Urology Flashcards
What is the management of acute prostatitis?
14 days ciprofloxacin
What is the most common type of prostate cancer?
Adenocarcinoma
What is the 2WW criteria for prostate cancer?
Man 50-69 with raised PSA or DRE suggestive of prostate cancer
Which imaging is used to diagnose prostate cancer?
Multi-parametric MRI
What hormone therapy can be used for prostate cancer? What is a complication of this?
GnRH agonist e.g. Goserelin
Suppresses testosterone
Can have an initial rise in testosterone (tumour flare) - this is avoided by also giving Cyproterone acetate
Where does prostate cancer most commonly metastasise?
Bone
What are indications for conducting a PSA?
Abnormal DRE
Symptoms of malignancy + LUTS
Can be done on request if >50
Can be done on request if >45 if black/family history
Which medications can cause erectile dysfunction?
Finasteride
SSRIs
Alcohol
Beta blockers
How is bladder cancer investigated?
1) urine dip
2) CT Urogram + flexible cystoscopy
3) Biopsy
Why does varicocele occur in renal cell carcinoma?
Compression of the left renal vein
What paraneoplastic features are associated with renal cell carcinoma?
Polycythaemia - increased EPO production
Hypercalcaemia - secretion of PTH mimick
Hypertension - increased renin secretion
Stauffer’s syndrome - Abnormal LFTs without liver mets
What are the types of testicular cancer? What marker are associated with them?
Main 2 are seminoma germ cell and non-seminoma germ cell
Non-seminoma highly associated with hCG and AFP
Seminoma slightly associated with bHCG
What is the management of renal calculi?
<5mm = Watch and wait
<1cm = can try medical management
1cm-<2cm = Shockwave lithiotripsy (Or uteroscopy if pregnant)
>2cm or staghorn = Percutaneous nephrolithiotomy
Causing obstruction = Nephrostomy
What is shockwave lithiotripsy?
Shockwave from outside the body fragments the stone
What is nephrolithotomy?
Invasive method of breaking down stone
What is a nephrostomy?
Decompression of the kidney if obstructed
What score is used to grade prostate cancer?
Gleason score
Prostate cancer management
x
How to manage a hydrocele?
In children - usually resolve within a few months. refer if not resolve by 1-2 years
In adults - testicular ultrasound
What can hydroceles develop secondary to?
Epididymo-orchitis
Testicular torsion
Testicular tumour
Which renal cancer is most common in occupational exposure?
Renal transitional cell carcinoma
Which malignancy are you at risk of after schistosomiasis infection?
Squamous cell carcinoma of the bladder
What are risk factors of Renal cell carcinoma?
Increasing age Smoking Obesity Von hipel-lindau syndrome Male Tuberous sclerosis
What are risk factors for prostate cancer?
Increasing age
Family history
Obesity
Afro-caribbean
What are risk factors for testicular cancer?
Infertility
Family history
Klinefelter’s syndrome
Orchitis due to mumps
Where do renal stones most commonly get lodged?
Vesico-ureteric junction
Renal pelvis
Pevi-ureteric junction
What is priapism and what are causes? How is it investigated? How is it managed?
Persistent penile erection
Causes:idiopathic, sickle cell crisis, erectile dysfunction medication
Investigation: Cavernosal blood gas analysis
Management:
If ischaemic - aspiration
If non ischaemic - observe
Which type of testicular cancer is most associated with gynaecomastia?
Leydig cell tumour
What is the management of erectile dysfunction?
management: Phosphodiesterase type V inhibitors (Sildenafil)
What are side effects of sildenafil?
Blue discolouration of vision Nasal congestion Flushing Priapism Headache
What are CI to sildenafil?
Patients taking nitrates
Hypotension
Recent stroke/MI in last 6 months
What are risk factors for pyelonephritis?
Female
Structural abnormalities
Versico-ureteric reflux
Diabetes
How is a stag horn calculus of any size managed?
Percutaneous nephrolithiotomy
What is a Bell Clapper deformity?
The testes is not fixed to the tunica vaginalis - it hangs freely and therefore is able to rotate
Predisposes to testicular torsion
What infection is most associated with Staghorn calculi?
Proteus infections
What is vesico-ureteric reflux?
Abnormal backflow of urine from bladder to ureter and kidney
Common in children, predisposes to UTI
How is vesico-ureteric reflux diagnosed?
Micturating cystourethrogram (MCUG)
DMSA can look for scarring
