Urology Flashcards by Matthew Ashman

Upper urinary tract obstruction presentation

Loin to groin / flank pain on affected side
Reduced or no urine output
Non-specific symptoms - vomiting
Reduced renal function kn bloods

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Causes of upper urinary tract infection

Kidney stones
Local cancer masses
Urethra strictures

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Investigation of choice for upper urinary tract obstruction

US (if hydronephrosis or hydroureter = CT)

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Management of upper urinary tract obstruction

Analgesia
Support
Nephrostomy / uretic stent - if hydronephrosis

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Lower urinary obstruction (bladder/urethra) presentation

Acute urinary retention with full bladder
Lower urinary tract symptoms - poor flow, difficulty initiating urination, dribbling
Reduced renal function on bloods
Confusion
Suprapubic pain

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Causes of lower urinary tract obstruction

Benign prostatic hyperplasia
Prostate cancer
Ureter or urethra strictures
Neurogenic bladder

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Management of lower urinary tract obstruction

Urethral of suprapubic catheter

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Nephrolithiasis presentation

Upper or lower urinary tract obstruction symptoms
Infection can coexist

Infection - pyelonephritis
Haematuria
Proteinuria
Anuria

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Calcium oxidate stones features

Hypercalciuria major risk factor
Urinary pH usually 6
Most common - 85%
Spikey, opaque

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Features of triple phosphate stones

Stag-horn calculi involve the renal pelvis

Opaque

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Tests for nephrolithiasis

Bloods - FBC, U+E, calcium and phosphate, glucose, bicarb, urate
Urine - positive in blood (90%)
MSC - culture
Urine pH

Imaging - non-contrast CT KUB - investigation of choice

Consider - KUB X Ray (US as alternative)

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Investigation of choice for kidney stones

Non-contrast CT KUB

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Management of nephrolithiasis

Analgesia - diclofenac
Fluids
Abx - pip/taz

Stones <5 mm in lower ureter - will pass spont.
Stones >5 mm / pain not resolving
- medical expulsion therapy - nifedepine, alpha blockers (tamulosin) most pass in 2 days

If not passing - shockwave lithotripsy or percutaneous nephrolithotomy. (Scope through the back to remove the stones)

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Presentation of benign prostatic hyperplasia

Lower urinary tract symptoms

hesitancy
urgency
increased frequency
straining to void
incomplete emptying
terminal dribbling
nocturia
retention

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Tests for benign prostatic hyperplasia

Confirm diagnosis, exclude malignancy
Urine dipstick
MSU
Bloods - FBC, U+Es, LFTs (ALP raised in boney mets)
PSA and digital rectal exam
Post void US
Imaging - US and MRI (evaluation and diagnosis of malignancy)

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Management of benign prostatic hyperplasia

Stable, mild symptoms - watch and wait
Exclude malignancy

Medical - alpha blockers (tamulosin), 5-alpha reductase inhibitors

Surgery - transurethral resection of prostate - rectoscope used to resect obstructing tissue

Transurethral incision - similar to TURP but involves incision of the outlet as opposed to resection

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Example of MoA of alpha blockers. SEs

Tamulosin
Inhibit the action of NE on smooth muscle in the prostate, resulting in reduced tone

Postural hypotension
Ejactulatory dysfunction
Can affect eyes

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Example of MoA of 5-alpha reductase inhibitors

Finasteride

Reduce production of dihydrotestosterone which mediate androgen affects on the prostate
Leads to apoptosis of prostatic epithelial cells and reduction in prostate volume

Presentation of prostate cancer

Asymptomatic (most common presentation) - local disease
Lower urinary tract symptoms
Visible haematuria
Erectile dysfunction
Weight loss, fever, night sweats
PR exam - hard, nodular, enlarged, asymmetrical

Advanced disease - back pain

Investigations for prostate cancer

PSA
Exam - abdo and PR
Multiparametric MRI is first-line investigation
Biopsy - transrextal US prostate biopsy

Management on prostate cancer

Goserelin
Surgery - radical proctectomy
Radiotherapy - local advanced disease
Do nothing - local disease, elderly

What is the most common cause of epididymo-orchitis?

Chlamydia

Features of epididymo-orchitis

Sudden onset
Testicular pain 
Tender
Swelling 
Dysuria 
Fever/sweats 
Swelling

History of sexual activity usually

Management of epididymo-orchitis of unknown cause

Ceftriaxone 500 mg IM single dose, plus doxycycline 100 mg BD PO for 10-14 days

What is a complications of radical prostatectomy

Erectile dysfunction

Types of bladder cancer

90% transitional cell cancer | 1-7% squamous cell carcinoma

Presentation of bladder cancer

``` Painless haematuria Recurrent UTIs Voiding irritability Microscopic haematuria Dysuria Weight loss ```

Risk factors for bladder cancer

Smoking Age Industry - aromatic amines (rubber industry) Family history

Investigations of bladder cancer

Bloods - FBC, U+E, LFT Cystoscopy with biopsy is diagnostic Urine - microscopy/cytology, urine dip CT /US / MRI

Management of bladder cancer

Non-invading - transurethral cystoscopy/resection of bladder tumour Chemo into bladder after surgery Weekly treatment with BCG vaccine squirted into bladder for 6 weeks Invasive - radical cystectomy

What is acute bacterial prostatitis caused by? Management

Gram negative bacteria entering the prostate gland via the urethra E. Coli the most common 2 weeks quinolone Consider screening for STIs

Varicocele features and management

Dilated testicular veins Feels like a bag of worms Left side most commonly affected (80%) Dull ache Associated with subfertility Test - US with doppler studies Most = Conservative therapy Surgery if troubled by pain ALWAYS RULE OUT RENAL CELL CARCINOMA

Investigstion of hydrocele

ALL NEED US to exclude underlying cause - tumour

What is TURP syndrome?

Rare life-threatening complication of transurethral resection of prostate Caused by irrigation with large volumes of glycine which is systemically absorbed when prostatic venous sinuses are opened during prostate resection Presentation - CNS, Resp and systemic systems. Also causes hyponatraemia

Symptoms of testicular torsion

``` Sudden pain in one of the testes Pain can be referred to lower abdomen Uncomfortable to work N+V Retracted testes ``` Swollen and red testes Absent cremasteric reflex

Tests and management of testicular torsion

US may demonstrate lack of blood flow But do not delay surgery Urgent surgical exploration Orchidectomy + bilateral fixation (fix to scrotum)

Sildenafil is a medication used for what?

Erectile dysfunction

Obstructed, infected UT kidney stone should be managed how?

Urgent decompression - ureteroscopy or nephostomy

Large proximal kidney stones should be managed how?

Percutaneous nephrolithotomy

Causes of bilateral hydronephrosis

Stenosis of urethra Urethral valve Prostatix enlargement Extensive bladder tumour

Classic presentation of renal cell cancer

Haematuria Loin pain Abdo mass

Tests for testicular cancer

US first line Tumour markers- hCG = seminomas AFP - non-seminomas

Types of testicular tumours

95% germ cell tumours - seminoma (55%) - Non-seminoma Also - teratoma

Presentation of testicular tumours

Painless lump Pain Hydrocele Gynaecomastia