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Urology Flashcards

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1
Q

What are the causes of obstructive uropathy?

A 
Upper:
Tumour: renal, ureteric, bladder or external compression e.g. colon cancer
Ureteric stricture or clot
Kidney/ ureteric stone
Retroperitoneal fibrosis

Lower:
Neuromuscular retention
Blood clot in urethra
Enlarged prostate: BPH / Ca
Urethral stricture
Ca bladder
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2
Q

What are the symptoms of obstructive uropathy?

A

Reduced urine output
Suprapubic pain/tenderness

Upper: renal colic, palpable mass, haematuria, deranged U&Es, vomiting in some

Lower: haematuria, hesitancy/poor urine flow, deranged U&Es

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3
Q

How would you investigate obstructive uropathy?

A 
A-E examination + full history
Bloods: FBC, U&E, CRP, PSA, bone profile (calcium)
Urine dip + send for MC&S
Ultrasound scan + bladder scan
CT KUB- non contrast
Urodynamics 
Cystoscopy
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4
Q

How would you bypass upper and lower urinary obstruction?

A

Upper: nephrostomy

Lower: urethral/ suprapubic catheter

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5
Q

How would you manage hydronephrosis?

A

Treat underlying cause
Nephrostomy to relieve immediate pressure

If idiopathic due to narrowing of the renal pelvis -> pyeloplasty

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6
Q

What are the indications for catheterisation?

A

Surgery/anaesthesia
Paralysis/neurogenic bladder
Monitor urine output
Immobile patients who can’t go to the toilet
Bladder irrigation
Intravesical medication e.g. bladder cancer
Severe, resistant incontinence

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7
Q

How should you manage asymptomatic bacteruria in a catheterised patient?

A

No management

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8
Q

How would you manage symptomatic bacteruria in a catheterised patient?

A

7 days antibiotics

Change catheter ASAP

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9
Q

What are the symptoms of BPH?

A

LUTS:
Frequency, urgency, hesitancy, intermittency, poor stream, incomplete emptying, straining, nocturia, terminal dribbling, incontinence (urge)

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10
Q

What score is used to grade the severity of prostate symptoms?

A

IPSS

International prostate symptom score

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11
Q

How is BPH investigated/diagnosed?

A
  1. Abdominal exam + DRE
    Palpable bladder, enlarged prostate
  2. Urine dip - rule out UTI
  3. Bloods: PSA - not directly after DRE, may be slightly raised or normal
  4. MRI prostate
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12
Q

How is BPH managed?

A
  1. If symptoms aren’t too bothersome, don’t need to treat
  2. Lifestyle to manage symptoms: double voiding, reducing fluid intake in the evening, reduce caffeine consumption
  3. a-blocker: tamsulosin
  4. 5a-reductase inhibitor: finasteride
  5. Surgical options:
    TURP- resection
    TUVP- electrovaporisation
    HOLEP- laser enucleation
    Prostatectomy
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13
Q

What are the complications of TURP?

A 
Bleeding
Infection
Pain
Erectile dysfunction
Incontinence
Retrograde ejaculation
Failure to resolve symptoms
Urethral stricture
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14
Q

What are the causes of raised PSA?

A 
BPH/Ca prostate
Recent manipulation- DRE, anal sex
Recent ejactulation
Strenuous exercise
Prostatitis
UTI
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15
Q

What is the most common causative organism in acute bacterial prostatitis?

A

E-Coli

STI- chlamydia

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16
Q

What are the symptoms of prostatitis?

A

Pelvic pain: rectal, penile, testicular, abdominal, groin, sacral, suprapubic
LUTS
Pain on defaecation
Sexual dysfunction
In acute/bacterial: fever, N&V, systemic symptoms

Prostate tender and enlarged on DRE

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17
Q

How would you investigate prostatitis?

A

DRE- tender, enlarged prostate
Urine dip, MC&S
STI screen
Bloods: FBC, CRP, U&E, PSA, cultures if systemic symptoms

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18
Q

How is acute prostatitis managed?

