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Year 3 Surgery > Urology > Flashcards

Urology Flashcards

1
Q

What is non-visible Haematuria?

5% risk of malignancy, 20% for visible

A

Anything more than a ‘trace’ of blood on dipstick

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2
Q

List 3 false positives for haematuria

A

Exercise

Periods

Myoglobin

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3
Q

List 2 false negatives for haematuria

A

Vit c intake

Heavy proteinuria

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4
Q

Compare Nitrites and Leucocyte use in diagnosing UTI

A

Nitrites: More specific for UTI (Less false +ves)

Leukocytes: More sensitive for UTI (Less false -ves)

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5
Q

What things are looked at on a urine dipstick

A 
Blood
Nitrites, Leukocytes 
Glucose
pH (Stones)
Urine specific gravity

Protein
Ketones
Bilirubin urobilinogen

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6
Q

What exams would you do in someone with haematuria

A

Abdomen

External genitalia if male
DRE if male

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7
Q

What would you ask about in history to someone with haematuria

A

Duration/ where in stream/ clots?

Past investigations/ treatment?

Cancer RFs (Smoking, Occupation, Fhx)

Anticoagulants?

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8
Q

List 3 radiological investigations for Haematuria

A

USS KUB

CT Urogram (Upper urinary tract)

Flexible Cystoscopy (Lower Urinary Tract)

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9
Q

What can USS detect?

A

Renal masses

Hydro

Bladder masses (if bladder full) or bladder enlargement

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10
Q

Which malignancy is USS less accurate at detecting?

A

Upper tract TCC

Rare, 0.75% of pts with visible haematuria

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11
Q

When is CT urogram used?

A

As a 2nd line test in recurrent visible haematuria where USS and Cystoscopy are negative

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12
Q

Compared to USS, what is a CT Urogram better at detecting?

What else can it show?

A

Upper tract TCC

Renal masses (RCC)
Filling defects in bladder (Tumour/ stones)
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13
Q

What is Pseudohaematuria?

List some causes

A

Red/ brown urine that is not due to presence of haemoglobin.

Medication (Rifampicin/ Methyldopa)
Hyperbilirubinuria
Myoglobinuria
Foods (Beetroot/ Rhubarb)

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14
Q

Compare CT urogram to non-contrast CT KUB

A

CT U: More definitive for UT-TCC. More radiation, requires IV contrast

nc CT KUB: Faster, used more for Stones,

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15
Q

Outline use of Cystoscopy

A

Done with Local Anaesthetic

Small biopsies can be taken for diagnosis, as well as looking

Not useful during active bleeding (poor views, needs a GA Cystoscopy and washout)

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16
Q

List haematuria causes

A

UTI/ Parasitic (Schistosomiasis)
Stones
Maligancy (Urinary tract or Prostate)

BPH
Trauma
Radiation cystitis

Nephrological causes (e.g IgA Nephropathy)

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17
Q

Where are Renal Cell Carcinomas (RCC)?

What’s the commonest type of RCC, and what is this associated with?

A

Kidney parenchyma

Clear Cell RCC, associated with Von-Hippel Lindau syndrome (Inherited disorder, causes tumours/ cysts to grow in multiple body parts- Inner eyes, Brain, Spinal cord, Pancreas, Adrenal glands, Kidney etc)

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18
Q

RCC is an Adenocarcinoma, more common in Males, derived from PCT epithelium.

What are some RFs

A

Smoking, Obesity, HTN, FHx, Dialysis

Anatomical abnormalities (Horseshoe pr Polycystic Kidney)
Industrial carcinogen exposure (Cadmium, Lead etc)
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19
Q

What is the presentation triad of RCC? (15% of cases)

A

Haematuria, Loin pain, Palpable mass

Possible Varicocoele, via Renal Vein obstruction

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20
Q

How soon does RCC metastasise

What substance may it secrete?

