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Surgery > Urology > Flashcards

Urology Flashcards

1
Q

What are the risk factors for bladder cancer?

A

Smoking, increased age, aromatic amines (dye + rubber carcinogens), schistosomiasis (squamous cell cancer of bladder)

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2
Q

What are the histological types of bladder cancer?

A
  • Transitional cell (90%)
  • Squamous cell cancer (5%)
  • Others-> adenocarcinoma, sarcoma, small-cell
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3
Q

How does bladder cancer typically present?

A
  • Painless haematuria

- Dysuria

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4
Q

What is the 2-week wait criteria for bladder cancer?

A
  • Age 45 or over-> unexplained visible haematuria without UTI or after treatment for UTI
  • Age 60 or over-> microscopic haematuria + dysuria or raised WCC on FBC
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5
Q

What is the non-urgent referral criteria for bladder cancer?

A

Aged 60 or over with recurrent UTI

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6
Q

How is bladder cancer diagnosed?

A

Cystoscopy (rigid or flexible)-> visualise

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7
Q

How is bladder cancer staged?

A

TMN staging for non-muscle invading + muscle invading

  • Tis/carcinoma in situ-> only urothelium + flat
  • Ta-> only urothelium + projects into bladder
  • T1-> invades connective tissue beyound urothelium
  • T2-T4-> muscle invasive + lymph nodes/mets involvement
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8
Q

How is bladder cancer treated?

A
  • Transurethral resection of bladder tumour (TURBT)-> when non-invasive
  • Intravesical chemo-> after TURBT to recude recurrence
  • Intravesical BCG vaccine-> stimulate immune system to attack tumours
  • Radical cystectomy with urostomy + ileal conduit-> continent urinary diversion (intermittent catheter needed), neobladder reconstruction, ureterosigmoidoscopy
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9
Q

What is the most common type of kidney tumour?

A

Adenocarcinoma of renal tubules

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10
Q

What are the different types of renal cell carcinoma?

A
  • Adenocarcinoma of renal tubules
  • Clear cell (80%)
  • Papillary
  • Chromophobe
  • Wilm’s tumour-> in kids under 5
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11
Q

How does renal cell carcinoma present?

A
  • Triad of haematuria + flank pain + palpable mass
  • Non-specific cancer signs
  • Paraneoplastic features-> polycythaemia, hypertension, hypercalcaemia, Stauffer’s syndrome
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12
Q

What is the 2-week wait criteria for renal cell carcinoma?

A

Aged 45+ with unexplained visible haematuria without UTI or after UTI treatment

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13
Q

What are the risk factors for renal cell carcinoma?

A

Smoking, obesity, hypertension, renal failure, tuberous sclerosis, Von Hippel-Lindau disease

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14
Q

Where do renal cell carcinomas metastasise to?

A
  • Gerota’s fascia + tissues around kidney-> via renal vein + IVC
  • Lungs-> cannonball mets ie circulat opacities
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15
Q

What might cannonball mets on a CXR be a sign of?

A

Renal cell carcinoma

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16
Q

What are the paraneoplastic features of renal cell carcinoma?

A
  • Polycythaemia-> unregulated erythropoietin production
  • Hypercalcaemia-> secretes hormones mimicing PTH
  • HTN-> increased renin
  • Stauffer’s syndrome-> abnormal LFTs without liver mets
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17
Q

How is renal cell carcinoma staged?

A

TMN system with CT-TAP

  • Stage 1-> <7cm + kidney only
  • Stage 2-> >7cm + kidney only
  • Stage 3-> local spread to tissues/veins not beyond Gerota’s fascia
  • Stage 4-> beyond Gerota’s fascia including mets
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18
Q

How is renal cell carcinoma managed?

A
  • Surgery-> partial or radical nephrectomy +/- tissues
  • Arterial embolisation-> cut off supply to kidney
  • Percutaneous cryotherapy-> liquid nitrogen to kill cells
  • Radiofrequency ablation
  • Chemo or radiotherapy
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19
Q

What are the different indications for a urinary catheter?

A
  • Urinary retention-> obstruction
  • Neurogenic bladder
  • Surgery
  • Output monitoring when acutely unwell
  • Bladder irrigation-> wash out blood clots
  • Delivery of chemo for bladder cancer
  • Post-void bladder scan-> may need if >500mls after emptying attempt
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20
Q

What should be used to monitor a patient during TWOC (trial without catheter)?

