urology Flashcards
urge incontinence
caused by overactivity of the detrusor muscle of the bladder
suddenly feeling the urge, rushing to bathroom + not making it
management of urge incontinence
bladder retraining - increasing time between voiding
anticholinergic med = oxybutynin (dry mouth/eye)
beta-3 agonist = mirabegron
invasive - sacral nerve stimulation, cytoplast (enlarge bowel), urinary diversion (stoma)
stress incontinence
urine leaks at times of increased bladder pressure due to weakness of pelvic floor + sphincter muscle - laughing, coughing or surprised
management of stress incontinence
pelvic exercises, avoid diuretics, caffiene
duloxetine
vaginal tape/sling, colsuspension, intral urethral bulking
pharmacological management of stress incontinence
duloxetine
–> SNRI antidepressant, second line where surgery is preferred
surgical management of stress incontinence
vaginal tape - sling arounf urethra
colsuspension - stitching anterior wall to pubic symphysis
intramural urethral bulking - injection to reduce diameter
artifical urinary sphincter - pump to deflate cuff around urethra
commonest cause of pyelonephritis
E. coli
klebsiella
both gram neg anaerobic rods
management of pyelonephritis
co-trimaxazole 7-10days
management of benign prostatic hyperplasia
immediate = alpha-blockers - tamsulosin (postural hypotension)
gradual = 5-alpha reductase inhbitors - finasteride
treatment of small ureteric stones
alpha blocker = tamsulosin
testicular torsion vs torsion of appendix testes
testicular torsion = absent cremasteric reflex
appendix = cremasteric reflex present, super young, blue dot, resolve without surgery
bell clapper deformity
testicular torsion
–> fixation between testicle + tunica vaginalis is absent, hangs horizontally
management testicular torsion
surgical exploration, >6hr pretty irretrievable
acute epididymitis cause
bacterial infection - gonorrhoea or chlamydia
amiodarone
history of UTI, catheter
commonest bacterial cuse of epididymo-orchitis
gonorrhea or chlamydia
epididymo-orchitis presentation
tenderness confined to epididymis
cremasteric reflex present
dysuria
management of epididymo-orchitis
analgesia, bed rst
ofloxacin
epididymo-orchitis investigation
us - swollen epidudymis, increased blood flow
urine culture
chlamydia PCR
hydrocele
fluid around testes - between tunica vaginalis + mesothelial lining
transilluminates, can “get above it”
variocele
bag of worms
Ix = US with doppler
can’t get above testicular lump
hernia
paraphimosis
Painful swelling of foreskin distal to phimotic ring
Often after foreskin retracted for catheter or cystoscopy + staff forget to put it back
–> Impairs venous return resulting in oedema
Management = reduce oedema, apply pressure while – if fails dorsal slit to cut foreskin
balanitis xerotic obliterans/lichen sclerosis
progressive inflammatory dermatosis glans penis + foreskin
common
young, present with phimosis/paraphimosis
histology = band of collagen + band of lymphocytes
what causes genital warts?
HPV 6 + 11
high risk HPV strains
16 + 18
priapism and treatment
prolonged unwanted erection (>4hrs)
aspiration of blood within corpus cavernosa + irrigation with salin
–> adrenaline may also be used, US to check for damage
fourniers gangrene
type of necrotising faciitis affecting perineum (male genitalia)
starts as cellulitis
mortality high in diabetics + alcoholics
Ix = xray/US - gas in tissue Mx = antibiotics + surgical debridement
commonest causative organism of emphysematous pyelonephritis
E. coli
emphysematous pyelonephritis
acute necrotising + perirenal infection caused by GAS-forming uropathogens
–> E.coli
common in diabetics, assoc with ureteric obstruction
emphysematous pyelonephritis presentation, investigation + management
px = fever, vomiting, flank pain ix = CT - gas in kidney
Mx = ITU, not settling then nephrectomy
perinephric abscess
flank mass, high WBC, high serum creatinine, pyuria
ix = CT
Mx = antibiotics + percutaneous surgical drainage
what is posterior urethral injury assoc with? investigation + management
fracture of pubic rami
ix = retrograde urethrogram mx = suprapubic catheter, delayed construction after at least 3 months
bladder injury presentation
assoc pelvic fracture
pain, tender, bruising
inability to void
guarding/rigidity
diminished bowels sounds
bladder injury investigation
CT cystography
extraperitoneal injury = flame-shaped collection of contrast in pelvis
bladder injury management
large bre catheter, antibiotic
repeat cystogram in 14days
penile fracture
typically happens during intercourse
cracking/popping sound followed pain, rapid detumenscence, discolouration + swelling
mx = prompt exploration + repair
benign prostatic hyperplasia, which lobe is most likely affected?
median lobe of prostate
hyposapadias
Hypospadias is a birth defect in boys in which the opening of the urethra is not located at the tip of the penis.
hy