A

Early, before local symptoms usually

PTH-rP

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21
Q

List some Paraneoplastic syndromes associated with RCC

A

Stauffer’s Syndrome (abnormal LFTs)

Hypercalcaemia (PTH-rP)
HyperT (Renin)

Polycythaemia (EPO)/ Anaemia
Amenorrhoea/ Baldness/ Cushing’s

Pyrexia

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22
Q

Outline diagnosis and staging investigations for RCC

A

USS picks most up

Contrast CT needed to confirm and stage

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23
Q

Outline surgical RCC treatment

A

Smaller tumours (T1): Partial nephrectomy

Larger tumours (T2): Radical nephrectomy
(Kidney, Perinephric fat, Para-aortic lymph nodes. Spare adrenal glands if possible)
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24
Q

How can RCC be managed non-surgically?

A

Percutaneous Radiofrequency Ablation
Laparoscopic/ Percutaneous Cryotherapy

Renal artery embolisation may be needed if haemorrhaging

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25
Q

Outline treatment of Metastases of RCC

Chemo+ Radio- therapy considered ineffective

A

Immunotherapy (IL-2 or IFN-Alpha agents)

Biological agent (TK-Inhibitors: Sunitinib, Pazopanib)

Metastasectomy

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26
Q

How does UT-TCC present?

A

Visible haematuria, Possible signs of obstruction

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27
Q

Outline diagnosis of UT-TCC

A

CT Urogram is test of choice

May need Ureteroscopy +/- Biopsy to confirm

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28
Q

Outline UT-TCC treatment

A

Small low grade tumours: Laser ablation sometimes

Otherwise: Nephro-ureterectomy (if possible, laparoscopically)

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29
Q

Outline rarity of Bladder cancers: TCC, SCC, Adenocarcinoma

Sarcomas very rare

A

TCC: 80%

SCC: 20%

Adenocarcinoma: 1%

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30
Q

List RFs of Bladder TCC

SCC: Long term catheters, recurrent UTI, Stones, Schistosomiasis

A

Smoking, Age, Exposure to aromatic amines (Dyes, Rubber, Plastic manufacture)
Schistosomiasis, Previous radiation to pelvis

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31
Q

Outline the 3 classes of bladder cancer

A

Superficial/ Non-muscle-invasive: Doesn’t penetrate into deeper layers of bladder wall

(T2) Muscle-invasive: Penetrates deeper layers of bladder wall

Locally advanced/ Metastatic: Spreads beyond bladder and distally

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32
Q

After detection of bladder cancer (Cystoscopy) outline the purpose of TURBT

A

Allows assessment of;

Histological type (TCC or SCC)
Grade (1,2,3)
Stage (Tis, Ta, T1, T2)

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33
Q

How is a non-muscle invasive bladder cancer treated?

A

Single dose of Intravesical Mitomycin

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34
Q

What are the 3 classes of a Superficial TCC

A

Low risk (Grade 1 or 2, Ta)

Intermediate risk

High risk (Grade 3, Ta or T1)

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35
Q

Outline process of TUBRT

A

Resection of bladder tissue by Diathermy, during Rigid Cystoscopy

Typically done under R/G Anaesthesia

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36
Q

How are Low, Intermediate and High risk Superficial TCCs treated?

A

Low: Cystoscopic surveillance

Intermediate: Consider x1/wk Mitomycin for 6wks

High: BCG regimen, Cystectomy if very high

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37
Q

Superficial TCCs have a high recurrence rate, and are likely to be more invasive.

What is BCG?

A

Bacillus Calmette Guerin
Live attentutated mycobacterium bovis

Used for TB inoculation, if given intravesically it stimulates type IV hypersensitivity activating cells to tumour antigens

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38
Q

How are Muscle-invasive TCC, SCC and Adenocarcinoma in Bladder treated?

A

Neoadjuvant Chemo + Radical Cystectomy (Urinary Diversion needed afterwards)

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39
Q

Outline Radical Cystectomy in Males and Females

Both get Pelvic Lymph node dissection

A

Males (Cystoprostatectomy) Removal of Bladder + Prostate +/- Urethra

Females (Anterior Exenteration): Remove Bladder, Uterus, Tubes, Ovaries, Anterior vaginal wall

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40
Q

Name 3 methods of Urinary Diversion after Radical Cystectomy

A

Ileal Conduit

Neobladder

Continent Cutaneous Diversion/ Indiana Pouch

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41
Q

Describe an Ileal Conduit

A

Ureters connected to part of SI, brought out as a stoma

Urine drains into Stoma bag

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42
Q

Describe a Neobladder

A

Ureters connected to new ‘bladder’ made of SI, connected to Urethra.

