Urology Flashcards
What symptoms should you specifically ask about when taking a renal history?
Dyspnoea (ET, triggers, diurnal variation, orthopnea, PND, relieving factors)
Leg swelling (site, severity, time of onset, amount of fluid intake)
Nausea /& Vommiting
Upper airway symptoms
Constitutional symptoms (fever, joint pains, muscle aches, weight changes, lethargy, night sweats, puritis)
LUTs (dysuria, frequency, qunaitity of urine, colour of urine, frothieness, heamaturia)
Flank Pain (durayion, radiation, associated symptoms, intensity, aggravating/relieveing factors)
ENT symptoms (nasal secretions, sinusitis, epistaxis, haemoptysis, sore throat, visual disturbances, hearing loss)
What should you be sure to clarify in dialysis patients?
Mode of RRT (APD/CAPD/Asissted PD/UHD/HHM)
What access?
When was the last dialysis?
Relevant PMH and SHx in renal patients?
Previous AKI Requiring dialysis CKD stage Cause of CKD/ESRF CVD risk factors: DM, HTN, Hypercholestorolaemia UTIs CHildhood infections Surgery Cancer
What OTC drug is often associated with renal insult?
NSAIDs - ibuprofen
What family history should be specifically asked for in renal patients?
Renal disease Cardiac disease DM HTN Genetic conditions
Is chronic retention painful?
Not usually
What kind of retention is nocturnal enuresis suggestive of?
Chronic
What volume of urine to patients with chronic retention generally have in their bladders?
> 1L in bladders
What should you be suspicious of in painful haematuria in a patient over 65? What is the most common diagnosis?
Bladder cancer until proven otherwise
Transitional cell carcinoma is the most common type of bladder cancer
What may be seen on X-ray of a patient with metastatic prostate cancer?
Sclerotic lesions (bone mets)
How is testicular torsion managed?
Surgical exploration with orchiopexy fixation
What is the most commonly found renal stone composition?
Calcium oxolate
What type of kidney stone will not be seen on X-ray (raidoopaque)?
Uric acidic
What kind of renal stones cause acidic urine?
Uric acid
Struvite stones
What size renal stone can be managed conservatively?
<5mm
When would a JJ stent be used in renal stones?
Sepsis, renal failure
What might be used to prevent uric acid stones?
Allopurinol
Management options for renal stones?
Active surveillance
Lithotripsy
Uretoscopy
Percutatinoeus lithotomoy
Most common renal stone compositions?
Calcium oxolate
Uric acid
Struvite
Gold standard investigation for renal stones?
CT-KUB without contrast
What examination of the affected testi show in testicular torsion?
Transverse lie and no movement of the testis when the ipsilateral inner thigh is stroked
Whats Phren’s sign?
When will it be positive?
Elevation of the testicle reveals pain
Positive in epididymitis, negative in testicular torsion
Risk factor for Fournier’s gangrene?
DM
ETOH
Steroid therapy
Obesity
What is paraphimosis?
When the foreskin gets retracted behind the glans and can’t be put back
Occludes blood supply leading to ischemia
Put the foreskin back after catheterisation
What may be felt on DRE of a patient with prostate cancer?
Hard and craggy
What is used to score prostate cancer?
Gleason score
What makes up the gleason score?
most prodominent cell type + second most prodominent cell type
e.g. highest is 4+3
What is active survelance for prostate cancer?
Continue investigations to monitor disease with the aim of curative treatment
What are the most common complications of radical-prostectomy?
Erectile dysfunction
Cancer recurrence
Urinary incontinence
What should patients be advised about raised PSA levels?
Could be raised in BPH, prostatitis, UTI, recent medical procedure
Used as a marker for early prostate cancer detection and treatment
75% false positive as marker for prostate cancer (negative biopsy)
Gold standard investigation for prostate cancer?
Transrectal ultrasound prostate biopsy
USS guided biopsy takes 10-12 cores
Risk factors for prostate cancer?
Age BRACA1/BRACA2 genes Lynch syndromes/hereditery non-polyposis colorectal cancer Black african or carribean Obesity
How can GnRH receptor agonists such as leuprolide, bruserelin and goserelintreat prostate cancer?
