Urology Flashcards
What are the common causes of upper urinary tract obstruction?
Kidney stones
Tumours pressing on the ureters
Ureter strictures
Retroperitoneal fibrosis
Bladder cancer (blocking the ureteral openings to the bladder)
Ureterocele (ballooning of the most distal portion of the ureter- this is usually congenital)
What are the causes of lower urinary tract obstruction?
BPH Prostate cancer Bladder cancer Urethral strictures Neurogenic bladder
What are the causes of neurogenic bladder?
Multiple sclerosis Diabetes Stroke Parkinsons Brain or spinal cord injury Spina bifida
What does neurogenic bladder result in?
Urge incontinence
Increased bladder pressure
Obstructive uropathy
What is the management of obstructive uropathy?
Nephrostomy- used to bypass an obstruction in the upper urinarh tract
Urethral or suprapubic catheter may be used to bypass an obstruction in the lower urinary tract
What are the typical presenting features of hydronepnrosis?
Vague renal angle pain
Mass in the kidney area
Can be seen on an US, CT scan or IV urogram
How can you relieve pressure from hydronephrosis?
Percutaneous nephrostomy
Antegrade ureteric stent
What is BPH?
Hyperplasia of the stromal and epithelial cells of the prostate. Usually presents with LUTS
What are the LUTS which occur in BPH?
Hesitancy Weak flow Urgency Frequency Intermittency Terminal dribbing Nocturia Straining Terminal dribbling
How can you assess the severity of lower urinary tract symptoms?
International prostate symptom score IPSS
What is the initial assessment of men presenting with LUTS?
Digital rectum exam Abdo exam Urinary frequency volume chart Urine dipstick Prostate specific antigen
What are the common causes of raised PSA
Prostate cancer BPH Exercise UTIs Prostatitis Recent ejeculation or prostate simulation
What would the prostate feel like if it was benign and what about if it was cancerous?
Benign- smooth, symmetrical and slightly soft
Cancerous- firm/hard, asymmetrical, craggy or irregular with loss of the central sulcus
What is the management of BPH?
Alpha blockers- tamsulosin (relax smooth muscle with rapid improvement in symptoms)
5- alpha reductase inhibitors- finasteride (gradually reduces prostate size)
The general rule is that alpha blockers are used for symptoms whereas5 alpha reductase inhibitors are used to reduce the enlargement.
What are the most notable side effects of
A) alpha blockers
B) finasteride
A) postural hypotension- if an old man is presenting with lightheadedness on standing or falls check if they are on tamsulosin
B) sexual dysfunction
Give an example of surgeries used for BPH?
TURP- transurethral resection of the prostate
Major complications= bleeding, infection, urinary incontinence, erectile dysfunction, retrograde ejaculation, urethral strictures
What is prostatitis?
Inflammation of the prostate, it can be classed as:
1) acute bacterial prostatitis- infection w/ more rapid onset of symptoms
2) chronic prostatitis- symptoms lasting for at least 3 months
What is the presentation of chronic prostatitis?
Chronic prostatitis presents with at least 3 months of..
- pelvic pain
- lower urinary tract symptoms
- sexual dysfunction
- pain with bowel movements
- tender and enlarged prostate on examination
What does acute bacterial prostatitis present like?
Similar symptoms to chronic prostatitis, as long as systemic symptoms of infection…
- fever
- myalgia
- nausea
- fatigue
- sepsis
What Ix would you do for prostatitis?
Urine dipstick testing
Urine microscopy, culture and sensitivities (MC and S) to clarify organisms and antibiotic sensitivities
Chlamydia and gonorrhoea NAAT testing on a first pass urine
What is the management of acute bacterial prostatitis?
Hospital admission for systemically unwell or septic pts (for bloods, blood cultures, Iv abx)
Abx 2-4 weeks
Analgesia
Laxatives if pain during bowel movements
What is the management of chronic prostatitis?
Alpha blockers (tamsulosin) relax smooth muscle, with rapid improvement in sx
Analgesia
Psychological treatment where indicated- CBT, antidepressants
Abx - if less than 6 months of sx or history of infection- doxycycline or trimethoprim for 4-6 weeks
Laxatives for pain during bowel movements
Where is prostate cancer most likely to spread to?
Lymph nodes and bomes
Its almost always androgen dependent- meaning they rely on testosterone to grow
Where are most of prostate cancers found?
Peripheral zone of the pro#tate