(Routine check of Bloods, B12 Folate as Ileum partially involved)

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43
Q

Describe Continent Cutaneous Diversion/ Indiana Pouch

A

Pouch fashioned from part of bowel (E.g Right Hemicolon)

Catheterisable Stoma- Pt passes catheter to empty pouch intermittently

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44
Q

When is Neobladder contra-I?

A

If tumour extends to Prostatic urethra

Urethrectomy needed

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45
Q

When is Continent Cutaneous Diversion/ Indiana Pouch contra-I?

(Issues: Metabolic acidosis, Stones, Incontinence, Mucus, Perforation)

A

Renal impairment
Hepatic impairment
Inadequate small bowel (Crohn’s)
Unable to catheterise

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46
Q

List Prostate Cancer RFs

Vasectomy doesn’t increase risk

A

Age, Fhx, Genetics (BRCA, HPC1), Black

Obesity, DMII, Smoking

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47
Q

Most Prostate cancers are Adenocarcinomas and Multi-focal.

Which prostate zones are affected?

A

Peripheral (>75%)

Transitional (20%)

Central (5%)

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48
Q

List causes of raised PSA

PSA is a serine protease, acting as a seminal anticoagulant

A 
Urinary retention 
UTI
BPH, Prostatitis etc 
Vigorous exercise 
Ejaculation

(Not affected by DRE)

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49
Q

List possible Prostate cancer symptoms in more advanced local disease

(Other than LUTS, Bone pain, Weight loss)

A

Haematuria, Haematospermia

Suprapubic pain, Loin pain

Tenesmus

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50
Q

Outline Prostate Cancer screening

A

No population based screening programme- BUT men can request, after counselling

ERSPC showed;

  • Screening probably reduces mortality (11yrs)
  • Significant overdiagnosis and overtreatment
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51
Q

PSA simply gives indication of risk of Cancer on biopsy

List 2 side effects of Aggressive treatment

A

Incontinence and impotence

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52
Q

List investigations fo prostate cancer

A

PSA, DRE

mpMRI + Bone scan (for staging)

TRUS Biopsy
Transperineal/ Template Biopsy preferred (Better for viewing anterior prostate)

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53
Q

Describe the TRUS (TransRectal UltraSound-guided) Biopsy

What is there a risk of?

A

Done transrectally, usually under Local Anaesthetic

12 cores taken bilaterally in equal distribution from Base to Apex.

1-2% risk of Sepsis

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54
Q

Describe a Template/ Transperineal Biopsy

Compare to TRUS

A

Done transperineally, as a day case under GA

  • Better access to anterior prostate
  • Lower risk of infection
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55
Q

Outline Gleason grading and the scores for Low, Intermediate and High grades

A

Overall Score: Sum of Most Common + 2nd Most Common growth patterns

Low grade: 3+3=6 (lowest score, as 1+2 not used anymore)
Intermediate Grade: 3+4=7
High Grade: 4+3=7 OR 8/9/10

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56
Q

2 types of Surveillance of Prostate Cancer are Active Surveillance and Watchful Waiting

Describe Watchful Waiting

A

Symptom guided approach where;

  • Definitive therapy is deferred
  • Hormone therapy is initiated at time of symptomatic disease
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57
Q

Who is Watchful Waiting for?

A

Older pts with lower life expectancy, but can be offered at any stage of Prostate Cancer

(Aim: Palliative treatment for Symptoms/ Metastases)

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58
Q

Describe Active Surveillance (Continual investigations to monitor disease with aim of curative treatment)

A

Monitoring;

  • PSA every 3mths
  • DRE every 6-12mths
  • Biospy every 1-3yrs
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59
Q

Outline Prostate Cancer treatment in;

  • Low risk
  • Intermediate and High risk
  • Metastatic disease
  • Castrate-resistant disease

(Risk takes into account Gleason Score, PSA and Staging)

A

Low risk: Active surveillance
Intermediate and High: Radical treatment
Metastatic: Chemo + anti-hormonal agents

Castrate-resistant: Further chemo (Docetaxel), CSs, Anti-androgen, Androgen deprivation therapy

