Urology Flashcards
What is the term which refers to urine refluxing from the bladder into the ureters?
Vesico-uteric reflux
What is the presentation of upper urinary tract infection?
Loin to groin or flank pain
Name some common causes for upper urinary tract obstruction
Kidney stones Tumours Ureter strictures Retroperitoneal fibrosis Bladder cancer Utereocele
Name some common causes for lower urinary tract obstruction
BPH Prostate cancer Bladder cancer Urethral strictures Neurogenic bladder
What is a neurogenic bladder and what are its common causes?
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
What is the management of obstructive uropathy?
Nephrostomy
Uretral or suprapubic catheter
What is hydronephrosis?
Swelling of the renal pelvis and calyces in the kidney
What are the LUTS which occur with BPH?
Hesitancy Weak flow Urgency Frquency Intermittency Straining Terminal dribbling Incomplete emptying Nocturia
Which scoring system can be used to assess the severity of LUTS in BPH?
The international prostate symptom score (IPSS)
What should be done on initial assessment of men with LUTS?
DRE Abdo exam (for palpable bladder) Urinary frequency volume chart Urine dipstick PSA
What are the medical management options for BPH?
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
How do 5-alpha reductase inhibitors work and how long does it take to see an effect?
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.
What are the surgical management options for BPH?
TURP
Transuretheral electrovaporisation of the prostate
Holumium laser enucleation of the prostate
Open prostectomy
What is a notable side effect of alpha-blockers?
Postural hypotension
What is a notable side effect of finasteride?
Sexual dysfunction
What is the most common complication of TURP?
Retrograde ejactulation
What are the two types of prostatitis?
Acute bacterial
Chronic (sx >3 months)
What are the symptoms of chronic prostatitis?
>3 months of: Pelvic pain LUTS Sexual dysfunction Pain with bowel movements Tender and enlarged prostate
What are the symptoms of acute bacterial prostatitis?
Fever Myalgia Nausea Fatigue Sepsis
Which investigations should be done in cases of chronic prostatitis?
urine dipstick
Urine MC&S
Chlamydia and gonorrhoea NAAT testing
What is the management of acute bacterial prostatitis?
Oral abx for 2-4 weeks (ciprofloxacin)
Analgesia
Laxatives
What is the management of chronic prostatitis?
Alpha blockers
Analagesia
antibiotics
Laxatives
What are the key risk factors for prostate cancer?
Increasing age Family history Black african or caribbean origin Tall stature Anabolic steroids
What are the common symptoms of prostate cancer?
Hesitancy Weak flow Terminal dribbling Nocturia Haematuria ED Weight loss, bone pain, cauda equina if advanced
What are the investigations which can be done for ?prostate Ca?
DRE
PSA
Multiparametric MRI
Biopsy
Which grading system is used in prostate cancer?
Gleason grading system
Which staging system is used in prostate cancer?
TNM
What is a key complication of external beam radiotherapy in prostate cancer?
Proctitis
What is brachytherapy?
Metal “seeds” are implanted into the prostate which delivers continuous and targeted radiotherapy to the prostate
What are the most common drugs in hormone therapy for prostate cancer?
Androgen receptor blockers (bicalutamide) GnRH agonists (goserelin)
What are the common side effects of hormone therapy in prostate cancer?
Hot flushes Sexual dysfunction Gynaecomastia Fatigue Osteoporosis
What are the key complications of radical prostatectomy?
Erectile dysfunction and urinary incontinence
What are the 4 common causes of epididymo-orchitis?
E.coli
Chlamydia
Gonorrhoea
Mumps
How does epididymo-orchitis present?
Gradual onset over minutes to hours
Unilateral
testicular pain, dragging or heavy sensation
Swelling of testicle
Tenderness on palpation
What is a key differential for epididymo-orchitis?
Testicular torsion
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
Which antibiotic is usually first line in epididymo-orchitis?
ofloxacin (if STI not suspected)
What is found on examination in testicular torsion?
