Urology Flashcards

1
Q

Commonest stone type

A

Calcium oxalate (85%)

hypercalciuria, hypercalcaemia, hyperoxaluria or hypocitraturia

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2
Q

Magnesium ammonium phosphate (struvite) stones

A

Secondary to UTI that breakdown urea into CO2 and ammonia
–> Alkalising urine

Proteus

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3
Q

Stone <0.5cm

A

Should pass conservatively

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4
Q

Pelviureteric junction obstruction (idiopathic hydronephrosis)

A

Moderate hydronephrosis causes ill-defined renal pain or ache that may be exacerbated by drinking large volumes of liquid (Dietls’ Crisis).

May produce a large painless mass in the loin;

Severest form: volume of urine in the hydronephrotic sac may simulate free fluid in the peritoneal cavity

Mx:
Either laparoscopic or open pyeloplasty

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5
Q

Retroperitoneal fibrosis

A

May cause ureteric obstruction and hydronephrosis
-Ureter often difficultto define on imaging

Causes:
Idiopathic
-Mediastinal fibrosis and Dupuytren’s contracture may coexist
-RAISED ESR

Malignant infiltration

Reactive fibrosis
-Radiotherapy, resolving blood clot, or extravasation of sclerosants

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6
Q

Innervation for detrusor contraction

A

S2- S4

Reach the sphincter either by the pelvic plexus or via the pudendal nerves

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7
Q

Intra-peritoneal rupture of bladder

A

Dome rupture –> intra-peritoneal leak

Ileus
Abdominal distension

Trauma with full bladder i.e. alcohol-fuelled fights

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8
Q

Management of bladder rupture

A

Intra-peritoneal
-laparotomy and repair

Extra-peritoneal

  • Catheter to relieve any tension
  • Conservative management, catheter in for minimum 6-10 days
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9
Q

Cancer of the bladder

A

Most common = transitional cell

Then: squamous cell carcinoma due to chronic inflammation e.g. schistomsomiasis

Rarely: Adenocarcinoma in urachal remnant in dome of bladder or form colorectal metastasis

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10
Q

Transitional cell carcinoma

A

Most common bladder and ureter cancer

Papillary tumours are less aggressive superficial cancers

Ulcerating are much more aggressive.

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11
Q

Management of superficial bladder tumours Ta, T1

A

Transurethral resection of the bladder tumour down to detrusor muscle is desired

If not endoscopic diathermy possible

Intra-vesical mitomycin C useful for multiple lesions

Regular check cystoscopies requried

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12
Q

Treatment of carcinoma in situ bladder cancer

A

Intra-vescial bacille Calmette-Guerin

BCG

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13
Q

Management of invasive bladder cancer T2-T3

A

<70 years –> Radical cystectomy

> 70 years –> Radiotherapy

Cystectomy always necessitates urinary diversion. Where the urethra can be retained, it may be possible to construct a new bladder from colon or small bowel
(orthotopic bladder replacement),

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14
Q

Treatment of T4 bladder cancer with fixed organ invasion

A

Palliative

Resection not possible

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15
Q

Mitomycin C

A

Single intra-vesical dose of mitomycin C post transurethral resection of superficial bladder cancer improves outcomes

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16
Q

Management of organised/localised prostate cancer

A

If patient young / life expectancy >10 years –> treat with curative intent

If Gleeson >/7, indicates high risk of progress so should be treated

If elderly, watchful waiting as most tumours take 10-15 years to be clinically relevant

17
Q

Management of locally advanced prostate cancer

A

External beam radiotherapy

AND

Hormonal therapy

Surgery is not curative

18
Q

Management of metastatic prostate cancer

A

Androgen suppression through orchiectomy or through gonadal axis suppression using GnRH

Bone pain can be treated with external beam radiotherapy or strontium

19
Q

Benign prostatic hyperplasia

A

Hyperplasia of peri-urethral tissues

Forms adenomas in transitional zone

20
Q

Complications of bladder diverticula

A

Drain poorly causing stasis

Leading to:
Infection
Stones
Tumour

21
Q

Small prostate benign hyperplasia obstruction management

A

Alpha-blockers

Tamulosin

22
Q

Large prostate benign hyperplasia obstruction management

A

5alpha-reductase inhibitors

23
Q

Management of acute retention

A

Catheter

Alfuzosin

TWOC 12 hours later

if fails –> TURP

24
Q

Dribbling incontinence in a child

A

Ectopic ureter

25
Q

Detrusor-sphincter dyssynergia

A

UMN lesion

Injury between the sacral segment and the pontine micturition centres

Develops a reflex bladder with impaired or absent
cortical control; that is, the bladder loses the coordination imposed by the pontine micturition centre.

Detrusor becomes overactive and attempted voiding results in detrusor contraction occurring synchronously with that of the external sphincter (detrusor-sphincter dyssynergia)

Result is poor bladder emptying and the development of a thick, trabeculated bladder wall

26
Q

Atonic myogenic bladder

A

Caused by prolonged outlet obstruction and
is found in the late stages of bladder decompensation.

Most common cause is silent prostatic obstruction, where progressive loss of the desire to void results in overflow incontinence

27
Q

Nerve innervation for micturation

A

Parasympathetic innervation S2 - S4 to the detrusor

Sympathetic innervation T10 - L2 to bladder neck and proximal urethra

Somatic innervation S2 - S4 to the bladder, pelvic floor and urethra

28
Q

Spinal cord damage and micturation

A

Below / at the level of T12 -L1
–> Flaccid bladder with overflow

Above T12 -L1 = UMN
–> Overactive bladder with poor coordination, causes poor bladder emptying

29
Q

Seminomas

A

Arise from Seminiferous tubules

Often low-grade

Sensitive to radiotherapy

30
Q

Teratoma

A

(non-seminomas)

Arise from primitive germinal cells

Not sensitive to radiotherapy