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60
Q

List 3 Radical treatment options for Locally advanced Prostate Cancer

A

Radical Prostatectomy
External beam Radiotherapy + Hormones
Brachytherapy

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61
Q

Outline Radical Prostatectomy

Can be done Laparoscopically, Open approach, Robotically- most common

A

Removal of Prostate gland, Resection of Seminal vesicles and surrounding tissue +/- Pelvic L Node dissection

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62
Q

List most common ADRs of Radical Prostatectomy

A

ED
Stress Incontinence
Bladder neck stenosis
Cancer re-occurrence

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63
Q

Compare External Beam Radiotherapy to Brachytherapy

A

External Beam Radiotherapy: Focused radiation

Brachytherapy: Transperineal implantation of Radioactive seeds directly into Prostate

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64
Q

List 2 Chemo drugs used in treating Prostate Cancer Metastases

A

Docetaxel, Cabazitazaxel

65
Q

List the MoA of these drugs;

Goserelin
Bicalutamide
Enzalutamide
Abiraterone

A

Goserelin: GnRH Receptor agonist
(Androgen levels rise at first, but then lower by -ve feedback)

Bicalutamide: Testosterone receptor antagonist

Enzalutamide: Lowers serum Testosterone
Abiraterone: Lowers serum Testosterone

66
Q

Penile cancer is a SCC and is very rare (1/100,000)

How is it treated

A

Excision (Circumcision, Glansectomy, Partial/ Total Penectomy)

Consider Inguinal and/or Pelvic L Node dissection

Superficial disease only: Topical Chemo (5-FU)

67
Q

List RFs of Penile cancer

Does Circumcision affect risk?

A

HPV (main one), Smoking, Phimosis, Lichen Sclerosis, untreated HIV

Yes, virtually unknown in pts circumcised as child

68
Q

Signs of Penile cancer

A

Palpable/ ulcerating penis lesion

Painless usually

Discharge/ prone to bleeding

69
Q

Outline Ureteric Colic history

Exam: May be TachyC, may have Flank/ IF Tenderness

A

Unilateral Sudden Colicky pain, radiating to Iliac Fossa/ Testicles/ Penis/ Labia

N+V

70
Q

List investigations for Ureteric Colic

A

Bloods: FBC, CRP, U&Es

Urine: Dipstick, MSSU for MC&S

Radiology: CT KUB

71
Q

How is Ureteric Colic managed?

A

Analgesia, Antiemetics +/- fluids

Stones will pass on own if ≤5mm, otherwise:

  • Uteroscopy + lasertrispy
  • ECSWL +/- JJ Stent
  • JJ Stent
72
Q

Infection associated with a Ureteric stone is an emergency. Why?

A

May be septic, May have Pyonephrosis (Can cause death)

73
Q

Outline Acute Pyelonephritis history

A

May have gradual onset pain, not usually colicky. Radiation to IF/ Supraubic region. Uni- or bi- lateral

‘Chills, Fever, Loin pain”

74
Q

Outline Acute Pyelonephritis on Examination

A

Fever, may have raised RR/ HR, may have low BP

Tender flank +/- Suprapubically

75
Q

Outline Investigations for Acute Pyelonephritis

A

Urine dip: Blood, WCCs, Nitrites
MSU for MC&S +/- blood culture

Consider Renal USS to rule out Pyonephrosis

Baseline bloods

76
Q

Outline Acute Pyelonephritis Management

A

Abx + Fluids (Oral or IV for both)

Analgesic, Antiemetic

DVT Prophylaxis

77
Q

What is a JJ Stent?

What is a Nephrostomy

A

JJ: Tube inserted into ureter to prevent/ treat obstruction of urine flow

Nephrostomy: When urine is drained from the kidney via a percutaneous tube and collected in an external bag

78
Q

Primary ddx for old men with nocturnal enuresis?

A

Chronic urinary retention with overflow incontinence

79
Q

How is Acute Urinary Retention treated?

A
  • Long-term Catheter (Urethral/ Suprapubic)
  • Record RV, Check if mass has disappeared
  • Alpha-blocker +/- 5-Alpha-reductase inhibitor
  • TWOC for 2-7days. If fails, TURP
80
Q

Compare High and Low pressure Chronic Urinary retention?

