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Urology Flashcards

1
Q

What is the term which refers to urine refluxing from the bladder into the ureters?

A

Vesico-uteric reflux

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2
Q

What is the presentation of upper urinary tract infection?

A

Loin to groin or flank pain

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3
Q

Name some common causes for upper urinary tract obstruction

A 
Kidney stones 
Tumours
Ureter strictures
Retroperitoneal fibrosis
Bladder cancer
Utereocele
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4
Q

Name some common causes for lower urinary tract obstruction

A 
BPH
Prostate cancer
Bladder cancer
Urethral strictures
Neurogenic bladder
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5
Q

What is a neurogenic bladder and what are its common causes?

A

Abnormal function of the nerves which innervate the bladder and urethra which results in under or over activity of the detrusor muscle and sphincters.

Causes include:
MS
Diabetes
Stroke
PD
Brain or spinal injury
Spina bifida
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6
Q

What is the management of obstructive uropathy?

A

Nephrostomy

Uretral or suprapubic catheter

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7
Q

What is hydronephrosis?

A

Swelling of the renal pelvis and calyces in the kidney

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8
Q

What are the LUTS which occur with BPH?

A 
Hesitancy
Weak flow
Urgency
Frquency
Intermittency
Straining
Terminal dribbling
Incomplete emptying
Nocturia
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9
Q

Which scoring system can be used to assess the severity of LUTS in BPH?

A

The international prostate symptom score (IPSS)

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10
Q

What should be done on initial assessment of men with LUTS?

A 
DRE
Abdo exam (for palpable bladder)
Urinary frequency volume chart
Urine dipstick
PSA
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11
Q

What are the medical management options for BPH?

A

Alpha-blockers (eg tamsulosin)
5-alpha reductase inhibitors (finasteride)

Alpha blockers are used to treat immediate symptoms as 5-alpha reductase inhibitors gradually reduce the size of the prostate

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12
Q

How do 5-alpha reductase inhibitors work and how long does it take to see an effect?

A

5-alpha reductase converts testosterone to dihydrotestosterone which is a more potent androgen hormone. 5-alpha reductase blockers reduce the levels of dihydrotestosterone which reduces the size of the prostate. It takes up to 6 months of treatment for the effects to result in an improvement in symptoms.

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13
Q

What are the surgical management options for BPH?

A

TURP
Transuretheral electrovaporisation of the prostate
Holumium laser enucleation of the prostate
Open prostectomy

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14
Q

What is a notable side effect of alpha-blockers?

A

Postural hypotension

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15
Q

What is a notable side effect of finasteride?

A

Sexual dysfunction

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16
Q

What is the most common complication of TURP?

A

Retrograde ejactulation

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17
Q

What are the two types of prostatitis?

A

Acute bacterial

Chronic (sx >3 months)

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18
Q

What are the symptoms of chronic prostatitis?

A 
>3 months of:
Pelvic pain
LUTS
Sexual dysfunction
Pain with bowel movements
Tender and enlarged prostate
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19
Q

What are the symptoms of acute bacterial prostatitis?

A 
Fever
Myalgia
Nausea
Fatigue
Sepsis
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20
Q

Which investigations should be done in cases of chronic prostatitis?

A

urine dipstick
Urine MC&S
Chlamydia and gonorrhoea NAAT testing

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21
Q

What is the management of acute bacterial prostatitis?

A

Oral abx for 2-4 weeks (ciprofloxacin)
Analgesia
Laxatives

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22
Q

What is the management of chronic prostatitis?

A

Alpha blockers
Analagesia
antibiotics
Laxatives

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23
Q

What are the key risk factors for prostate cancer?

A 
Increasing age
Family history
Black african or caribbean origin
Tall stature
Anabolic steroids
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24
Q

What are the common symptoms of prostate cancer?