A
  • Urine output

- Bladder scanner

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21
Q

How should a sample be collected when a catheter-associated UTI is suspected?

A
  • Directly from catheter or via sample port with aseptic technique
  • Catheter bag may be contaminated as not sterile
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22
Q

How are catheter-associated UTIs managed?

A
  • No symptoms-> no antibiotics needed

- Symptoms-> 7 days oral or IV antibiotics eg amoxicillin/nitro/trimethoprim (depending on severity)

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23
Q

What is obstructive uropathy?

A
  • Blockage preventing urine flow through ureters, bladder and urethra
  • Can lead to back pressure + hydronephrosis, vesicoureteral reflux, post-renal AKI
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24
Q

Where would you expect to find renal angle tenderness?

A

Costovertebral angle-> between 12th rib + vertebral column-> where lower kidneys are

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25
Q

How does upper obstructive uropathy present?

A
  • Loin-to-groin or flank pain on affected side
  • Reduced/no urine output
  • Impaired renal function-> raised creatinine
  • Systemic-> vomiting etc
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26
Q

How does lower obstructive uropathy present?

A
  • Difficulty passing urine-> poor flow, difficulty initiating
  • Urinary retention
  • Impaired renal function-> raised creatinine
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27
Q

What are the causes of upper obstructive uropathy?

A

Kidney stones, tumours, ureter strictures, retroperitoneal fibrosis, bladder cancer, ureterocele (ballooning- often congenital)

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28
Q

What are the causes of lower obstructive uropathy?

A

BPH, prostate cancer, bladder cancer, urethral strictures, neurogenic bladder

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29
Q

What is neurogenic bladder?

A

Abnormal nerve function leads to detrusor under/overactivity + urethral sphincters-> can lead to urge incontinence, increased bladder pressure + obstructive uropathy

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30
Q

What causes neurogenic bladder?

A

MS, stroke, brain or spinal cord injury

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31
Q

How is obstructive uropathy managed?

A
  • Remove or bypass obstruction
  • Urethral or suprapubic catheter-> lower obstruction bypassed
  • Nephrostomy-> drain urine
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32
Q

What are the potential complications of obstructive uropathy?

A

Pain, AKI, CKD, infection, hydronephrosis, retention, overflow incontinence

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33
Q

What is hydronephrosis?

A

Swelling of renal pelvis + calyces in kidney

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34
Q

What causes hydronephrosis?

A
  • Obstructive uropathy-> BPH, prostate cancer, bladder cancer, urethral strictures, neurogenic bladder
  • Idiopathic-> narrow PUJ, congenital etc
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35
Q

What are the features of hydronephrosis?

A

Renal angle tenderness + palpable mass

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36
Q

How is hydronephrosis investigated?

A
  • US
  • CT
  • IV urogram-> Xray with contrast
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37
Q

How is hydronephrosis managed?

A
  • Percutaneous nephrostomy
  • Antegrade ureteric stent
  • Pyeloplasty-> if narrow PUJ
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38
Q

What is benign prostatic hyperplasia (BPH)?

A

Hyperplasia of the stromal + epithelial cells of the prostate

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39
Q

What are the lower urinary tract symptoms (LUTS)?

A

FUNWISED-> frequency, urgency, nocturia, weak flow, intermittency, straining, emptying incomplete, dribbling

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40
Q

What are the symptoms of benign prostatic hyperplasia (BPH)?

A

LUTS ie FUNWISED-> frequency, urgency, nocturia, weak flow, intermittency, straining, emptying incomplete, dribbling

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41
Q

How is benign prostatic hyperplasia (BPH) assessed/investigated?

A
  • Symptoms + international prostate symptom score (IPSS)-> for severity
  • DRE-> shape, size, character
  • Abdominal exam-> bladder
  • PSA blood test
  • Urinary dipstick-> infection + haematuria etc
  • Urinary frequency volume chart-> 3 days of input/output
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42
Q

What are the potential reasons for a raised PSA (prostate specific antigen) test?

A

Prostate cancer, BPH, prostatitis, UTI, vigorous exercise, recent stimulation

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43
Q

What are some of the problems surrounding getting a PSA (prostate specific antigen) test?

A
  • Can prompt invasive investigations + complications-> 75% false positives
  • Can lead to false reassurance-> 15% false negatives
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44
Q

What might a prostate cancer feel like on DRE?

A

Firm/hard, arymmetrical, craggy, irregular, loss of sulcus

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45
Q

How is benign prostatic hyperplasia (BPH) managed?

