Urology Flashcards
Summarise Benign Prostatic Hyperplasia
Presentation: LUTS (hesitancy, weak flow, incomplete emptying, straining, dribbling, urgency, frequency, nocturia, intermittency), smooth, soft, central and symmetrical prostate.
Assessment:
DRE, PSA, urine chart, urine dipstick
Mx:
Tamsulosin (alpha-1 receptor antagonist relax SM) - treat sx
Finasteride (5-alpha-reductase inhibitors) - reduce prostate size by reducing testosterone
TURP - remove part of prostate to create more space for urine flow
If in acute urinary retention put in catheter - keep watch for post-obstructive diuresis after
Summarise Prostatitis
Chronic: >3m of pelvic pain, LUTS, ED, haematospermia, pain on BO, tender, large and warm prostate OE
Acute: fever, fatigue, sepsis, sytemically unwell
Ix: dipstick to show infection, Urine MCS, NAAT STI check
Mx:
Admit if septic
Abx - ciprofloxacin
Chronic (alpha blockers)
Summarise Prostate Cancer
Pathophysiology: Androgen dependent. Commonly spreads to lymph nodes and bones. Majority are adenocarcinomas that grow in the peripheral zone.
RF: Age, fhx, tall, anabolic steroids
Presentation: LUTS, Haemturia, ED,
On DRE hard, asymmetrical, craggy prostate, B sx
Ix: PSA (75% false positives, 15% false negatives) - may be false positive due to BPH, ejaculation/ prostate stimulation, prostatitis, UTI, vigorous exercise.
MRI –> biopsy (take samples from multiple areas and use Gleason score)
Mx: Watchful waiting early on, Prostatectomy (SE: ED, incontinence), brachytherapy/ radiotherapy (prostatitis), hormones (Androgen blockers eg bicalutamide, GnRH agonists eg goserilin - menopause like SE)
Summarise Epididymo-orchitis
Pathophysiology: Inflammed testicle and epididymis (sperm mature and storage which drains into vas deferens)
Causes: e.coli, chlamydia trachomatis, neisseira gonorrhoea, mumps
Presentation: Gradual, unilateral, painful, dragging, swollen, discharge in STIs, systemic sx
Ix: Urine MCS, NAAT of urine, charcoal swab of dicharge, PCR for mumps, US is suspect torsion or tumour
Mx:
- Ofloxacin (unless STI identified)
- Levofloxacin/ ciprofloxacin/ doxycycline
Summarise Testicular Torsion
Pathophysiology: Twisting of the spermatic cord
RF: Bell-Clapper Deformity
Presentation: Most common in teenagers. Acute unilateral severe testicular and abdo pain with N+V, swollen, elevated and in horizontal lie, loss of cremasteric reflex
Ix: Can US to show a whirlpool sign but if sus clinically don’t delay
Mx: NBM, analgesia, urology referral, orchiopexy.
Summarise some differentials for scrotal lumps
Varicocele:
Veins in pampniform plexus swollen. Can cause infertility as disrupt testicle temperature. Left side drains into renal vein –> possible RCC.
Present with dragging sensation, low fertility, bag of worms, more prominence of standing and disappear when lie down, dull pain.
If don’t disappear on lying down refer urology.
Hydrocele:
Fluid in the tunica vaginalis - soft and fluctuant, can transilluminate. Can be caused by torsion/ cancer/ infection. Aspirate and mx cause.
Cyst:
Spermatocele = sperm containing
Occur head of epididymis
Soft, round, separate from testicle.
Summarise UTIs
Cause: Most commonly e.coli (gram neg rod)
Klebsiella pneumoniae
enterococcus
RF: Female, catheter
Presentation: Dysuria, frequency, urgency, suprapubic pain, haematuria, fever, systemically unwell, confusion in elderly
Ix:
Nitrites/ leukocytes + RBC on dipstick.
Urine MCS if pregnant, recurrent, abx not working
Mx:
1. Nitrofurantoin/ trimethoprim
2. co-amoxiclav
3 days in simple infection for women, 7 days for men, pregnant, catheters
In children consider vesico-ureteric reflux if recurrent infection - ix ysing MCUG
Summarise Pyelonephritis
RF: vesico-ureteric reflux, female, structural abnormalities, DM.
Presentation: TRIAD: Loin to groin pain, fever and N+V. renal angle tenderness, sysemtically unwell, haematuria
Ix:
Dipstick shows signs of infection. MSU MCS. Bloods show infection.
Mx:
cefalezin, co-amox, ciprofloxacin. Sepsis 6.
If not getting better consider abscess or stones.
Summarise Bladder Cancer
Pathophysiology: urothelium most commonly affected, causing transitional cell carcinoma. Majority are superficial.
RF: Working with dyes/ rubbers, schistosomiasis (SCC), smoking
Presentation: Painless hamaeturia –> 2WW.
Ix: Cystoscopy
Mx: TURBT, intravesical chemo, Intravesical BCG vaccine, cystectomy. Chemo and radio.
Summarise Kidney Stones
Pathophysiology: calcium based most common (ca oxalate commonest). Can also get uric acid stones.
RF: High Ca –> hyperparathyrois, myeloma, breast/ lung Ca
Staghorn calculus = stone forms in shape of renal pelvis. seen XR.
Presentation: Loin to groin colicky pain, haematuria, pt feels restless, N+V, septic.
Ix: Dipstick shows haematuria. CT KUB gold standard.
Mx:
IM diclofenac most effective analgesia. Antiemetics, abx.
WW if stone <5mm.
Surgery if larger: Lithotripsy, uteroscopy, open.
Long term: dietary advice t, fluids. Potentially try potassium citrate/ thiazide diuretics
Summarise Renal Cell Carcinoma
Pathophysiology: Clear cell mosr common. Wilm’s tumour specific to kids.
RF: Smoking, obesity, htn, CKD, tuberous scerosis
Presentation: Haematuria, Flank pain, palpable mass. B sx. May get L sided varicocele.
Ix:
Cannonball mets on XR
Paraneoplastic features - htn, polycythaemia, hypercalcaemia
Mx: MDT, Nephrectomy, chemo, radio
Summarise testicular cancer
Pathophysiology: seminomas or non seminomas (teratoma)
RF: Undescended testes, infertility, fhx, height
Presentation: Usually young, unilateral, painless swelling, hard, ireegular, no transillumnation or fluctuance. Gyncaecomastia - leydig tumour
Ix:
Alpha-fetoprotein (teratoma), bet-hcg, lactate dehydrogenase (non-specific)
U/S first line
Royal Marsden Staging system used
Mx: MDT, Orchidectomy, chemo, radio, sperm banking for fertility
Summarise Undescended Testicles
Pathophysiology: testicles migrate down the inguinal cancal and into the scotum. Can lead to torsion, infertility and cancer in later life
RF: premature, fhx, SFGD, LBW
Mx:
If still undescended at 6m need urology referral for orchidopexy
Summarise Hypospadias
Urethral meatus displaced onto ventral side of the penis . Usually means foreskin also deformed –> Need foreskin if decide on surgery