Firm swollen testicle
Elevated (retracted) testicle
Absent cremasteric reflex
Abnormal testicular lie
What is a congenital deformity which is a common cause of testicular torsion?
Bell-clapper deformity
What is the test which can confirm a diagnosis of testicular torsion and which sign is seen?
A scrotal ultrasound
Whirlpool sign
What is a hydrocele?
A collection of fluid within the tunica vaginalis which surrounds the testes
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
What are the 5 causes of hydrocele?
Testicular cancer Testicular torsion Epididymo-orchitis Trauma Idiopathic
How can hydrocele be managed?
Exclude serious causes
Conservative
In large or symptomatic cases- surgery, aspiration or sclerotherapy
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
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.
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
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
What is a epididymal cyst which contains sperm called?
Spermatocele
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
What are the 2 sub-types of testicular cancer?
Seminomas
Non-seminomas (usually teritomas)
What are the risk factors for testicular cancer?
Undescended testes
Male infertility
Family Hx
Increased height
What is the usual presentation of testicular cancer?
Painless lump
Gynaecomastia is associated with leydig cell tumours
What are the 3 tumour markers for testicular cancer?
Alpha fetoprotein (teratomas) Beta hCG (teratomas and seminomas) Lactate dehyrdogenase (very non-specific)
Which staging system is used in testicular cancer?
Royal Marsden
Where does testicular cancer often metastasise to?
Lymphatics
Lungs
Liver
Brain
What is the presentation of pyelonephritis?
Fever
Loin to groin pain
Nausea and vomiting
Renal angle tenderness
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
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
What is the most common cause of UTI? What does these bacteria look like under a microscope?
E.coli
Gram-negative, anaerobic, rod shaped
When should nitrofurantoin be avoided in UTI treatment?
In GFR <45
The last trimester of pregnancy (neonatal haemolysis)
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
What are the complications from UTI in pregnancy?
Pyelonephritis
Premature rupture of membranes
Pre-term labour
When should trimethoprim be avoided in UTI treatment?
The first trimester of pregnancy. Works as a folate antagonist
What are the risk factors for pyelonephritis?
Female
Structural urological abnormalities
Vesico-ureteric reflux
Diabetes
What are 2 differentials for the cause of pyelonephritis in patients who do not respond to treatment?
Renal abscess
Kidney stones
Which type of scan can be used to assess for renal scarring?
DMSA
What is interstitial cystitis?
Chronic condition causing inflammation in the bladder. Also called bladder pain syndrome and hypersensitive bladder syndrome
What is the presentation of interstitial cystitis?
Suprapubic pain
Frequency
Urgency
for more 6 weeks
What is the diagnostic investigation for interstitial cystitis and what is seen?
Cystoscopy
Hunner lesions and granulations
What are the main risk factors for bladder cancer?
Smoking, increased age
Aromatic amines (in fabric dye and rubber)
Schistosomiasis
Which is the most common type of bladder cancer?
Transitional cell carcinoma
Which type of bladder cancer is associated with schistosomiasis?
Squamous cell carcinoma
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
How is bladder cancer investigated?
Cystoscopy
What are the management options for bladder cancer?
TURBT Intravesical chemotherapy BCG vaccine into bladder wall Radical cystectomy Chemo and radiotherapy
What are the 2 key complications of kidney stones?
Obstruction and infection
What is the most common type of kidney stone?
Calcium oxalate
Which type of kidney stone cannot be seen on x-ray?
Uric acid
Which type of kidney stone is associated with infection because it is made by bacteria?
Struvite
What is the investigation of choice for kidney stones?
non-contrast CT KUB
What is the most effective form of analgesia in kidney stones?
IM diclofenac
What are the treatment options for kidney stones?
Extracorporeal shock wave lithotripsy (ESWL)
PCNL
Open surgery
What is the classic triad of symptoms in renal cell carcinoma?
Haematuria, flank pain, palpable mass
What can be seen on chest xray when RCC metastisises?
Cannonball metastases
What is the classic scar left in kidney transplant?
Hockey stick scar