A

High pressure: Associated with renal impairment

Low pressure: Doesn’t affect renal function

81
Q

Outline Chronic Urinary retention management

A

Long-term Indwelling catheter

CISC, TURP

82
Q

Suggest a complication of catherisation in chronic urinary retention

A

Post-obstructive diuresis

83
Q

List some causes of testicular pain

A

Torsion
Tumour
Trauma

Epididymitis/ Orchitis/ Epididymo-orchitis (UTI, STI, Mumps)

Ureteric Calculi (Rare)

84
Q

Where can testicular torsion pain radiate to

A

Groin, Iliac fossa, Flank

85
Q

How is testicular torsion managed?

A

Scrotal exploration

+/- Orchidectomy
+/- Bilateral Orchidopexy

86
Q

Outline Epididymo-orchitis history

A

Gradual onset, Usually unilateral pain

Often history of;

  • UTI
  • Unprotected sex
  • Catheter/ urethral instrumentation

May have Storage LUTS, Dysuria, Discharge
- Mumps (Bilateral pain)

87
Q

State the usual cause of Epididymo-orchitis in men 20-40 and 40+

A

20-40: STI (Especially Chlamydia)

40+: UTI (Especially E. coli)

88
Q

Outline Epididymo-orchitis examination

A

May have fever/ Hydrocoele

Red scrotum, tender enlarged Testes/ Epididymis

89
Q

Name and describe an emergency that is rarely associated with Epididymo-orchitis

(Mortality rate approx 20%, pts rapidly deteriorate wit sepsis and shock)

List some RFs

A

Fournier’s Gangrene- Necrotising fasciitis that affects the Perineum

DM
Alcohol excess
Poor nutrition 
Steroid use 
Haematological malignancies 
Recent trauma
90
Q

How is Fournier’s gangrene treated?

A

Broad spectrum Abx + Surgical debridement

91
Q

Outline Epididymo-orchitis management

Check local guidelines

A

Ciprofloxacin
Doxycycline

Analgesia/ supportive treatment
Reduction of non-essential activity
Consider STI clinic

92
Q

What can cause Iatrogenic Hypospasdias

A

Long term catheter use

93
Q

How can strictures present?

A

Weak stream

Diagnosed by Flow studies

94
Q

How is Paraphimosis managed

A

Mechanical compression,

Dextrose soaked gauze

Dundee technique

Dorsal slit: Leads to circumcision

95
Q

Bladder Outflow Obstruction, BOO is mainly in men.

List 2 causes

A

BPH

Urethral strictures

96
Q

Nocturia is just nocturnal Polyuria. It is due to the loss of Circadian Urine output rhythm with age.

How is it managed?

A

Advice;

  • Reduce night-time fluids
  • Try low dose loop diuretic 4-6hrs before bed
  • Demsopressin as last resort
97
Q

Flow rate interpretation needs at least 150ms voided

What Qmax values suggest obstruction chance;

10–30%
60%
90%

A

10-30: >15ml/s

60: 10-15ml/s
90: <10ml/s

98
Q

Outline the phases of a Urodynamic study

A

Filling Phase;

  • Should be slow gentle pressure rise
  • Phasic contractions could= OAB (Detrusor)
  • Pt asked to cough (stress incontinence?)

Voiding Phase;

  • High pressure, low flow= Obstruction
  • Low pressure, low flow= Detrusor failure
99
Q

Outline the Medical Treatment for BOO

A

Alpha blockers

5-alpha-reductase inhibitors

Anticholinergics (if OAB symptoms)

100
Q

Outline the Surgical Treatment for BOO

A

TURP/ Various forms of laser prostate surgery

Open Retropubic (Millin’s) prostatectomy

101
Q

Outline Alpha-blocker use in the treatment of BOO

List 2 ADRs

A

Relax prostatic/ bladder neck smooth muscle

Tamsulosin, Alfuzosin are “Uro-selective”
Doxazosin if BP control needed

ADRs: Retrograde ejaculation, Postural HypoT

102
Q

List 3 ADRs of 5-alpha-reductase inhibitor use in the treatment of BOO

A

ED, Rash, Reduced libido

103
Q

When would you operate on BOO

Complications: Chronic retention, Bladder stones, Benign Prostatic Haematuria

A

LUTS not controlled on medication

Acute retention- Failed TWOC on Alpha-blockers

104
Q

With regards to TURP;

