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Surgery finals > Urology > Flashcards

Urology Flashcards

1
Q

Describe the epidemiology of urinary tract calculi

A

Very common (10%)
M > F
More common in hot, dry climates

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2
Q

Describe the types of urinary tract calculi and risk factors

A
  1. Calcium stones (oxalate, phos): 80%
    - ^ in Crohn’s disease, thiazides, hypercalcaemia
  2. Uric acid stones: 10%
    - RF: gout
  3. Triple stones/struvite (Mg ammonia phos)
    - Assoc w Proteus UTI
  4. Cystine: amino acid
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3
Q

Describe the presentation of urinary tract calculi

A
  • Renal colic: intermittent, severe, loin->groin pain, agitation
  • N+V, anorexia
  • Haematuria

Complications: UTI, obstruction, sepsis

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4
Q

Describe the investigations for urinary tract calculi

A

-Urine: dip, UPT, 24-hour-collection (rare)
-Bloods: FBC, CRP, U+Es and chemistry, pregnancy, VBG and culture (sepsis)
-Imaging: non-contrast CT-KUB (1st line)/ USS (<16/pregnant)
Extra tests: IVU, stone analysis

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5
Q

Describe the management of urinary tract calculi

A

Acute management: analgesia (NSAIDs -> IV paracetamol, opioids), fluids

Conservative:

  • <5mm in lower 1/3 ureter: discharge and wait
  • Chronic: hydration, reduce salt/mod protein

Medical:

  • Acute: medical expulsive therapy (MET) if 5-10mm eg. tamsulosin. Most pass in 48hrs
  • Chronic: stop precipitating meds, oral alkinisation therapy (K citrate), thiazides (Ca stones)

Surgical: stones <10mm not passing/infection, >10mm

  • Shock wave lithotripsy (SWL), ureteroscopy, percutaneous nephrolithotomy (PCNL)
  • Stone >20mm: PCNL
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6
Q

Describe the prognosis of urinary tract calculi

A

50% will have recurrence within 10 years

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7
Q

Describe the classic features of a hydrocoele

A

Testicular mass: smooth, fluctuant, painless, one with testis, transilluminates

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8
Q

Describe the classic features of a varicocoele

A

‘Bag of worms’- soft, nontender, lumpy, separate to testis
May have dull ache
More common in the L testicle because drains into the L renal vein (compared with R, which drains into IVC)

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9
Q

Describe the classic features of epididymo-orchitis + causes

A

Painful testicular swelling +/- urethritis (dysuria etc)
Fever, sweating
O/E: tender, red, swollen, hot- esp on back side of testis (epididymis). Pain relief on lifting testis.
Causes: STIs (gonorrhoea, chlamydia), E coli, mumps

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10
Q

Describe the investigations for epididymo-orchitis

A

Urine: dip, MC&S, NAAT (STI)
Swab (STI screen)

Can also consider:
Bloods: FBC, CRP, U+Es
USS to exclude abscess

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11
Q

Describe the management of epididymo-orchitis

A
  • Drink lots of fluids

- PO ABx: doxycycline or cipro

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12
Q

Describe the classic features of prostatitis

A

Back pain, rectal pain, pain on ejaculation
Dysuria
Haematuria
Fevers, sweating
O/E: swollen, boggy, tender prostate on PR

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13
Q

Describe the investigations and management of prostatitis

A

Ix: urine dip + MC&S, STI screen
Mx: ciprofloxacin 14 days

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14
Q

Describe the classic features of testicular torsion

A

Sudden onset severe pain in testes +/- abdo pain
N+V

O/E: extremely tender testes, riding high and transverse. Loss of cremasteric reflex

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15
Q

Describe the differentials for testicular torsion and how these are different

A

Torsion of Hydatid of Morgagni: small blue dot visible on scrotum, less painful

Epididymo-orchitis: not quite so sudden onset, less painful, assoc with fever + dysuria

Strangulated hernia: history of lump/swelling

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16
Q

Describe the investigations and management of testicular torsion

A

Ix: if suspected, do not delay treatment for Ix
-USS useful, detects absent blood flow

Mx: surgical emergency. Time is testicle.

  • Call urologists ASAP
  • Make NBM, get IV access for bloods, fluids + analgesia
  • Detort and bilateral orchidopexy +/- orchidectomy
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17
Q

Describe the complications of undescended testes

A
  • Subfertility
  • Malignancy (x10), some risk even with surgery
  • Torsion
  • Hernias (patent processus vaginalis)
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18
Q

Describe the management of hydrocoele and varicocoele

A

Hydrocoele:

  • Conservative: allow resolution
  • Surgical: aspiration (risk of recurrence), repair (2 types)

Varicocoele:

  • Conservative: scrotal support
  • Surgical: clipping of testicular vein
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19
Q

Describe the epidemiology and risk factors for testicular cancer

A

Commonest cancer in younger men (<45)

RFs: undescended testes, family history

20
Q

Describe the types of testicular cancer

A

Widely split into germ cell, sex-cord stromal and lymphoma:

1) Germ cell (95%): can be seminomas (40%) or non-seminomatous (60%)
Seminomas: commonest single subtype. Young M. May have raised bHCG
Non-seminomas:
-Teratoma: malignant in adults. Secrete bHCG and AFP
-Yolk sac: commonest in children
-Choriocarcinoma: very rare.

