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Medicine > Urology > Flashcards

Urology Flashcards

1
Q

Upper urinary tract obstruction presentation

A

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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2
Q

Causes of upper urinary tract infection

A

Kidney stones
Local cancer masses
Urethra strictures

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3
Q

Investigation of choice for upper urinary tract obstruction

A

US (if hydronephrosis or hydroureter = CT)

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4
Q

Management of upper urinary tract obstruction

A

Analgesia
Support
Nephrostomy / uretic stent - if hydronephrosis

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5
Q

Lower urinary obstruction (bladder/urethra) presentation

A

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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6
Q

Causes of lower urinary tract obstruction

A

Benign prostatic hyperplasia
Prostate cancer
Ureter or urethra strictures
Neurogenic bladder

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7
Q

Management of lower urinary tract obstruction

A

Urethral of suprapubic catheter

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8
Q

Nephrolithiasis presentation

A

Upper or lower urinary tract obstruction symptoms
Infection can coexist

Infection - pyelonephritis
Haematuria
Proteinuria
Anuria

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9
Q

Calcium oxidate stones features

A

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

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10
Q

Features of triple phosphate stones

A

Stag-horn calculi involve the renal pelvis

Opaque

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11
Q

Tests for nephrolithiasis

A

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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12
Q

Investigation of choice for kidney stones

A

Non-contrast CT KUB

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13
Q

Management of nephrolithiasis

A

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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14
Q

Presentation of benign prostatic hyperplasia

A

Lower urinary tract symptoms

  • hesitancy
  • urgency
  • increased frequency
  • straining to void
  • incomplete emptying
  • terminal dribbling
  • nocturia
  • retention
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15
Q

Tests for benign prostatic hyperplasia

A

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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16
Q

Management of benign prostatic hyperplasia

A

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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17
Q

Example of MoA of alpha blockers. SEs

A

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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18
Q

Example of MoA of 5-alpha reductase inhibitors

A

Finasteride

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

19
Q

Presentation of prostate cancer

A

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

20
Q

Investigations for prostate cancer

A

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

21
Q

Management on prostate cancer

A

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

22
Q

What is the most common cause of epididymo-orchitis?

A

Chlamydia

23
Q

Features of epididymo-orchitis

A 
Sudden onset
Testicular pain 
Tender
Swelling 
Dysuria 
Fever/sweats 
Swelling

History of sexual activity usually

24
Q

Management of epididymo-orchitis of unknown cause

A

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

25
Q

What is a complications of radical prostatectomy

A

Erectile dysfunction

26
Q

Types of bladder cancer

A

90% transitional cell cancer

1-7% squamous cell carcinoma

27
Q

Presentation of bladder cancer

A 
Painless haematuria
Recurrent UTIs 
Voiding irritability 
Microscopic haematuria 
Dysuria 
Weight loss
28
Q

Risk factors for bladder cancer

A

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

29
Q

Investigations of bladder cancer

A

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

30
Q

Management of bladder cancer

A

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

31
Q

What is acute bacterial prostatitis caused by? Management

A

Gram negative bacteria entering the prostate gland via the urethra

E. Coli the most common

2 weeks quinolone
Consider screening for STIs

32
Q

Varicocele features and management

A

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

33
Q

Investigstion of hydrocele

A

ALL NEED US to exclude underlying cause - tumour

34
Q

What is TURP syndrome?

A

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

35
Q

Symptoms of testicular torsion

A 
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

36
Q

Tests and management of testicular torsion

A

US may demonstrate lack of blood flow
But do not delay surgery

Urgent surgical exploration
Orchidectomy + bilateral fixation (fix to scrotum)

37
Q

Sildenafil is a medication used for what?

A

Erectile dysfunction

38
Q

Obstructed, infected UT kidney stone should be managed how?

A

Urgent decompression - ureteroscopy or nephostomy

39
Q

Large proximal kidney stones should be managed how?

A

Percutaneous nephrolithotomy

40
Q

Causes of bilateral hydronephrosis

A

Stenosis of urethra
Urethral valve
Prostatix enlargement
Extensive bladder tumour

41
Q

Classic presentation of renal cell cancer

A

Haematuria
Loin pain
Abdo mass

42
Q

Tests for testicular cancer

A

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

43
Q

Types of testicular tumours

A

95% germ cell tumours

  • seminoma (55%)
  • Non-seminoma

Also - teratoma

44
Q

Presentation of testicular tumours

A

Painless lump
Pain
Hydrocele
Gynaecomastia

Medicine (25 decks)

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