  • Why is Glycine used?
  • List 4 side effects/ complications
A
  • For irrigation, acts as an electrical insulator to prevent current dispersing

Confusion, Fits, Visual symptoms, BradyC, Vomit all due to Hyponatraemia caused by absorption of irrigation fluid

105
Q

Define OAB:

A

Urgency, w/ or w/o incontinence, often accompanied by Frequency and Nocturia

106
Q

List Conservative OAB treatment

A
  • Weight loss, stop smoking, avoid caffeine
  • Pelvic floor exercises
  • Bladder training
107
Q

List Medical OAB treatment

A

Anticholinergics (Oxybutinin, Tolterodine)

Topical oestrogens (if post-menopausal)

B3 Agonist (Mirabegron)

108
Q

Stress incontinence is treated Conservatively with W loss and Pelvic floor exercises.

Medically, Duloxetine no longer used.

Outline surgical treatment

A

TVT (Tension-free vaginal tape) or TOT (Transobturator tape)
Autologous slings w/ Rectus Fascia
Colposuspension, Urinary diversion, Artificial Sphincter (rare in women)

109
Q

List neurological conditions that can affect Bladder/ Sphincter function

A 
Spina Bifida
Spinal Cord injury 
Diabetes
MS
Parkinson’s
110
Q

What percentage of urinary tract stones are made of calcium?

List the 3 types

A

80%

Calcium Oxalate (35%)

Mixed Oxalate and Phosphate (35%)

Calcium phosphate (10%)

111
Q

List types of Non-calcium stones

A

Struvite stones (Mg ammonium phosphate)

Urate stones (Only radiolucent stones)

Cystine stones (Associated with familial disorders)

112
Q

Describe Struvite stones

Often large

A

Most common cause of Staghorn Calculi (stone fills renal pelvis)

Often due to infection

113
Q

Outline pathophysiology of Urate stones

A

High levels of Purine in blood either from Diet or Haematological disorders

(Red meat, Myeloproliferative disorder)

114
Q

Outline pathophysiology of Cystine stones

A

Associated with Homocystinuria

(HCS Affects absorption and transport of cystine in bowel and kidneys

115
Q

Outline non-imaging investigations for Ureteric stones

A

Urine dip
FBC, CRP, U&Es

Urate and Calcium levels

Analysis of stone if possible

116
Q

Best imaging investigation for Renal tract stones?

A

Non-contrast CT KUB

117
Q

List 4 criteria for Inpatient admission in a pt with renal tones

A

Post-obstructive AKI

Uncontrollable pain

Evidence of infection

Large stones (>5mm)

118
Q

Suggest 2 initial urgent managements for a pt with renal stones who has signs of SIRS

A

Stent insertion

Nephrostomy

119
Q

Outline Retrograde Stent Insertion

JJ Stent

A

Stent within ureter, approaching from distal to proximal via Cystoscopy

Keeps ureter patent to temporarily relieve obstruction

120
Q

List 3 definitive managements for renal tract Calculi

A

ESWL, Extracorporeal Shock Wave Lithotripsy

PCNL, Percutaneous Nephrolithotomy

Flexible Uretero-renoscopy, URS

121
Q

Outline ESWL

List 2 contra-Is

A

Sonic waves to break up the stone.

Typically reserved for small stones (<2cm) via USS/X-ray

Contra-indications include pregnancy or stone positioned over a bony landmark (e.g. pelvis).

122
Q

Outline PCNL

A

For renal stones only, being the preferred method for large renal stones (E.g staghorn calculi).

Percutaneous access to kidney w/ a nephroscope passed into the renal pelvis. Stones then fragmented by lithotripsy.

123
Q

Outline Flexible URS

A

Passing a scope retrograde up into the ureter

Stones fragmented by laser lithotripsy and removed.

124
Q

Recurrent renal stones can cause scarring and loss of kidney function

How are these pts managed? (Depends on stone type)

A

Oxalate formers: Avoid high Purine (Red meat, Shellfish) + Oxalate foods (Nuts, rhubarb, sesame)

Ca formers: Check PTH levels to exclude primary Hyperparathyroidism. Avoid excess salt.