A
  • None if mild + manageable symptoms
  • Tamsulosin-> alpha-blocker to relax smooth muscle
  • Finasteride-> 5-alpha reductase inhibitor
  • Transurethral resection of prostate (TURP)-> remove some via diathermy loop + make room for urine flow
  • Other surgery-> transurethral electrovaporisation of prostate (TEVAP/TUVP), open prostatectomy
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46
Q

What are the potential complications of transurethral resection of prostate (TURP)?

A

Incontinence, erectile dysfunction, retrograde ejaculation, urethral strictures

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47
Q

How does tamsulosin work?

A

Alpha blocker-> relaxes smooth muscle in prostate

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48
Q

How does finasteride work?

A

5-alpha reductase inhibitor-> enzyme converts testosterone to dihydrotestosterone so when inhibit this leads to reduction in size of prostate

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49
Q

What type of prostate cancer is the most common?

A

Adenocarcinoma of the peripheral zone

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50
Q

What are the risk factors for prostate cancer?

A

Older age, family history, Black African or Caribbean, anabolic steroids

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51
Q

How does prostate cancer present?

A
  • Asymptomatic
  • LUTS-> frequency, urgency, nocturia, weak flow, intermittency, straining, emptying incomplete, dribbling
  • Haematuria
  • Erectile dysfunction
  • Mets symptoms-> weight loss, bone pain etc
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52
Q

What is prostate specific antigen?

A
  • Produced by epithelial cells of the prostate
  • To thin semen
  • Glycoprotein secreted in semen + small amount enters blood
53
Q

What is considered a normal PSA level?

A

<4ng/mL

54
Q

How does the Gleason scoring system for prostate cancer work?

A
  • Based on histology
  • Greater score-> poorly differentiated + worse prognosis
  • 2 numbers-> grade of most prevalent pattern + 2nd most prevalent
  • Scores-> <6 (low risk), 7 (intermediate), 8+ high
55
Q

What are renal stones usually made out of?

A
  • Calcium oxalate
  • Calcium phosphate
  • Uric acid
  • Struvite-> eg staghorn calculus
  • Cystine
56
Q

What is a staghorn calculus?

A

Renal stone that forms in the shape of the renal pelvis-> usually struvite made from bacteria in infection

57
Q

How do renal stones present?

A
  • Asymptomatic
  • Renal colic-> unilateral severe loin-to-groin pain, fluctuate in severity
  • Restless, N+V, haematuria, reduced urine output, sepsis signs
58
Q

How are renal stones investigated?

A
  • Non-contrast CT-KUB within 24 hours-> gold standard
  • Urine dip-> haematuria
  • Bloods-> infection, U+Es, serum calcium
  • AXR-> may show calcium-based stones
  • US-KUB-> good for kids + pregnancy
  • Analyse type-> cause + risk of recurrence
59
Q

What are the risk factors for renal stones?

A
  • Dehydration
  • Low urine output
  • Hypercalcaemia-> calcium stones
60
Q

Where do renal stones usually get stuck + cause symptoms?

A
  • Vesico-ureteric junction

- Ureters

61
Q

How are renal stones managed?

A
  • Supportive-> diclofenac (IM/rectal), IV paracetamol, antiemetics, antibiotics if needed
  • If <5mm-> likely pass on own so watchful waiting
  • If >10mm or obstruction/infection-> surgical eg lithotripsy or nephrolithotomy
62
Q

What are the surgical management options for renal stones?

A
  • Extracorporeal shock wave lithotripsy-> break up stone under X-ray so easy to pass
  • Ureteroscopy + laser lithotripsy
  • Percutaneous nephrolithotomy-> break up + remove stones under GA via nephroscopy, my keep nephrostomy in
  • Open surgery-> uncommon
63
Q

How are recurrent renal stones prevented?

A
  • 2.5-3L fluid a day
  • Lemon juice to water-> binds to urinary calcium
  • Reduce salt
  • Depends on type-> less oxalate rich foods eg spinach (calcium), less purine rich eg sardines (uric acid)
  • Meds for calcium stones-> potassium citrate, indapamide
64
Q

What is prostatitis?

A

Inflammation of the prostate

  • Acute-> bacterial
  • Chronic-> >3 months
65
Q

What are the different types of chronic prostatitis?

A
  • Chronic prostatitis or chronic pelvic pain syndrome-> no infection but inflammation persists
  • Chronic bacterial prostatitis-> infection persists
66
Q

How does chronic prostatitis present?