A

Admit if unstable
2-4 weeks antibiotics- ciprofloxacin usually
Paracetamol/NSAID analgesia
Laxatives to relieve pain on defecation

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19
Q

How is chronic prostatitis managed?

A 
a-blocker e.g. tamsulosin
Paracetamol/NSAID analgesia
Laxatives
Antibiotics if acute symptoms or <6m
CBT in chronic, refractory disease (pelvic pain syndrome)
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20
Q

Where does prostate cancer most commonly metastasise?

A

Lymph nodes

Bone- pelvis/lower spine often

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21
Q

What are the symptoms of prostate cancer?

A

May be asymptomatic
LUTS + haematuria
Sexual dysfunction
Urinary obstruction
B-symptoms: weight loss, fever, night sweats, fatigue
In advanced disease: bone pain, cord compression

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22
Q

How is prostate cancer investigated?

A
  1. Abdominal exam + DRE- hard, craggy, enlarged prostate
  2. Urine dip, MC + S
  3. Bloods: PSA
  4. Multi-parametric MRI scan
  5. Prostate biopsy (transrectal or transperineal)
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23
Q

What is the scoring/severity system for prostate cancer?

A

Gleason score: most common pathology score + second-most common

6= low risk
7= moderate risk
8+= high risk

TNM also used

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24
Q

How is prostate cancer managed?