GnRH receptor agonists decrease circulating androgens by negative feedback
Falters the cancer growth as prostate cancer is stimulated by androgens
Risk factors for bladder cancer?
Smoking Exposure to dyes/textiles/paints (aromatic amines) Chronic cystitis Intermittent self catheterisation Longterm catheterisation Schostosomiasis Radiotherapy to the pelvis
Triad of investigations for haematuria?
Urine cytology - abnormal cells in urine
USS KUB - anatomical changes
Flexible cytoscopy - visualise abnormal growths in bladder
What is the most common type of bladder cancer?
Transitonal cell carcinoma
What type of bladder cancer is associated with schistosomiasis?
Squamous cell carcinoma (rare)
What is the only curative option for T2 bladder cancer?
Radical cystectomy (+ illeal conduit)
When is TURBT a suitable curative treatment for bladder cancer?
T1 bladder cancers
Most common causative organism in UTI?
E coli
First line treament for pyelonephritis?
co-amoxiclav
How many UTIs a year warrent an US-KUB in a girl under 16?
3 or more
Voiding LUTS?
Haematuria+/- dysuria Hesitancy Poor flow Terminal dribbling Incomplete voiding
Storage LUTS?
Frequency Urgency Urge incontinence Noctura Bedwetting (due to high pressure chronic retention)
How is urinary retention diagnosed?
Post-void bladder scan
What complication should be monitored for post drainage of a patient with urinary retention?
AKI
Kidney had adapted to fluid overload
Massive diuresis
Kidney cannot compensate
Classifcations of haematuria?
Visable
Symptomatic non visable
Asymptomatic non visable
Pseudohaematuria (brown urine not secondary to the presence oof haemoglobin)
Causes of pseudohaematuria?
Rifampicin Methydopa Hyperbilirubinuria Myoglobinuria Foods such a beetroot or rhubarb
Most common cause of haematuria?
UTI Prostatitis Pyelnoephritis Urothelial carcinoma Stone disease Trauma or recent surgery Radiation cystitis Parasitic (schistosomiasis) Adneocarcinoma of the prostate BPH
What symptoms may be associated with haemturia?
Suprapubic pain Renal colic LUTs Fevers Rigors Weight loss
What does total haematuria suggest?
Bladder or upper tract source
What does terminal haematuria suggest?
Potential severe bladder irritation
Initial investigations when a patient presents with haematuria?
Urinalysis (true haematuria? nitrites + leukocytes = infection) Baseline bloods (FBC U&E clotting) PSA after appropriate counselling where prostatic pathology considered Urinary protein levels (albumin:creatinine or protein creatinine) if derranged renal function or suspected nephrological cause
What level of blood on dipstick constitutes haematuria?
1+ blood
NOT TRACE
What is the criteria for urgent referal in haematuria in a patient 45 or older?
Unexplained visible haematuria without UTI
Visible haematuria that persists or recurrs after sucsessful treatment or UTI
When should patients with asymptomatic haematuria be reffered for further investigations?
non-visable haematuria present on two out of three tests
When should a patient with haematuria who is over 60 be referred urgently to an adult urological service?
Unexplained non-visable haematuria and either dysuria or a raised WCC on blood test
What is the gold standar investigation for lUT?
Flexible cystoscopy
Performed under local anesthetic
What, more commonly used in follow up of patients with proven mallignancy, may be sent in an initial assement of haematuria?
Urine cytology
Upper urinary tract imaging that may be used in haematuria?
US KUB - non visable
CT urogram - visable
Which is more likely to be malignancy: non visable or visable haematuria?
Visable (20% of presenting patients vs 5%)
Most common urinary tract stones in order?
Calcium oxolate
Mixed calcium oxolate and phosphate
Calcium phosphate
Struvite, urate, cystine
Which stones are often large and soft, the most common cause of ‘‘staghorn calcuili’ whereby the stone will fil the renal pelvis?
Struvite stones (magnesium ammonium phosphate)
What is the only renal tract stone composition that is radiolucent?
Urate
Basis for formulation of urinary tract stones?
Over-saturation of urine
i.e. urate stones - high levels of purine in the blood, resulting in increas of urate formation and subsequent crystalisation in the urine