2) Sex cord stromal tumours
- Leydig cell: may secrete testosterone
- Sertoli cell

3) Lymphomas/leukemia:
- NHL: common in elderly
- ALL: common in very young children

21
Q

Describe the investigations for testicular lumps

A

Bloods: FBC, CRP, U+Es, LDH, bHCG, AFP
Imaging: USS (CT CAP also if suspected cancer, but do not delay surgery for this)

*NO biopsy

22
Q

Describe the management of testicular cancer

A

Medical:

  • Radiotherapy (used in early seminomas)
  • Chemotherapy (used in higher stage disease)

Surgical: mainstay for every stage
-Orchidectomy with groin approach

23
Q

Describe the classic features of benign prostatic hypertrophy

A 
Increasingly common with older age- 90% at 80 years
Presents with LUTS:
-Hesitancy and intermittency 
-Incomplete voiding 
-Poor stream 
-Straining 
Frequent UTIs
24
Q

Describe the investigations for BPH

A

DRE
Urine: dip
Bloods: FBC, CRP, U+Es, PSA
Imaging: transrectal US

25
Q

Describe the management of BPH

A

Conservative:
-Reduce caffeine + alcohol intake

Medical:

  • A blockers: tamsulosin, doxazosin
  • 5a reductase inhibitors: finasteride

Surgical: multiple options

  • TURP
  • Laser or open prostatectomy
26
Q

Describe some side effects of alpha-blockers and 5a reductase inhibitors used in BPH

A

Alpha-blockers:

  • Hypotension
  • Drowsiness

5a reductase inhibitors:
-ED

27
Q

Describe some complications of TURP

A

Immediate:

  • TURP syndrome
  • Haemorrhage (very vascular organ)

Early:

  • Infection
  • Clot retention -> bladder irrigation w 3 way catheter

Late:

  • Retrograde ejaculation (common)
  • ED
  • Incontinence
  • Stricture
  • Recurrence
28
Q

What is TURP syndrome?

A

A rare but very serious complication of TURP. Occurs due to absorption of large volumes of hypotonic solution used to flush bladder during procedure
-> hyponatraemia, ECG changes, confusion, coma etc

29
Q

Describe the management of TURP syndrome

A

Stop procedure
Monitor plasma Na and osm
IV diuretics if overloaded
IV hypertonic saline in severe cases

30
Q

Describe the presentation of prostate cancer

A

LUTS eg. hesitancy, incomplete voiding, poor stream
Systemic symptoms: weight loss, fatigue
Mets: back pain

O/E: hard, craggy, enlarged, asymmetrical prostate

31
Q

Describe the investigations for prostate cancer

A

Urine: dip
Bloods: FBC, U+Es, LFTs, bone profile, PSA
Imaging: transrectal US -> staging scans eg CT CAP
Biopsy

32
Q

Describe the grading of prostate cancer

A

Gleason grade

Take 2 samples from worst affected areas, each is given Gleason score 1-5, total out of 10

33
Q

Describe the management of prostate cancer

A

Conservative:
-Active monitoring- suitable for lower grade in elderly

Medical:

  • Brachytherapy
  • Endocrine therapy: LHRH analogues (goserelin), anti-androgens (bicalutamide)

Surgical: only for younger patients
-Radical prostatectomy

34
Q

Describe the types of bladder cancer and RFs

A

Transitional cell carcinoma: 90%
SCC: assoc with schistosomiasis
Adenocarcinoma

RFs: smoking, dye exposure, rubber workers, radiotherapy

35
Q

Describe the classic features of bladder cancer

A

Older males
Painless haematuria is classic presentation
+/- storage symptoms: frequency, urgency, nocturia
Retention

36
Q

Describe the investigations for bladder cancer

A

Urine: dip, cytology
Bloods
Imaging: cystoscopy + biopsy is diagnostic -> CT/MRI for staging

37
Q

Describe the management of bladder cancer

A

Medical:

  • Radiotherapy
  • Chemotherapy: may be intravesical

Surgical:

  • 80% are superficial -> transurethral resection of bladder tumour (TURBT)
  • Invasive: radical cystectomy + ileal conduit

**Important to follow up because recurrence is common

38
Q

Describe the classic features of renal cancer

A 
Often found incidentally
Triad of:
-Microscopic haematuria
-Back/loin pain 
-Abdominal mass 
Systemic symptoms: weight loss, anorexia
Paraneoplastic syndromes: EPO, PTHrP, ACTH
39
Q

Describe the common types of renal cancer

A

Children: nephroblastoma/Wilm’s
Adults:
-Renal cell carcinoma: clear cell, papillary, chromophobe
-Transitional cell carcinoma

40
Q

Describe the risk factors for renal cancer

A
  • Older age
  • Male
  • Smoking
  • Obesity
  • Dialysis
  • Genetic syndrome eg. VHL
41
Q

Describe the investigations for renal cancer

A

Bloods:
Urine
Imaging: CXR, USS, IVU, CT/MRI

42
Q

Describe the management of renal cancer

A

Medical: chemotherapy
Surgical: radical nephrectomy

43
Q

Describe the causes of hydronephrosis

A 
Obstruction:
Intra-luminal: Urolithiasis, clots
Mural: strictures
Extra-luminal: 
-Malignancy: prostate, intra-abdo 
-BPH
44
Q

Describe the management of hydronephrosis

A 
Treat cause of obstruction
Temporary measures:
-Nephrostomy 
-Ureteric stent
-Catheterisation: suprapubic or urethral
45
Q

What are some complications of catheterisation?

A 
Trauma eg. to prostate 
Pain
Infection
Haematuria
Post-obstruction diuresis

Surgery finals (16 decks)

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