A

3+ months of…

  • Pelvic pain-> perineum, testicles, rectum, suprapubic
  • LUTS-> frequency, dysuria, hesistancy, retention
  • Sexual dysfunction-> erectile, pain, haematospermia
  • Pain on bowel movement
  • Tender + enlarged prostate on exam
67
Q

How does acute bacterial prostatitis present?

A

Acute history of…

  • Pelvic pain-> perineum, testicles, rectum, suprapubic
  • LUTS-> frequency, dysuria, hesistancy, retention
  • Sexual dysfunction-> erectile, pain, haematospermia
  • Pain on bowel movement
  • Systemic-> fever, myalgia, nausea
  • Tender + enlarged prostate on exam
68
Q

How are the investigations for prostatitis?

A
  • Scoring tool for chronic-> severity + QoL
  • Urine dip-> infection
  • Urine MC&S-> organism + sensitivities
  • 1st pass urine for STI NAAT testing
69
Q

How is acute prostatitis managed?

A
  • Admit if unwell
  • Oral antibiotics-> 2-4 weeks of ciprofloxacin or ofloxacin or trimethoprim
  • Analgesia + laxatives
70
Q

How is chronic prostatitis managed?

A
  • Alpha blockers (tamsulosin)-> relax smooth muscle
  • Analgesia, laxatives, CBT
  • Antibiotics-> if <6 months of infection give trimethoprim/doxycycline for 4-6 weeks
71
Q

What are the complications of prostatitis?

A

Sepsis, abscess (eg fluctuant mass), acute retention, chronic prostatitis

72
Q

What warrants a 2 week wait referral for prostate cancer?

A
  • Examination shows firm, asymmetrical, craggy, irregular prostate, may lose central sulcus or feel nodules
  • PSA levels above age-specific reference range
73
Q

What is the Linkert scale for prostate cancer and what are its different stages?

A
  • Based on result from multiparametric MRI
  • Likelihood of suspected localised prostate cancer
  • Very low suspicion (1), low (2), equivocal (3), probable (4), definite (5)
74
Q

When is a suspected prostate cancer biopsied?

A

Linkert scale result of 3 or more after multiparametric MRI

75
Q

How is prostate biopsy performed?

A
  • Use multiple needles to reduce risk of false negative
  • Transrectal US-guided-> through rectum wall into prostate
  • Transperineal-> use local anaesthetic
  • Risks-> pain, bleeding, infection, urinary retention (short term swelling), erectile dysfunction
76
Q

What are the different TMN stages for prostate cancer?

A
  • Tx-> unable to assess
  • T1-> too small to be felt on exam or see on scan
  • T2-> contained in prostate
  • T3-> extends out of prostate
  • T4-> spread to nearby organs
  • Nodes-> unable to asess (Nx), none (N0), spread (N1)
  • Mets-> M0 (none) or M1 (some)
77
Q

What investigations may be performed when prostate cancer is suspected?

A
  • Examination
  • Serum PSA
  • Multiparametric MRI-> for Linkert scale score
  • Prostate biopsy-> when Linkert score 3+
  • Gleason grading-> based on histology + help with treatment decisions
  • TNM staging
  • Isotope bone scan-> for mets
78
Q

What are the treatment options for prostate cancer?

A
  • Surveillance or watchful waiting
  • External beam radiotherapy + prednisolone (reduce inflammation
  • Brachytherapy-> continuous radiotherapy via implanted metal seeds
  • Hormones-> androgen receptor blockers (bicalutamide) or GnRH agonists (eg gosrelin ie Zoladex)
  • Bilateral orchidectomy-> hormone therapy
  • Radical prostatectomy-> may be curative
79
Q

What are some of the complications/side effects of external beam radiotherapy treatment for prostate cancer?

A

Proctitis ie pain, altered bowel habit, bleeding

80
Q

What are some of the complications/side effects of brachytherapy treatment for prostate cancer?

A
  • Inflammation in nearby organs
  • Erectile dysfunction
  • Bladder + rectal cancers
81
Q

What are some of the complications/side effects of hormone therapy treatment for prostate cancer?

A

Hot flushes, sexyal dysfunction, gynaecomastia, osteoporosis

82
Q

What are some of the complications/side effects of radical prostatectomy treatment for prostate cancer?

A

Erectile dysfunction, urinary incontinence

83
Q

What is epididymo-orchitis?

