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
Give 5 risk factors in renal cancers
Smoking
Obesity
Heavy metals
PCKD
Hypertension
What classification is used to describe renal malignancies?
Bosniak classification
How might kidney cancer present?
Flank pain
Haematuria
Palpable mass
May be found on incidental imaging
What cells are usually involved in bladder cancers?
Transitional cells (carcinomas account for 90% bladder tumours)
Squamous cell (metaplasia, carcinoma), can occur, schistomiasis is a risk)
What does a ‘string of beads’ indicate on MR angiography?
Fibromuscular dysplasia
Proliferation of cells in the walls of the artery
Causes vessels to bulge or narrow, can cause an acute AKI after the start of an ACE-i
Give some potential causes of a bladder obstruction
Polycystic kidneys, ectopic kidneys, ureterocele, stricture
Tumours, radiation therapy, prostatitis
Trauma, AAA, pregnancy, BPH, lymphocoele
What are common locations for renal stones?
Ureteropelvic junction
Vesicoureteric junction
Pelvic brim
How might renal stones present symptom-wise?
Pain - colicky
Nausea or vomiting
Haematuria
Risk of sepsis with fever, tachycardia, low BP
Give some differentials of colicky loin pain
AAA
Pancreatitis
Renal stones
Gallstones
MSK
Pyelonephritis
How are renal calculi treated?
Supportively - most pass naturally
Analgesia - NSAIDs (Diclofenac)
Lithotripsy (ESWL)
Nephrectomy
IV Fluids
Smooth muscle relaxants (tamsulosin) CCB (nifedipine)
What are the three types of urinary incontinence?
Urgency incontinence - an urgent desire to voice
Stress incontinence - coughing or straining association, common in pelvic floor problems
Mixed incontinence - stress and urgency combination
Overflow - full bladder
Continuous - fistula
What can you give in an overactive bladder?
Lifestyle change - caffeine reduction, bladder drill, reduced alcohol
Anti-cholinergic - Solifenacin
Botox - antiacetylcholine receptor blocker
What is autonomic dysreflexia?
Occurs in nerve lesions below T6
A painful stimuli to the sympathetic nervous system causes bradycardia, high blood pressure but has no feedback to stop it
Causes headaches, flushing, strokes and requires reversal with GTN spray
Give some causes of haematuria
Malignancy
Stones
Infection
Trauma
Renal artery disease
What are risk factors for UTI?
Elderly
Post-menopausal
Pregnancy
Sexual intercourse
Common in children
Catheterisation
Enlarged prostate
What scale is used for prostate cancer?
Gleason
What investigations are used in prostate cancer and which is most useful?
Prostate-Specific Antigen (PSA) - not specific, rises with BPE, UTI, prostatitis
DRE (Digital Rectal Examination) - PR - prostate feels hard and craggy
Transrectal Ultrasound-Guided Needle Biopsy - diagnostic, usually only done if symptomatic
Where does prostate cancer metastasise to?
Bone
Lung
Liver
A patient presents with acute flank pain radiating to groin. What is your management?
Acute - IM diclofenac 75mg
Urgent surgical referal
What investigation should be done on patients with renal stones?
Non-contrast CT KUB
What urinary symptoms does BPH usually present with?
Weak or intermittant flow, straining, hesitancy
Urgency, frequency
Nocturia
What are you management options for BPH?
Watchful waiting
A1A - tamsulosin
5ARI - finasteride
What are some side effects of f-alpha-reductase inhibitors?
Erectile dysfunction, gynaecomastia, reduced libido
What is a varicocele?
Mild ache, scrotum feels like ‘bag of worms’
Sign of malignancy due to renal vein compression
Hydrocele feels like…?
Smooth, cystic lump
Causes of hydronephrosis are…?
Unilateral - pelvic-ureteric obstruction (congenital or acquired), aberrant renal vessels, calculi, tumours
Bilateral - stenosis, urethral valve, prostatic enlargement, extensive bladder tumour, retroperitoneal fibrosis
What should urinary flow rate be over?
14
What is solifenacin and what is it used to treat?
An anticholinergic
Used for urgency and frequency and nocturia
What is the most common kind of bladder cancer?
Transitional Cell
This cell type can be found from renal pelvis to proximal urethra
What are risk factors for bladder cancer?
Smoking
Schistosomiasis
Radiation
What are risk factors for testicular cancer?
Klinefelter’s syndrome
Family history
Male infertility
Cryptorchidism
What tumour markers are tested for in testicular cancer?
Alpha fetoprotein
Beta-Human Chorionic Gonadotrophin
What lymph node group is testicular cancer most likely to spread to?
Para-aortic nodes
What kind of testicular cancer arises from all three embryonal layers?
Teratoma / Non-seminomatous germ cell tumour
Does CKD lead to a high or low phosphate and what effects does this have?
High phosphate, leads to increase in calcium being ‘dragged’ from the bone, results in osteomalacia, lack of vitamin D
Secondary parathyroidism – low calcium and high phosphate and low vitamin D