A
  1. MDT discussion
  2. Active surveillance in low-grade/elderly patients
  3. External beam therapy +/- brachytherapy
  4. Hormone treatments: androgen receptor blockers, goserelin (GnRH antagonist), orchidectomy
  5. Radical prostatectomy
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25
What are the differentials for testicular lumps?
``` Hydrocele Varicocele Epididymal cyst Testicular cancer Hernia Testicular torsion ```
26
What are the differentials for testicular pain?
``` Epididymo-orchitis Testicular torsion Strangulated hernia Trauma Scrotal oedema Tumour/hydrocele/varicocele ```
27
What are the common causative organisms of epididymo-orchitis?
E-coli Chlamydia Gonorrhoea
28
What are the symptoms of epididymo-orchitis?
Testicular pain, swelling Urethral discharge Dragging/heavy sensation in scrotum Systemic features e.g. fever
29
How would you investigate epididymo-orchitis?
Urine MC+S STI screen Penile swab USS to rule out torsion/tumour
30
How is epididymo-orchitis managed?
Supportive: analgesia, supportive underwear, reduced activity, abstain from sex Antibiotics- depending on cause if not STI, usually 14 days ofloxacin If STI- refer to GUM
31
What are the potential complications of chronic untreated epididymo-orchitis?
Chronic pain Testicular atrophy Infertility Scrotal abscess
32
What deformity predisposes men to testicular torsion?
Bell-clapper deformity - Absence of fixation between testicle and tunica vaginalis - Testicle hangs in more horizontal position
33
What are the signs of testicular torsion on examination?
Swelling and redness of the scrotum, firm Exquisitely tender testicles Absence of cremasteric reflex Abnormal lie of the testicle
34
What is the name of the sign seen on USS in testicular torsion?
Whirlpool sign
35
How is testicular torsion managed?
Orchidopexy - surgical fixation of the testicle This is usually done bilaterally, providing prophylactic fixation of the contralateral testicle. Orchidectomy if necrosis has already occurred
36
What is a hydrocele like on examination?
Soft, round, fluctuant mass Irreducible Transilluminates
37
Why should hydroceles be investigated?
Because they can be associated with testicular cancer, torsion, infection
38
What causes varicoceles?
Increased resistance in the testicular vein leading to engorgement of the pampiniform plexus. 90% occur on the left hand side, as the L testicular vein drains into the L renal vein- can therefore be associated with renal cell carcinoma.
39
What is a varicocele like on examination?
"Bag of worms" More prominent on standing and disappears when lying down Asymmetry in testicular size
40
What are the complications of varicoceles?
Testicular atrophy | Subfertility
41
What does an epididymal cyst feel like on examination?
Soft, round, fluctuant mass Separate to the testicle, more associated with the epididymis May transilluminate if large
42
What are the two most common histological types of testicular cancer?
Seminoma | Teratoma
43
What are the symptoms of testicular cancer?
Painless testicular lump - may be associated with pain in some cases - > hard, irregular, irreducible, immobile, will not transilluminate - > arising from the testicle B symptoms Symptoms of metastasis
44
What are the most common site of metastasis of testicular tumours?
Lung, liver, brain
45
What are the blood markers for testicular cancer?
LDH- very non-specific AFP- teratomas B-hcg- teratomas and seminomas
46
What are the most common causative organisms in UTI?
E-Coli Klebsiella Enterococci Pseudomonas
47
What are risk factors for UTI?
``` Female gender Old age, incontinence, poor hygiene Sexual activity, anatomical complexities Catheter use Immunosuppression ```
48
What are the symptoms of UTI?
``` Dysuria, frequency, haematuria Suprapubic pain Nocturia, incontinence Fever + systemic symptoms Cloudy/strong smelling urine Confusion/delirium ```
49
How is UTI diagnosed?
Urine dip - nitrite + leucocyte +/- blood positive Bloods: raised inflammatory markers MSU: MC&S Bloods + cultures if septic Catheter culture / sample from bag
50
How long should you treat a UTI for?
3 days- simple UTI 5-10 days- anatomical, recurrent, immunosuppressed 7 days- men, pregnant women, catheter-related
51
When should nitrofurantoin be avoided in pregnancy and why?
Trimester 3 | Due to foetal haemolysis
52
When should trimethoprim be avoided in pregnancy and why?
Trimester 1 | Due to folate antagonism
53
What are the symptoms of pyelonephritis?
UTI symptoms + renal angle tenderness/back pain | More likely to have systemic symptoms
54
How is pyelonephritis diagnosed?
Urine dip + MSU to confirm infection Bloods: raised inflammatory markers, U&E deranged, cultures USS kidney CT KUB
55
How is pyelonephritis managed?
7-10 days antibiotics- usually cephalexin, co-amoxiclav/trimethoprim, ciprofloxacin If septic- admit, IV abx and sepsis 6 protocol Supportive: paracetamol, fluids
56
What is the red flag symptom of bladder cancer?
Painless haematuria
57
What are the risk factors of bladder cancer?
Age Occupational exposure to chemicals involved in the dye and rubber manufacturing industry Smoking
58
What is the most common histology of bladder cancer?
Transitional cell carcinoma
59
How is bladder cancer diagnosed?
Flexible cystoscopy with biopsy = gold std Urine dip, MC + S, USS Staging CT
60
How is bladder cancer treated?
Trans-urethral resection of the tumour if non-muscle invasive Intra-vesical chemotherapy - cisplatin, 5-FU Intra-vesical BCG Radical cystectomy + urostomy / diversion Chemo/radiotherapy
61
What is the most common type of kidney stone?
Calcium oxalate RF= Hypercalcaemia + reduced UO
62
Which type of kidney stone is not visible on x-ray?
Uric acid
63
Which type of kidney stone is associated with infection?
Struvite stones
64
Which type of kidney stone is most associated with forming staghorn calculi?
Struvite
65
What are the symptoms of ureteric stones?
May be asymptomatic Renal colic- loin-groin pain, writhing around Haematuria Nausea and vomiting, oliguria, may have fever if infective
66
How do you diagnose ureteric stones?
Urine dip- haematuria Bloods: U+E, calcium +/- uric acid level AXR may show some calcium stones non-contrast CTKUB = gold standard
67
How are ureteric stones managed?
NSAIDs e.g. IM diclofenac Buscopan can help in some cases Anti-emetics + antibiotics if needed Plentiful fluid If < 5mm: watchful waiting Tamsulosin can encourage passage Surgical: external lithotripsy, laser lithotripsy, percutaneous nephrolithotomy, open surgery

Finals Revision (23 decks)

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