A

Infection of epididymis + testicle-> usually unilateral

84
Q

What can cause epididymo-orchitis?

A

E.coli, Chlamydia trachomatis, N.gonorrhoea, mumps

85
Q

What is the anatomy of the testicle and epididymis?

A
  • Epididymis at back of testicle
  • Sperm from testicle-> head of epididymis (at top)-> head-> body-> tail-> drain to vas deferens
  • Sperm matures + stored in epididymis
86
Q

How does epididymo-orchitis present?

A
  • Gradual onset-> unilateral pain, dragging/heavy, swelling, tender
  • Urethral discharge-> think STI
  • Systemic-> fever, sepsis
  • Torsion is important differential-> treat as this until proven otherwise
87
Q

How is epididymo-orchitis diagnosed?

A
  • Torsion is important differential-> treat as this until proven otherwise
  • Ultrasound-> if suspect torsion or tumour
  • STI more likely-> <35, multiple sexual partners, urethral discharge
  • Urine MC&S
  • 1st pass urine STI test (NAAT)
  • Charcoal swab or discharge
  • Saliva swab-> PCR for mumps
  • Serum antibodies-> IgG/IgM for mumps
88
Q

How is epididymo-orchitis managed?

A
  • If low risk of STI-> ofloxacin 14 days 1st line

- Analgesia, supportive underwear, abstain from sex

89
Q

What are the potential complications of epididymo-orchitis?

A

Chronic pain + infection, testicular atrophy, sub/infertility, scrotal abscess

90
Q

What are quinolone antibiotics (eg ciprofloxacin) used for and why?

A
  • UTIs, pyelonephritis, epididymo-orchitis, prostatitis

- Broad spec + give good gram negative cover

91
Q

What are the side effects of quinolone antibiotics (eg ciprofloxacin)?

A
  • Lowers seizure threshold

- Tendon damage + rupture-> especially Achilles

92
Q

What is testicular torsion?

A

Surgical emergency-> twisting of spermatic cord + rotation of testicle

93
Q

Who typically gets testicular torsion?

A

Teenagers but can be any age

94
Q

How does testicular torsion present?

A
  • Often after activity/sport
  • Acute + rapid unilateral pain
  • Abdominal pain + vomiting
  • Examination-> firm + swollen, elevated/retracted, absent cremasteric reflex, horizontal lie, rotation
95
Q

What is Bell-Clapper deformity?

A
  • Normal fixation between tunica vaginalis and posterior testicle absent
  • Testicle horizontal + able to rotate at cord-> twist vessels and cut off supply
  • Can cause testicular torsion
96
Q

How is testicular torsion managed?

A
  • NBM, analgesia + urgent senior urology review
  • Scrotal US-> whirlpool sign (spiral appearance to cord + BVs)
  • Surgery within 6 hours-> exploration, orchiopexy (correct + fix), orchidectomy (if necrosis/delay)
97
Q

What is the typical sign for testicular torsion on ultrasound?

A

Whirlpool sign-> spiral appearance to cord + BVs

98
Q

What is a hydrocele?

A

Collection of fluid in tunica vaginalis (sealed membrane pouch surrounding the testes)

99
Q

What is the tunica vaginalis?

A
  • Sealed membrane pouch surrounding the testes

- Originally from peritoneal membrane-> separates + covers testes in foetal development

100
Q

How does hydrocele present?

A
  • Painless, fluctuant + soft scrotal swelling
  • Can feel testicle within
  • Irreducible + no bowel sounds
  • Transilluminates
101
Q

What are the causes of hydrocele?

A

Idiopathic, testicular cancer, epididymo-orchitis, trauma

102
Q

How is hydrocele managed?

A
  • Rule out serious causes (eg TC)
  • Conservative
  • Surgery
  • Aspiration
  • Scleopathy
103
Q

What is a varicocele?

A

Veins of the pampiniform plexus (in spermatic cord) swell due to increased resistance in testicular vein

104
Q

What is the role of the pampiniform plexus?

A
  • Venous drainage of testes into testicular vein

- Regulates temperature of blood entering the testes by absorbing head from the testicular artery

105
Q

What is the pathophysiology of a varicocele?

A
  • Increased resistance in testicular vein-> blood flow back into pampiniform plexus
  • Can be due to incompetent valve
  • Left sided may be renal cell carcinoma-> left testicular vein drains into left renal artery (obstruction-> backlog)
106
Q

What might a left-sided varicocele indicate and why?

