Urology Flashcards
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
Causes of upper urinary tract infection
Kidney stones
Local cancer masses
Urethra strictures
Investigation of choice for upper urinary tract obstruction
US (if hydronephrosis or hydroureter = CT)
Management of upper urinary tract obstruction
Analgesia
Support
Nephrostomy / uretic stent - if hydronephrosis
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
Causes of lower urinary tract obstruction
Benign prostatic hyperplasia
Prostate cancer
Ureter or urethra strictures
Neurogenic bladder
Management of lower urinary tract obstruction
Urethral of suprapubic catheter
Nephrolithiasis presentation
Upper or lower urinary tract obstruction symptoms
Infection can coexist
Infection - pyelonephritis
Haematuria
Proteinuria
Anuria
Calcium oxidate stones features
Hypercalciuria major risk factor
Urinary pH usually 6
Most common - 85%
Spikey, opaque
Features of triple phosphate stones
Stag-horn calculi involve the renal pelvis
Opaque
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)
Investigation of choice for kidney stones
Non-contrast CT KUB
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)
Presentation of benign prostatic hyperplasia
Lower urinary tract symptoms
- hesitancy
- urgency
- increased frequency
- straining to void
- incomplete emptying
- terminal dribbling
- nocturia
- retention
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)
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
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
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