Urate formers: Avoid high Purine foods. Consider urate-lowering meds (Allopurinol)

Cystine formers: Consider genetic testing

125
Q

What commonly causes Bladder stones

Caused by Urine stasis in bladder

A

Chronic urinary retention

May occur due to infections (Schistosomiasis)

126
Q

How are bladder stones managed definitely

A

Cystoscopy, allowing stones to drain or fragmenting via lithotripsy

127
Q

A UTI is defined by Symptoms + Bacteriuria

Outline management of Asymptomatic Bacteriuria

A

DO NOT TREAT unless;

  • Pregnant woman
  • Prior to urological surgery

(Treatment is actively harmful as low virulence organisms replaced with worse ones)

128
Q

List common Abx used in UTI treatment

A

Trimethoprim, Nitrofurantoin

Cefalexin, Augmentin, Ciprofloxacin

(IV options: Augmentin, Tazocin, Gentamicin, Meropenem)

129
Q

Compare use of trimethoprim and Nitrofurantoin

A

Tri;

  • Upto 30% community resistance
  • Don’t use in 1st trimester

Nitro;

  • Only active in urine (Useless for Pyelonephritis)
  • Not effective in renal failure
  • Don’t use in 3rd Trimester
130
Q

How are UTIs due to MGNOs (Multi-drug Resistant Gram Negative Organisms) treated?

A

In community: Some treated with Trimethoprim/ Nitrofurantoin if sensitive. Can also use Oral Fosfomycin

In hospital: IV Meropenem

131
Q

How are recurrent UTIs in women managed in terms of advice and investigations

A

Excuse structural cause with USS +/- Cystoscopy

Avoid synthetic pants, Expensive/ perfumed soaps. Showers > baths

132
Q

How are recurrent UTIs in women managed in terms of Abx and Non-Abx

A

Non-Abx;

  • Topical Oestrogen if post-menopause
  • Cranberry capsules (weak evidence)
  • D-Mannose (Expensive, non-prescription)
  • Methenamine Hippurate (Weak evidence)

Abx;

  • Poist-coitus: Single Abx dose
  • Self-start at 1st sign of symptoms
  • Low dose continuous prophylaxis
133
Q

When should Pyelonephritis be considered in men

A

NEVER

Consider Stones, Pyonephrosis etc

(Pyonephrosis- Pus in renal pelvis)

134
Q

Compare Acute and Chronic prostatitis

Chronic Pancreatitis AKA Chronic Pelvic Pain Syndrome

A

Acute: Rare, pts unwell and usually in hospital on IV ABx

Chronic;

  • Pelvic/ perineal pain
  • Men may have urinary/ sexual dysfunction
135
Q

How is Orchitis investigated + managed

Stay swollen for 4-6wks

A

Investigations;

  • 1st void urine for Chlamydial PCR
  • MSU, USS

Management;

  • Oral Ciprofloxacin (+ Doxazosin in young men)
  • IV ABx if unwell

10-14 days of Abx

136
Q

How are Unilateral Undescended testes at birth managed?

A

Review at 6-8wks old. If unresolved, review again at 3mths.

If undescended at 3mths, refer to surgeons

137
Q

By age 1, 2/3rds of pts with undescended testes will have spontaneously resolved.

After what age are testes unlikely to descend? When is surgical correction recommended

A

6mths

Between 6-18mths

138
Q

How are Biilateral Undescended testes at birth managed?

A

Senior paediatrician referral in <24hours;
- Endocrine or Genetic testing

Once excluded, and testes undescended by 3mths, refer to surgery by 6mths

139
Q

Outline Acute Prostatitis treatment

A

1st line: Oral Ciprofloxacin
2nd line: Oral Trimethoprim

(E.coli is resistant to Trimethoprim, but is a common cause of Prostatitis)

140
Q

Klinefelter’s Syndrome results from an extra X Chromosome in boys (47XXY)

How does it present

A

Tall
Hypogonadism
Gynaecomastia
Delayed puberty

141
Q

How long do Tamsulosin and Finasteride take to work

A

T: 24hrs
F: Upto 6 mths

142
Q

Outline surgical treatment for Overactive Bladder if medical doesn’t work

A

Botox injections:
- ADR: Urinary retention (1 in 5), teach pt to self Catherine

Sacral nerve stimulation (S3)
Clam Ileocystoplasty
Urinary diversion (Ileal conduit)