A 
Hesitancy
Weak flow
Terminal dribbling
Nocturia
Haematuria
ED
Weight loss, bone pain, cauda equina if advanced
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25
What are the investigations which can be done for ?prostate Ca?
DRE PSA Multiparametric MRI Biopsy
26
Which grading system is used in prostate cancer?
Gleason grading system
27
Which staging system is used in prostate cancer?
TNM
28
What is a key complication of external beam radiotherapy in prostate cancer?
Proctitis
29
What is brachytherapy?
Metal "seeds" are implanted into the prostate which delivers continuous and targeted radiotherapy to the prostate
30
What are the most common drugs in hormone therapy for prostate cancer?
``` Androgen receptor blockers (bicalutamide) GnRH agonists (goserelin) ```
31
What are the common side effects of hormone therapy in prostate cancer?
``` Hot flushes Sexual dysfunction Gynaecomastia Fatigue Osteoporosis ```
32
What are the key complications of radical prostatectomy?
Erectile dysfunction and urinary incontinence
33
What are the 4 common causes of epididymo-orchitis?
E.coli Chlamydia Gonorrhoea Mumps
34
How does epididymo-orchitis present?
Gradual onset over minutes to hours Unilateral testicular pain, dragging or heavy sensation Swelling of testicle Tenderness on palpation
35
What is a key differential for epididymo-orchitis?
Testicular torsion
36
What investigations can be done to establish the cause of epididymo-orchitis?
``` Urine MC&S Chlamydia and gonorrhoea NAAT testing Charcoal swab Saliva swab (for mumps) Ultrasound (torsion and tumours ```
37
Which antibiotic is usually first line in epididymo-orchitis?
ofloxacin (if STI not suspected)
38
What is found on examination in testicular torsion?
Firm swollen testicle Elevated (retracted) testicle Absent cremasteric reflex Abnormal testicular lie
39
What is a congenital deformity which is a common cause of testicular torsion?
Bell-clapper deformity
40
What is the test which can confirm a diagnosis of testicular torsion and which sign is seen?
A scrotal ultrasound Whirlpool sign
41
What is a hydrocele?
A collection of fluid within the tunica vaginalis which surrounds the testes
42
What is found on examination in hydrocele?
Testicle is palpable Soft, fluctuant and large Irreducible and no bowel sounds (distinguishing from a hernia) Can be transilluminated
43
What are the 5 causes of hydrocele?
``` Testicular cancer Testicular torsion Epididymo-orchitis Trauma Idiopathic ```
44
How can hydrocele be managed?
Exclude serious causes Conservative In large or symptomatic cases- surgery, aspiration or sclerotherapy
45
What is a varicocele?
Occurs when the veins in the pampiniform plexus become swollen. They are the result of increased resistance in the testicular vein
46
On which side to varicoceles usually occur?
Left The right testicular vein drains directly into the inferior vena cava. The left testicular vein drains into the left renal vein. Most varicoceles (90%) occur on the left due to increased resistance in the left testicular vein. A left-sided varicocele can indicate an obstruction of the left testicular vein caused by a renal cell carcinoma.
47
What is the presentation of varicoceles?
Throbbing or dull pain Dragging sensation Sub-fertility or infertility Scrotal mass feels like a bag of worms. It is more prominent when standing and disappears when lying down
48
How are varicoceles managed?
Ultrasound with doppler to confirm the diagnosis Semen analysis and hormone profiles if concerned about fertility Uncomplicated cases can be managed conservatively
49
What is a epididymal cyst which contains sperm called?
Spermatocele
50
What is found on examination with epididymal cysts?
``` Soft, round lump Typically at the top of the testicle Associated with the epididymis Separate from the testicle May be able to transluminate ```
51
What are the 2 sub-types of testicular cancer?
Seminomas | Non-seminomas (usually teritomas)
52
What are the risk factors for testicular cancer?
Undescended testes Male infertility Family Hx Increased height
53
What is the usual presentation of testicular cancer?
Painless lump | Gynaecomastia is associated with leydig cell tumours
54
What are the 3 tumour markers for testicular cancer?
``` Alpha fetoprotein (teratomas) Beta hCG (teratomas and seminomas) Lactate dehyrdogenase (very non-specific) ```
55
Which staging system is used in testicular cancer?
Royal Marsden
56
Where does testicular cancer often metastasise to?
Lymphatics Lungs Liver Brain
57
What is the presentation of pyelonephritis?
Fever Loin to groin pain Nausea and vomiting Renal angle tenderness
58
What is seen on a urine dipstick to suggest a UTI?
Nitrites or leukocytes +RBCs Nitrites is a better indication of UTI than leukocytes and RCs
59
Which groups of patients with UTI symptoms should have MSUs sent?
Pregnant patients Patients with recurrent UTIs Atypical symptoms When symptoms do not improve with abx
60
What is the most common cause of UTI? What does these bacteria look like under a microscope?
E.coli Gram-negative, anaerobic, rod shaped
61
When should nitrofurantoin be avoided in UTI treatment?
In GFR <45 | The last trimester of pregnancy (neonatal haemolysis)
62
How long should abx be prescribed for in UTI management?
3 days- women 5-10 days- immunosupressed, abnormal anatomy 7 days- men, pregnant women, catheter related
63
What are the complications from UTI in pregnancy?
Pyelonephritis Premature rupture of membranes Pre-term labour
64
When should trimethoprim be avoided in UTI treatment?
The first trimester of pregnancy. Works as a folate antagonist
65
What are the risk factors for pyelonephritis?
Female Structural urological abnormalities Vesico-ureteric reflux Diabetes
66
What are 2 differentials for the cause of pyelonephritis in patients who do not respond to treatment?
Renal abscess | Kidney stones
67
Which type of scan can be used to assess for renal scarring?
DMSA
68
What is interstitial cystitis?
Chronic condition causing inflammation in the bladder. Also called bladder pain syndrome and hypersensitive bladder syndrome
69
What is the presentation of interstitial cystitis?
Suprapubic pain Frequency Urgency for more 6 weeks
70
What is the diagnostic investigation for interstitial cystitis and what is seen?
Cystoscopy Hunner lesions and granulations
71
What are the main risk factors for bladder cancer?
Smoking, increased age Aromatic amines (in fabric dye and rubber) Schistosomiasis
72
Which is the most common type of bladder cancer?
Transitional cell carcinoma
73
Which type of bladder cancer is associated with schistosomiasis?
Squamous cell carcinoma
74
What is the presentation of bladder cancer?
Painless haematuria 2 week wait for >45 yo with unexplained visible haematuria Aged over 60 with microscopic haematuria plus dysuria or raised WCC
75
How is bladder cancer investigated?
Cystoscopy
76
What are the management options for bladder cancer?
``` TURBT Intravesical chemotherapy BCG vaccine into bladder wall Radical cystectomy Chemo and radiotherapy ```
77
What are the 2 key complications of kidney stones?
Obstruction and infection
78
What is the most common type of kidney stone?
Calcium oxalate
79
Which type of kidney stone cannot be seen on x-ray?
Uric acid
80
Which type of kidney stone is associated with infection because it is made by bacteria?
Struvite
81
What is the investigation of choice for kidney stones?
non-contrast CT KUB
82
What is the most effective form of analgesia in kidney stones?
IM diclofenac
83
What are the treatment options for kidney stones?
Extracorporeal shock wave lithotripsy (ESWL) PCNL Open surgery
84
What is the classic triad of symptoms in renal cell carcinoma?
Haematuria, flank pain, palpable mass
85
What can be seen on chest xray when RCC metastisises?
Cannonball metastases
86
What is the classic scar left in kidney transplant?
Hockey stick scar

Alice's finals cards (21 decks)

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