prostate biopsy
Isotope bone scan
What are the risks of a prostate biopsy?
Pain Bleeding Infection Urinary retention Erectile dysfunction
Which system is used to grade prostate biopsies?
Gleason - the greater the score, the poorly differentiated the tumour is and worse the prognosis is
Which system is used to stage prostate cancer?
TNM staging
tumour, lymph nodes and mets
How would you manage localized prostate cancer?
Radical prostatectomy
Radical radiotherapy
Hormone therapy - androgen receptor blockers
Watchful waiting
How would you manage metastatic prostate cancer?
Androgen deprivation: GNrH analogues + LH antagonists
Radiotherapy
How would you manage castration resistant prostate cancer?
2nd line hormone therapy e.g. enzalutamide
Chemo e.g. docetaxel
Bisphosphonates
What is the key complication of radiotherapy?
Proctitis = inflammation in rectum
What are the key complications of radical prostatectomy?
Erectile dysfunction
Urinary incontinence
Which cells does testicular cancer arise from?
Germ cells
Name the types of testicular cancer
Seminoma
Non-seminoma
Mixed
What are the risk factors of testicular cancer?
Undescended testis Previous testicular tumour FH Infertility Infant hernia
What are the signs of testicular cancer?
Painless lump on testicle
Gynaecomastia
Which type of tumour causes gynaecomastia?
Leydig cell
How does a testicular cancer lump appear?
Non tender Arise from testicle Hard Irregular Not fluctuant No transillumination
What scans would you do to diagnose testicular cancer?
Scrotal USS
CT
What are the tumour markers for testicular cancer?
Alpha-fetoprotein
Beta-hCG
Lactate dehydrogenase (LDH)
How would you manage testicular cancer?
Radical orchidectomy - testis and spermatic cord are removed
Radiotherapy
Chemo
Sperm banking - treatment can cause infertility
How does an epididymal cyst appear?
Cyst on epididymis (top of testicle) which contains clear or milky fluid
A hydrocele is a collection of fluid where?
Tunica vaginalis
What are the clinical features of a hydrocele?
Testicle is palpable within hydrocele Soft Irreducible No bowel sounds (separate from hernia) Transilluminated
What is hydrocele secondary to?
Testicular cancer
Testicular torsion
Epididymo-orchitis
Trauma
A varicocele is dilated veins of what structure?
Pampiniform plexus
The pampiniform plexus is a venous plexus, which is found in the spermatic cord and drains the testes. The pampiniform plexus drains into the testicular vein. It plays a role in regulating the temperature of blood entering the testes by absorbing heat from the nearby testicular artery. The testicles need to be at an optimum temperature for producing sperm.
What are the complications of a varicocele?
Testicular atrophy
Impaired fertility
Varicoceles are the result of increased resistance in the testicular vein. Where do the right and left testicular veins drain into?
Right testicular vein —> inferior vena cava
Left testicular vein —> Left renal vein
Which side do varicoceles most commonly occur in and why?
Left, due to increased resistance in left testicular vein
A left-sided varicocele can indicate an obstruction of the left testicular vein caused by what?
Renal cell carcinoma
What are the symptoms of a varicocele?
Dull pain
Infertility
What are the signs of a varicocele?
Scrotal mass that feels like a bag of worms
More prominent on standing
Disappears when lying down
Which conditions can cause erectile dysfunction?
MS Hypogonadism Hyperthyroidism Cord lesions Pelvic surgery
Which drugs can cause erectile dysfunction?
Beta blockers
Diuretics
Anti-psychotics
Anti-depressants
Which hormones are needed to produce an erection?
Testosterone
Nitric oxide
Which hormone returns penis to flaccid state?
Phosphodiesterase
What are the signs of erectile dysfunction?
Fibrous plaque and deviated penis - Peyronies disease
Prostatic enlargement
Small testes - hypogonadism
Which investigations can you do to determine cause of erectile dysfunction?
Morning testosterone - if this is low, measure prolactin, FSH + LH
Nocturnal penile tumescence
Arteriography
How would you conservatively manage erectile dysfunction?
