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Finals > Urology > Flashcards

Urology Flashcards

1
Q

Types - Bladder Cancer

A

Transitional cell (90%)
Squamous (3-5%)
Adenocarcinoma (2-3%)

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2
Q

Risk factors - Bladder Ca

A 
age 
SMOKING
occupation - dyes, rubber
pelvic rt
cyclophosphamide 
recurrent utis 
Schistosomiasis - SCC
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3
Q

Clinical features - Bladder Ca

A 
HAEMATURIA - visible or non visible 
urinary frequency 
urgency
dysuria
later sx: anorexia, W/L, bone pain, flank pain
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4
Q

2WW Criteria - Bladder Ca

A

Aged 45 or over w/ visible haematuria w/o UTI
Aged 45 or over w/ visible haematuria which persists/recurs after successful tx of UTI
Aged 60 or over w/ non-visible haematuria + dysuria or raised WCC on FBC

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5
Q

Investigations - Bladder Ca

A

urinalysis - C&S, microscopy, dipstick
bloods - fbc, u&es, lfts
cystoscopy - visualise & biopsy
imaging - uss/ct/mri (can be useful for staging or other causes)

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6
Q

Management options - bladder cancer

A

TMN staging - dependent

TUBRT - Transurethral resection of bladder tumour (1st line for non-invasive bladder tumours)

Intravesical chemotherapy (often used after TURBT to reduce risk of recurrence)

Intravesical BCG (immunotherapy)

Radical cystectomy (used in cancers which have invaded muscle, requires urinary diversion)

Chemo + RT

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7
Q

Presentation - Prostate Cancer

A 
• Frequency
• Hesitancy 
• Nocturia
• Weak stream 
• Incomplete emptying 
• Intermittency 
• Straining 
• Terminal dribbling
• Haematuria
ED

Or can p/w symptoms of advanced disease or metastasis e.g. weight loss, bone pain, cauda equina syndrome

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8
Q

Investigations - Prostate Cancer

A

Bedside
• Urinalysis - dipstick, C&S (r/o UTI?)
• Examination (DRE) - prostate may feel enlarged craggy, hard, irregular mass, loss of midline sulcus

Bloods
	• FBC
	• U&Es
	• PSA (prostate specific antigen)
		○ Valves are age related & it is non-specific, can be raised during infection, in BPH, following catheter
	• LFTs 
	• Bone profile

Imaging
• Multiparametric MRI - now commonly first line investigation in dx of prostate cancer
• Imaged guided prostate biopsy (+ Trans-rectal ultrasound)
• Bone isotope scan/CT/MRI - can all be considered for staging

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9
Q

2WW Criteria - Suspected Prostate Ca

A

2WW CRITERIA
• Abnormal prostate on DRE (‘‘feels malignant’’)
• PSA elevated above age specific range

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10
Q

Management options - Prostate Ca

A

Active surveillance
• Option in low risk patients
• Watchful waiting & PSA monitoring

Radical prostatectomy
• For tumours localised to gland

Radical radiotherapy
• External beam radiotherapy (EBRT) and brachytherapy

Medical androgen-depravation therapy
• GnRH agonist; persistent presence of an agonist causes downregulation of receptors on the pituitary gland leading to reduced LH/FSH release. Goserelin is a commonly used GnRH agonist (brand name Zoladex).

Docetaxel chemotherapy
• used in non-metastatic high-risk disease as well as locally advanced and metastatic prostate cancer.

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11
Q

How does BPH present?>

A

Lower urinary tract symptoms
• Hesitancy – difficult starting and maintaining the flow of urine
• Weak flow
• Urgency – a sudden pressing urge to pass urine
• Frequency – needing to pass urine often, usually with small amounts
• Intermittency – flow that starts, stops and varies in rate
• Straining to pass urine
• Terminal dribbling – dribbling after finishing urination
• Incomplete emptying – not being able to fully empty the bladder, with chronic retention
Nocturia – having to wake to pass urine multiple times at night

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12
Q

Assessment of BPH

A

Digital rectal examination (prostate exam) to assess the size, shape and characteristics of the prostate

Abdominal examination to assess for a palpable bladder and other abnormalities

Urinary frequency volume chart, recording 3 days of fluid intake and output

Urine dipstick to assess for infection, haematuria (e.g., due to bladder cancer) and other pathology

Prostate-specific antigen (PSA) for prostate cancer, depending on the patient preference

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13
Q

Management of BPH

A

Conservative – watch & wait, long term catheter
Medical – 𝛼 blockers (Tamsulosin), 5𝛼 reductase inhibitors (Finasteride)
• Alpha blockers relax smooth muscle, with rapid improvement in symptoms
• 5𝛼 reductase inhibitors - gradually reduce size of prostate
Surgical - TURP