A
  • Renal cell carcinoma

- Left testicular vein drains into left renal artery (obstruction-> backlog)

107
Q

How does varicocele present?

A
  • Throbbing/dull pain, dragging, worse on standing
  • Sub/infertility
  • Exam-> asymmetrical, ‘bag of worms’ scrotal mass, more prominent on standing, disappear when lie down
108
Q

If a varicocele doesn’t disappear when the patient lies down, what might that indicate?

A

Retroperitoneal tumour-> obstruction to renal vein drainage

109
Q

How is varicocele investigated?

A
  • Examination
  • US doppler
  • Semen analysis + hormone tests if concerns
110
Q

How is varicocele managed?

A
  • Conservative if uncomplicated

- If complications-> surgery, endovascular embolisation

111
Q

What are the potential complications of varicocele?

A

Impaired fertility, atrophy (affect size + function)

112
Q

What is an epididymal cyst?

A
  • Fluid-filled sac at head of epididymis
  • If contains sperm-> spermatocele
  • Very common
113
Q

How do epididymal cysts present?

A
  • Asymptomatic or incidental finding on US
  • May have felt lump
  • Exam-> soft round lump, top of testicle, separate from testicle, may transilluminate if large
114
Q

How are epididymal cysts managed?

A
  • Usually leave alone
  • Surgical removal if painful
  • Can sometimes cause torsion
115
Q

What age group is testicular cancer most common in?

A

15-35 years

116
Q

What are the two types of testicular cancer?

A
  • Seminomas

- Non-seminomas (eg teratomas)

117
Q

What cell type do the majority of testicular cancers arise from?

A

Germ cells in testes (produce gametes)

118
Q

How does testicular cancer present?

A
  • Lump-> painless, from testicle, hard, irregular, non-fluctuant, no transillumination
  • Common mets-> lymphatics, lungs, liver, brain
  • Gynaecomastia-> with Leydig cell tumours
119
Q

How is testicular cancer investigated?

A
  • Examination
  • Scrotal US
  • Staging CT
  • Tumour markers-> b-hCG, AFP (teratomas only), LDH (non-specific)
120
Q

What is the Royal Marsden staging system and what are its different stages?

A

Staging system for testicular cancer

  • 1-> isolated to testicle
  • 2-> spread to retroperitoneal lymph nodes
  • 3-> spread to lymph nodes above diaphragm
  • 4-> mets to other organs
121
Q

How is testicular cancer treated?

A
  • Chemotherapy
  • Radiotherapy
  • Radical orchidectomy +/- prosthesis
  • Sperm banking
  • Follow up-> tumour markers, CTs, CXRs
122
Q

What are the side effects of treatment for testicular cancer?

A

Infertility, hypogonadism (may need testosterone replacement), peripheral neuropathy, hearing loss, kidney/liver/heart damage, increased risk of other cancers

123
Q

What is the prognosis of testicular cancer?

A
  • 90% cure when treated early
  • Can cure mets
  • Seminomas have better prognosis
124
Q

What is interstitial cystitis?

A

AKA bladder pain syndrome of hypersensitive bladder syndrome-> chronic inflammation due to dysfunction of nerves, BVs, immune system and epithelium

125
Q

Who is interstitial cystitis more common in?

A

Women

126
Q

How does interstitial cystitis present?

A
  • Persistent lower UTI for 6+ weeks
  • Suprapubic pain-> worse with full bladder + better when empty
  • Frequency + urgency
  • Symptoms worse during menstruation
127
Q

How is interstitial cystitis investigated?

A
  • Urinalysis
  • STI swabs
  • Cystoscopy-> Hunner lesions (red and inflamed lesions) + granulations (haemorrhages)
  • Prostate exam if indicated
128
Q

What might be seen on cystoscopy when a patient has interstitial cystitis?

A
  • Hunner lesions (red and inflamed lesions)

- Granulations (haemorrhages)

129
Q

How is interstitial cystitis managed?

A
  • Pelvic floor exercises
  • Bladder retraining
  • Transcutaneous electrical nerve stimulation-> TENS
  • Analgesia
  • Anticholinergics-> oxybutynin or solifenacin
  • Mirabegron-> beta-3 adrenergic receptor antagonist
  • Ciclosporin-> immunosuppression
  • Intravesical meds-> lidocaine, hyaluronic acid, botox
  • Hydrodistention-> fill bladder with water during cystoscopy (under GA)
  • Cauterise Hunner lesions

Surgery (8 decks)

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