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ALS > Urology > Flashcards

Urology Flashcards

1
Q

UTI

A

^E.coli, F>M

Upper
= fever, loin pain, renal angle tenderness, haematuria, systemically unwell
-> admit? 7-10d broad Abx (cephalosporin/ quinolone)

Lower
= dysuria, frequency, urgency, incontinence, confusion, suprapubic pain
-> 3d trimethoprim or nitrofurantoin (7d if M/ catheter - only treat if symptoms)

Inv - urine dip (nitrates, leukocytes), culture if >65/ M/ preg/ catheter

Pregnancy; nitro (not in T3, use amox)

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2
Q

Bacterial Prostatitis

A

Cause - E.coli

RF - UTI, urogenital instrumentation, catheterisation

= fever, pain (perineum, back or penis), tender boggy prostate, obstructive voiding, myalgia, sepsis

-> 14d quinolone, STI testing

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3
Q

Balanitis

A

Inflammation of the glans penis

Candidiasis = after sex, itching, white discharge
-> topical clotrimazole

Dermatitis = Hx elsewhere, very itchy, painful, clear non-urethral discharge (contact/ allergic) or none (eczema/ psoriasis)
-> steroids

Bacterial = pain, itchy, yellow discharge (^staph)
-> PO fluxloxacillin

Anaerobic = itchy, offensive yellow non-urethral discharge
-> saline washing

Lichen Planus= itchy, Wickham’s striae, violaceous papules

Lichen sclerosis (balanitis xerotica obliterans) = itchy, white plaques, scarring, can cause phimosis
-> high-dose steroids e.g., clobetasol

Circinate Balanitis = painless erosions, link to reactive arthritis
-> steroids

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4
Q

Circumcision

A

Use - phimosis, recurrent balanitis, balanitis xerotica obliterans, paraphimosis, ^Jewish/ muslim

*reduces penile cancer, UTI, STI

NOT if hypospadias

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5
Q

Epididymal Cyst

A

Most common cause of scrotal swellings in primary care

RF - PCKD, CF, vHL

= separate from body of teste, posterior to testicle

Inv - US

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6
Q

Epididymo-orchitis

A

Infection of the epididymis +/- testis

Cause - chlamydia, N gonorrheae, E.coli

= unilateral teste pain and swelling, urethral discharge (^STI), dragging sensation

Inv - STI screen, urine MSU

-> refer to sexual health, IM ceftriaxone + 10-14d doxy, 14d quinolone if E.coli

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7
Q

Erectile Dysfunction

A

Persistent inability to attain and maintain an erection that permits satisfactory sexual performance

RF - CVD, alcohol, beta blockers, SSRIs

Organic = gradual onset, normal libido, no erection

Psychological = sudden onset, low libido, can get one on own, premature ejaculation

Inv - free testosterone 9-11am, if abnormal do FSH/ LH/ prolactin

-> PDE-5 inhibitor

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8
Q

Hydrocele

A

Collection of fluid in the tunica vaginalis, communicating (patent processus vaginalis) or non-communicating (excessive fluid production)

Cause - can be second to infection of testes/ epididymis, torsion or tumour

= soft, non-tender swelling, anterior and below the teste, can get above it, transilluminates

-> reassure newborn and repair if not gone by age 1-2, fix adults + US to excl tumour

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9
Q

Varicocele

A

Abnormal enlargement of the testicular veins

= bag of worms, ^left (?RCC, esp if doesn’t disappear lying), infertility due to ^temp

Inv - US with doppler, 2ww RCC

-> surgery if pain, testicular atrophy or fertility issues

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10
Q

Testicular Cancer

A

Most common cancer in men in 20s, met to lymph, lung, liver and brain

Germ cell (95%): seminomas, non-seminomas (yolk, teratoma, choriocarcinoma)
Non-germ cell: leydig, sarcoma

RF - infertility, cryptorchidism, FHx, Klinefelter’s, mumps orchitis

= painless lump, +/- pain, hydrocele, gynaecomastia (^oes:androgen)

Inv - hCG (80% non, 20% sem), AFP (80% non), LDH (40% both), US

-> orchidectomy, chemo/ radio

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11
Q

Renal Stones

A

= abdo pain + blood + leucocytes

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12
Q

Renal Stones - Types

A

Calcium Oxalate (radio-opaque)
- RF: ^Ca, ^oxalate, v citrate

Calcium phosphate (radio-opaque)
- RF: RTA T1/3, ^urine pH

Uric acid (radiolucent)
- RF: v urine pH, malignancy, inborn errors of metabolism

Cysteine (radiodense)
- RF: inherited disorder of cysteine transport (AR)

Struvite (radio-opaque)
- Mg, ammonium, phosphate
- RF: urease-producing bacteria in chronic infections

XR - C’s you can see (cysteine - semi) and others can’t.

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13
Q

Renal Stones - RF

A

Dehydration
PCKD
Gout
Ileostomy - loss of bicarb so ^acidity of urine
Loop diuretic, steroids, acetazolamide and theophylline (^calcium in urine)

*Thiazides protective

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14
Q

Renal Stones - Management

A

Inv - non-contrast CT KUB <24hrs of admission, US if pregnant/ children

-> NSAID (diclofenac) or paracetamol

Renal
< 5mm and asymptomatic = wait
5-10mm = shockwave lithotripsy
10-20mm = lithotripsy or ureteroscopy
>20mm/ staghorn/ complex = PC nephrolithotomy

Ureteric
<10mm = lithotripsy +/- a-blockers
10-20mm = ureteroscopy

If obstruction + infection need decompression (nephrostomy tube or catheters)

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15
Q

Chronic Retention

A

= painless and insidious

High pressure - impaired renal function + bilateral hydronephrosis

Low pressure - normal renal function + no hydro

Comp - decompression hematuria (no treatment)