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14
Q

Differentials of Scrotal Swellings

A

Hydrocele - fluid around testis (communicating e.g. due to PPV or non-communicating)
Varicocele - dilated veins in pampiform plexus
Inguinal hernia - part of an organ that protrudes outside the walls of its usual cavity. (direct or indirect - via deep inguinal ring)

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15
Q

Hydrocele - risk factors, clinical features, investigations & management

A

Trauma, infection, torsion, congenital (PPV), testicular ca

Non-tender scrotal swelling, smooth, non-reducible & transilluminates

Testicular USS

Observations or surgical repair

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16
Q

Varicocele - risk factors, clinical features, investigations & management

A

Most commonly occurs in adolescent boys
Strongly associated with infertility - 40% of men undergoing fertility investigations found to have varicocele

increased pressure in plexus - can be due to incompetent or absent valves
Can also be a sign/due to renal malignancy

Scrotal swelling - on examination ‘‘bag of worms’’, frequently asymptomatic, may reduce while lying down & occasionally can be painful, cause dragging sensation

Clinical dx - refer in symptomatic

Observation in adolescence w/ yearly examination
Refer those that are symptomatic or develop testicular asymmetry (can cause atrophy)
Surgical options

17
Q

Inguinal Hernia - risk factors, clinical features, investigations & management

A

Protrusions in the inguinal or scrotal region, can be direct (through posterior wall of inguinal canal) or indirect (through deep inguinal ring - most common)

Risk factors

  • Chronic cough
  • Constipation
  • Pregnancy
  • Older age

Bulge, dragging sensation in groin, reducible or non-reducible

Investigations: observations, bloods,
Imaging - USS: if there is diagnostic uncertainty, USS normally confirms or excludes the presence of a hernia, CT: may be used for diagnosis, more commonly completed in patients presenting with complications (e.g. obstruction, strangulation), MRI: normally used to investigate for other causes of symptoms e.g. ‘sports hernia’.

• Observation - with education on signs of obstruction/strangulation
• Surgical Open or laproscopic
18
Q

Peyrone’s Disease - definition & management

A

Build up of scar tissue on the side of the penis which leads to curative & painful erections
Usually painful erections, 3-6mths later curative noticed & erections become more painful, can be a/w ED
Clinical course of 12-24mths

No routine investigations needed

13% resolve, of the remainder 50% progress & 50% stabilise
Management
○ Reassurance & explanation to patient
○ Stretching - vacuum & traction devices
○ Medical - collegenase injections (break down plaques)
○ Surgical (last resort) - wait 24mths

19
Q

Premature ejaculation - causes, management

A

premature ejaculation occurs when a man ejaculates sooner during sexual intercourse than he or his partner would like
• Causes (debatable)
○ Psychological – early sexual experiences, abuse, body image
○ Erectile dysfunction
○ Relationship problems
○ Biological causes – hormones, inflammation, hereditary
○ Some evidence that life long is related to central 5-HT receptor sensitivity
○ Some evidence that acquired is related to anxiety
• Treatment
○ Combined approach
○ Psychosexual support – pelvic floor exercises / squeeze technique
○ Condoms / Topical anaesthetics – reduce sensation
○ Oral medications – drugs such as Dapoxetine that have the side effect of delaying ejaculation
○ If ED is a problem address that too

20
Q

Erectile Dysfunction - history & clues to cause

A

○ Onset (sudden - psychogenic, gradual - organic)
○ Situational (psychogenic) vs Always (organic)
○ Morning/Night time erections - psychogenic
○ Libido
○ PMHx inc medications, drug use, trauma
○ RFs for CVD inc FHx

21
Q

Erectile Dysfunction - Causes

A 
• vascular (CVD)
	• neurogenic; spinal cord injuries, DM, MS
	• drugs; SSRIs, alcohol, weed
	• endocrine
psychogenic
22
Q

Erectile Dysfunction - Investigations & Management

A 
Investigations 
	• important to screen for CV risks, good opportunity for intervention
		○ CV risk; BMI, BP, lipids, HbA1c
		○ Secondary sexual characteristics
		○ Lower limb pulses 
Management 
	• Lifestyle Modification 
		○ weight loss, exercise, stop smoking
	• Phosphodiesterase inhibitors (PDE5i) 
		○ Sildenafil
	• Alprostadil preparations 
	• Vacuum devices/pumps
	• Testosterone replacement 
• Considerations for treatment 
	○ Contraindications -Unfit for sexual activity, recent MI, angina, uncontrolled HTN, hypotension or uncontrolled hypertension
	○ Side Effects – all fairly common, Facial flushing and headache, masal congestion, dizziness due to low blood pressure

Finals (16 decks)

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