143
Q

Compare Physiological to Pathological/ Scarred Phimosis

A

Physiological: Foreskin non-retracted before age 2

Pathological/ Scarred: Episodes of 4skin infection lead to scarring, leading to more infections

144
Q

Compare presentation of Physiological and Pathological Phimosis

A

Physiological;

  • Parents may bring in child, may notice adhesions
  • Recurrent 4skin infection and UTIs

Pathological;

  • Painful erection
  • Preputial pain (Pain of skin of Glans)
  • Haematuria, Weak stream
  • Recurrent UTIs
145
Q

What is Peyronie’s Disease

A

Fibrous plaque formation in Corpus Cavernosum’s Tunica Albuginea

Leads to Penile Angulation or hourglass-like deformity with distal flaccidity

146
Q

How can Peyronie’s Disease present?

Thought to be due to vascular trauma-> Leakage/ immune reaction in TA. Some aspect of genetic susceptibility

A

Usually only affects erect penis

  • Curved penis
  • Painful intercourse
147
Q

List RFs for Testicular Cancer

Most common cancer in Males 20-40

A

Caucasian/ North European descent
Cryptorchidism

Fx, Previous testicular mlignancy
Kleinifelter’s Syndrome

148
Q

Outline the Classification of Primary Testicular Cancers

Are they Malignant or Benign usually?

A

GCTs (95%);

  • Usually Malignant
  • Seminomas or NSGCTs (Yolk Sac, Chroriocarcinomas, Embryonal Carcinomas, Teratomas)

NGCTs (5%);

  • Usually Benign
  • Leydig Cell or Sertoli Cell Tumours
149
Q

Compare Leydig and Sertoli Cell tumours

A

Leydig: Secrete Androgens
Sertoli: Secrete Oestrogens

150
Q

Compare Seminomas and NSGCTs

A

Seminomas: Remain localised until late, V good prognosis

NSGCTs: Early Mets, Worse prognosis

151
Q

How may Testicular Cancers present?

Lymphatic drainage to Para-aortic nodes

A

Unilateral, Painless testicular lump
O/E: Irregular, Firm, Fixed, Doesn’t Transilluminate

Signs of Mets: W Loss, Back pain, Dyspnoea

152
Q

Outline use of Tumour Markers in Testicular Cancer

A

Both, Diagnostic + Prognostic means

  • AFP: Raised in some NSGCTs, never Pure Seminomas
  • LDH: Tumour volume + treatment response
  • Beta-HCG: High in 60% of NSGCTs, 10% of Seminomas
153
Q

Outline non-tumor marker Investigations for Testicular Cancer

Why should a Trans-scrotal Percutaneous Biopsy NOT be done?

A

Scrotal USS: Initial assessment + tumour markers
CT w/ Contrast: For Staging

Might cause Seeding of the cancer

154
Q

Outline the Royal Marsden Classification

A

Used to Stage Testicular Cancer

Stage 1: Confined to Testes
Stage 2: L nodes involved below Diaphgram
Stage 3: L Nodes involved A+B Diaphragm
Stage 4: Extralymphatic Metastases

155
Q

Outine Management of Testicular Cancer IN GENERAL (non-specific)

A

Pre-treatment Fertiity Assessment
Semen analysis + Cryptopreservation offered to all pts

Surgery: Radical Orchidectomy (Removal of Teste, Epididymis, Spermatic Fascia+Cord)
- May use Radiotherapy, Chemotherapy

156
Q

Compare Treatment of Seminomas and NSGCTs

A

NSGCTs;

  • Orchidectomy (Alone if Stage 1)
  • Chemo (Adjuvant if no Mets, 1/+ Cycles if Mets)

Seminomas;

  • Orchidectomy (Alone if Stage 1)
  • Consider Chemo if high recurrence risk
  • Radio or Chemo, if Metastatic
157
Q

Outline Testicular Cancer Prognosis and Complications of Treatment

A

High rate of complete remission

Radio + Chemo: High risk of 2ndary malignancy (e.g leukaemia)

158
Q

What is the analgesia of choice for renal colic

A

IM Diclofenac

159
Q

What is Hydronephrosis

A

Dilation of the Renal Pelvis from hydrostatic pressure/ Urinary tract obstruction

Year 3 Surgery (7 decks)

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