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Finals Revision > Urology > Flashcards

Urology Flashcards

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
Q

What are the differentials for testicular lumps?

A 
Hydrocele
Varicocele
Epididymal cyst
Testicular cancer
Hernia
Testicular torsion
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26
Q

What are the differentials for testicular pain?

A 
Epididymo-orchitis
Testicular torsion
Strangulated hernia
Trauma
Scrotal oedema
Tumour/hydrocele/varicocele
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27
Q

What are the common causative organisms of epididymo-orchitis?

A

E-coli
Chlamydia
Gonorrhoea

28
Q

What are the symptoms of epididymo-orchitis?

A

Testicular pain, swelling
Urethral discharge
Dragging/heavy sensation in scrotum
Systemic features e.g. fever

29
Q

How would you investigate epididymo-orchitis?

A

Urine MC+S
STI screen
Penile swab
USS to rule out torsion/tumour

30
Q

How is epididymo-orchitis managed?

A

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
Q

What are the potential complications of chronic untreated epididymo-orchitis?

A

Chronic pain
Testicular atrophy
Infertility
Scrotal abscess

32
Q

What deformity predisposes men to testicular torsion?

A

Bell-clapper deformity

  • Absence of fixation between testicle and tunica vaginalis
  • Testicle hangs in more horizontal position
33
Q

What are the signs of testicular torsion on examination?

A

Swelling and redness of the scrotum, firm
Exquisitely tender testicles
Absence of cremasteric reflex
Abnormal lie of the testicle

34
Q

What is the name of the sign seen on USS in testicular torsion?

A

Whirlpool sign

35
Q

How is testicular torsion managed?

A

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
Q

What is a hydrocele like on examination?

A

Soft, round, fluctuant mass
Irreducible
Transilluminates

37
Q

Why should hydroceles be investigated?

A

Because they can be associated with testicular cancer, torsion, infection

38
Q

What causes varicoceles?

A

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
Q

What is a varicocele like on examination?

A

“Bag of worms”
More prominent on standing and disappears when lying down
Asymmetry in testicular size

40
Q

What are the complications of varicoceles?

A

Testicular atrophy

Subfertility

41
Q

What does an epididymal cyst feel like on examination?

A

Soft, round, fluctuant mass
Separate to the testicle, more associated with the epididymis
May transilluminate if large

42
Q

What are the two most common histological types of testicular cancer?

A

Seminoma

Teratoma

43
Q

What are the symptoms of testicular cancer?

A

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
Q

What are the most common site of metastasis of testicular tumours?

A

Lung, liver, brain

45
Q

What are the blood markers for testicular cancer?

A

LDH- very non-specific
AFP- teratomas
B-hcg- teratomas and seminomas

46
Q

What are the most common causative organisms in UTI?

A

E-Coli
Klebsiella
Enterococci
Pseudomonas

47
Q

What are risk factors for UTI?

A 
Female gender
Old age, incontinence, poor hygiene
Sexual activity, anatomical complexities
Catheter use
Immunosuppression
48
Q

What are the symptoms of UTI?

A 
Dysuria, frequency, haematuria
Suprapubic pain
Nocturia, incontinence
Fever + systemic symptoms
Cloudy/strong smelling urine
Confusion/delirium
49
Q

How is UTI diagnosed?

A

Urine dip - nitrite + leucocyte +/- blood positive
Bloods: raised inflammatory markers
MSU: MC&S
Bloods + cultures if septic

Catheter culture / sample from bag

50
Q

How long should you treat a UTI for?

A

3 days- simple UTI
5-10 days- anatomical, recurrent, immunosuppressed
7 days- men, pregnant women, catheter-related

51
Q

When should nitrofurantoin be avoided in pregnancy and why?

A

Trimester 3

Due to foetal haemolysis

52
Q

When should trimethoprim be avoided in pregnancy and why?

A

Trimester 1

Due to folate antagonism

53
Q

What are the symptoms of pyelonephritis?

A

UTI symptoms + renal angle tenderness/back pain

More likely to have systemic symptoms

54
Q

How is pyelonephritis diagnosed?

A

Urine dip + MSU to confirm infection
Bloods: raised inflammatory markers, U&E deranged, cultures
USS kidney
CT KUB

55
Q

How is pyelonephritis managed?

A

7-10 days antibiotics-
usually cephalexin, co-amoxiclav/trimethoprim, ciprofloxacin

If septic- admit, IV abx and sepsis 6 protocol

Supportive: paracetamol, fluids

56
Q

What is the red flag symptom of bladder cancer?

A

Painless haematuria

57
Q

What are the risk factors of bladder cancer?

A

Age
Occupational exposure to chemicals involved in the dye and rubber manufacturing industry
Smoking

58
Q

What is the most common histology of bladder cancer?

A

Transitional cell carcinoma

59
Q

How is bladder cancer diagnosed?

A

Flexible cystoscopy with biopsy = gold std

Urine dip, MC + S, USS
Staging CT

60
Q

How is bladder cancer treated?

A

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
Q

What is the most common type of kidney stone?

A

Calcium oxalate

RF= Hypercalcaemia + reduced UO

62
Q

Which type of kidney stone is not visible on x-ray?

A

Uric acid

63
Q

Which type of kidney stone is associated with infection?

A

Struvite stones

64
Q

Which type of kidney stone is most associated with forming staghorn calculi?

A

Struvite

65
Q

What are the symptoms of ureteric stones?

A

May be asymptomatic
Renal colic- loin-groin pain, writhing around
Haematuria
Nausea and vomiting, oliguria, may have fever if infective

66
Q

How do you diagnose ureteric stones?

A

Urine dip- haematuria
Bloods: U+E, calcium +/- uric acid level
AXR may show some calcium stones
non-contrast CTKUB = gold standard

67
Q

How are ureteric stones managed?

A

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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