Counselling
Stop smoking and reduce alcohol
Penile ring
Which medications can you give for erectile dysfunction?
Oral phosphodiesterase inhibitors e.g. sildenafil
Intracavernous injections
Prostheses
What is a prolonged erection called?
Priapism
What are the symptoms of chlamydia in a male?
Dysuria
Urethral discharge
What are the complications of chlamydia in a male?
Epididymo-orchitis
Reactive arthritis
Which investigation is done in males for chlamydia?
First void urine sample
How would you treat chlamydia?
Doxycycline for 7 days
What are the symptoms of gonorrhoea in a male?
Urethral discharge
Dysuria
Tenesmus
Proctitis
What are the complications of gonorrhoea in a male?
Prostatitis
Sepsis
Reactive arthritis
Infective endocarditis
Which investigation is done in males for gonorrhoea?
Male urethra sample
What kind of bacteria is gonorrhoea?
Gram -ve diplococci
How would you treat gonorrhoea?
1g ceftriaxone IM
What are the symptoms of primary syphilis?
Non tender ulcers on genitals
What are the symptoms of secondary syphilis?
Skin rash Mucous membrane lesions Lymphadenopathy Fever Headache Fatigue Weight loss
What are the symptoms of tertiary syphilis?
Focal neurological deficits
Seizures
Skin granulomata
Which investigation is done in males for syphilis?
Blood test
How would you treat syphilis?
Parenteral benzylpenicillin
What are the symptoms of genital herpes?
Flu like prodrome Papule lesions burst into ulcers around genitals Urethral discharge Dysuria Urinary retention
How would you treat genital herpes?
Analgesia
Topical lidocaine
Antivirals
What are the risk factors for UTI?
Catheter
Sexual intercourse
Pregnancy
What are the symptoms of UTI?
Dysuria Suprapubic pain Frequency Urgency Incontinence Haematuria Cloudy urina Confusion - elderly
How would a UTI appear on a urine dipstick?
Nitrites
Leukocytes
Red blood cells
NICE guidelines: UTI is likely with presence of nitrites OR leukocytes, AND red blood cells
A midstream urine (MSU) sample sent for microscopy, culture and sensitivity testing will determine the infective organism and the antibiotics that will be effective in treatment. Which patients would you not do a MSU in?
Prgenant women
Patients with recurrent UTIs
Atypical symptoms
Symptoms do not improve after antibiotics
Which organism most commonly causes UTI?
E. coli (gram -ve, rod shaped)
Name the two first line antibiotics for UTI
Trimethoprim
Nitrofurantoin
When can you not give nitrofurantoin?
In patients with eGFR <45
How long is an antibiotic course for men with UTI?
7 days
What are the causes of upper urinary tract obstruction?
Kidney stones
Tumour
Ureter stricture
Ureterocele
What are the causes of lower urinary tract obstruction?
BPH
Prostate cancer
Urethral strictures
Neurogenic bladder
Benign prostatic hyperplasia (BPH) is a very common condition affecting men in older age (usually over 50 years). It is caused by hyperplasia of the stromal and epithelial cells of the prostate. What are the symptoms of this?
Hesitancy Weak flow Urgency Frequency Intermittency Straining Terminal dribbling Nocturia
What is used to score severity of lower urinary tract symptoms?
International prostate symptom score (IPSS)
How would you investigate BPH?
PSA
DRE
Urine dipstick
Urinary frequency volume chart
Which zone of the prostate does BPH affect?
Inner transitional zone
Which drugs would you give to treat BPH?
Alpha blockers e.g. tamsulosin
5-alpha reductase inhibitor e.g. finasteride
Which surgery can you do for BPH?
Transurethral resection of the prostate (TURP)
Transurethral electrovaporisation of the prostate (TEVAP/TUVP)
Prostatectomy
What is the main side effect of alpha blockers?
Postural hypotension
What is the main side effect of finasteride and why?
Sexual dysfunction due to reduced testosterone
