Urology Flashcards
What antibiotics do you use for prostatitis?
First line - flourquinolones (ciprofloxacin)
Second line - trimethoprim-sulfamethoxazole
What are some common bacterial causes of prostatitis?
Gram negative - e.coli, enterobacter, pseudomonas, proteus, STIs
How might prostatitis present?
Acutely - very unwell patient with fever, malaise, arthralgia
Lower back pain
Urinary symptoms - frequency, urgency, dysuria, nocturia, hesitancy
What findings may occur on examination in prostatitis?
Prostate may feel boggy, normal or nodular. It may be tender on palpation or hot to touch.
Diagnosis is made on urine culture and microscopy - bacterial growth and WBC, lipid-laden macrophages and oval fat bodies under microscope.
What are some differentials for lower back pain, fever and urinary symptoms?
- prostatitis
- BPH
- urinary tract stones
- foreign body in urinary tract
- bladder cancer
- prostatic abscess
What investigation is used for hydronephrosis?
Ultrasound
What are some potential causes of hydronephrosis?
- pelvic ureteric obstruction
- abhorrent vessels
- calculi
- tumours
What can cause painful testicular problems?
- testicular torsion
- orchitis
What is variocele?
Fluid collection in the testicles
How do you determine a hernia?
Ask the patient to cough
A patient presents with a smooth lump in the testes. What is a possible cause?
Epididymal cyst
Recurrent UTIs could be a sign of….?
Bladder cancer
Where does a bladder cancer metastasise to?
Liver
Lung
Adrenals
What investigation do you do for prostate cancer?
Transrectal ultrasound guided biopsy
What are some potential complications of TRUS?
Retention
Incontinence
What is your medical management in prostate cancer?
1 - antiandrogens (tamoxifen)
2 - LHRH agonists
What is soldenafil?
Phosphodiasterase inhibitor
What are the 3 symptoms for filling, voiding and post-micturation?
Filling - urgency, nocturia, frequency
Voiding - hesitancy/intermittancy, straining, weak stream
Post-micturation - dribbling, incomplete emptying
What are the 4 types of renal stones?
Calcium oxalate
Cystine
Uric Acid
Calcium phosphate
Struvite
Which renal stones are seen on x-ray?
Uric acid - radiolucent
Struvite - slightly radio-opaque
Calcium phosphate - radio-opaque
Calcium oxalate - radio-opaque
Cysteine - radiodense
Give key features of each of these types of renal stone.
Calcium oxalate
Cystine
Uric Acid
Calcium phosphate
Struvite
Calcium oxalate - hypercalcuria is a risk
Cystine - inherited recessive disorder, multiple may form
Uric Acid - low urinary pH, can be caused by tissue breakdown
Calcium phosphate - high urinary pH, renal tubular acidosis association
Struvite - Mg, ammonium, phosphate, chronic infections
Post-renal AKI is managed how?
Continuous bladder irrigation
There is an obstruction to the bladder outlet causing the AKI, so the first line management is to relieve the obstruction