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16
Q

Acute Retention

A

Cause - BPH, strictures, calculi, constipation, anticholinergics, TCA, antihistamines, opioids

= pain, confusion, palpable distended bladder, tenderness

Inv - abdo, PR and neuro exam, US (>300ccc confirms)

-> catheter

Comp - post-obstructive diuresis, AKI

17
Q

Hydronephrosis

A

Unilateral - PACT
Pelvic ureteric obstruction
Aberrant renal vessels
Calculi
Tumours

Bilateral - SUPER
Stenosis of urethra
Urethral valve
Prostatic enlargement
Extensive bladder tumour
Retro-peritoneal fibrosis

Acute obstruction -> nephrostomy
Chronic -> stent or pyeloplasty

18
Q

Vasectomy

A

Under LA

Inv - semen analysis to ensure azoospermia at 16 and 20wks

Comp - reversal works in 55% of cases <10yrs, drops to 25% after this

19
Q

Transitional Cell Carcinoma

A

Cancer of the urothelium - ureters or bladder

20
Q

BPH

A

^transitional zone, hyperplasia

RF - age, black ethnicity

= voiding and storage issues, UTI, retention, obstructive uropathy

Inv - urine dip, PSA, IPSS score (20-35 severe, 8-19 mod)

-> alpha 1 blocker (tamsulosin) in moderate, + 5 alpha reductase (finasteride) if sig enlargement or risk of progression (6m to work), may add tolterodine/ darifenacin if void + storage, TURP if fails

21
Q

Torsion

A

Spermatic cord twists around its own blood supply.

RF - 10-30yrs

= severe pain, n+v, lose cremasteric reflex, phren’s signs (elevation does not help pain)

-> bilateral orchidopexy

Bell-clapper deformity: teste not fixed to the tuniva vaginalis, bilateral

22
Q

False Positive PSA

A

Ejaculation / vigorous exercise last 48 hours
BPH
Instrumentation
Prostatitis / UTI last month
Retention

23
Q

LUTS

A

Hesitancy - difficulty starting or maintaining flow
Weak flow
uregency
Frequency
Straining
Terminal Dribbling
Nocturia

24
Q

Chronic Prostatitis

A

> 3 months, chronic pelvic pain syndrome (no infection) or bacterial

= pelvic pain, LUTS, sexual issues, tender prostate, painful poo

-> alpha blockers, analgesia, psychosocial treatment i.e., CBT

25
Q

Prostate Cancer

A

Most common cancer in men, 95% adenocarcinoma, ^peripheral zone, slow growing, met to bones or lymph nodes

RF - age, FH, black, tall, anabolic steroids

= BOO, hematuria/ hematospermia, back/ perineal pain, hard nodular prostate, loss of median sulcus

Inv - multiparametric MRI + biopsy, prev via TRUS, Likert scale, PSA

-> radical prostatectomy, radio, met use Goserelin (GnRH agonist) + bicalutamide (ant.) or cyproterone acetate (anti-androgen) to prevent tumour flare

26
Q

Gleason score

A

Prognosis in prostate cancer, based on Histology

Two numbers (out of 5) added together;
First is the grade of the most prevalent pattern
Second is grade of second most prevalent pattern

8+ is high risk

27
Q

Interstitial Cystitis

A

Chronic inflammation of the bladder, combination of dysfunction of blood vessels, nerves, immune system and epithelium, ^F

= suprapubic pain, frequency, urgency, >6wks

Inv - cystoscopy (Hunner red inflamed lesions with small blood vessels)

-> analgesia, antihistamines, bladder instillations

28
Q

Bladder Cancer

A

90% TCC, 5% SCC, 2% adeno

RF - smoking, M 50-80yrs, amine dye (printing/ textiles), rubber, schistosomiasis

= painless haematuria

2WW:
45+ unexplained macroscopic blood
66+ with microscopic blood + dysuria or ^WCC

Inv - cystoscopy, pelvic MRI, CT

-> TURBT / Intravescial chemo / cystectomy (need urostomy via ileal conduit after)

29
Q

Renal Stones: Prevention

A

^Fluid, fresh lemon juice (citric acid reduces stone formation)

v Salt, spinach/ rhubarb (oxalates), liver/ sardines (purines, uric)

Thiazides, potassium citrate

30
Q

Renal Cell Carcinoma

A

Adenocarcinoma arising from renal tubules, ^clear cell

RF - M, smoking, obesity, HTN, TS, VHL, rubber/ textiles (TCC)

= haematuria, loin pain, mass, fever, polycythaemia (secrete EPO), ^Ca (PTHrp), paraneoplastic hepatic dysfunction, left varicocele, Stauffer (cholestasis, organomegaly), HTN (renin)

Spread - via renal vein and IVC to lungs (cannon ball mets)

-> partial or radical nephrectomy, interferon a/ TK inhibitors

31
Q

Priapism

A

Persistent painful erection

Cause - idiopathic or 2nd to ED drugs, trauma or sickle cell

Ischemic: impaired vasorelaxation, ^CO2, vO2, v PH
-> if >4 hours then aspirate blood, vasoconstriction agent (phenylephrine) if fails, surgery

Non-ischemic: high arterial inflow, normally 2nd to fistula formation
-> observe first line

Inv - cavernosal blood gas analysis, US

32
Q

Lower Genitourinary Tract Trauma

A

Bladder Injury
= blunt trauma, 85% pelvic fracture, can’t wee

Urethral Injury
= ^bulbar (retain, perineal hematoma, bloody meatus) or membranous (2nd to fracture, prostate displaced up so exam is hard)
-> suprapubic catheter

ALS (22 decks)

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