Urology Flashcards
Treatment of renal colic (oral opioids of choice, expulsion therapy)
1) Tapentadol 50mg IR or Tramadol 50-100mg PO
Expulsion therapy = tamsulosin if >5mm stone/distal segment
Causes of haematuria (DDx), 5 broad categories
1) Transient (exercise induced, trauma, sexual intercourse, vaginal atrophy)
2) Malignancy (urothelial, renal cell, prostate)
3) Infectious (pyelonephritis, radiation cystitis, UTI)
4) Renal disease (IgA nephroopathy, interstitial nephritis)
5) Obstructive (Kidney stone, BPH)
Investigation - gold standard for haematuria (and others to consider)
CT IVP gold standard
Urine MCS
Bloods - FBE, UEC, coags
Renal tract uSS - if <50 or renal impairment
Urine cytology - low sensitivity for low grade tumours (3 mid morning specs on 3 consecutive days)
Investigation - gold standard for haematuria (and others to consider)
CT IVP gold standard
Urine MCS
Bloods - FBE, UEC, coags
Renal tract uSS - if <50 or renal impairment
Urine cytology - low sensitivity for low grade tumours (3 mid morning specs on 3 consecutive days)
Management of low risk microscopic haematura
Risk stratification first
Repeat urine microscopy in 6/12
-Could monitor annually if persistent
Antibiotic prophylaxis doses for recurrent UTIs (3)
-Trimethoprim 150mg nocte
-Cefalexin 250mg nocte
-Nitrofurantoin 50mg nocte
Post-coital option - single dose above within 2 hours post-intercourse
Management of recurrent UTIs (non-Abx)
Topical oestrogen
Methenamine hippurate (Hipprex) 1g BD
Epididymo-orchitis Rx
(presumed STI)
(urinary tract pathogen)
-Ceftriaxone 500mg in 2ml 1% lignocaine IM + Doxycycline 100mg BD 14 days OR Azithro 1g PO stat & repeated in a week
-Trimethoprim 300mg 7 days OR ceflex 500mg BD 7 days
Erectile dysfunction risk factors (7)
-Age
-Antidepressant use
-Antihypertensive use
-BPH/obstructive LUTS
-CVS disease/diabetes/dyslipidaemia/obesity
-Smoking
-Pelvic surgery/trauma
Erectile dysfunction baseline bloods
Essentially CV bloods (FBE, UEC, HbA1c, lipids, fasting BSL) plus early AM testosterone
Erectile dysfunction aetiology (categories) (6)
Vasculogenic (CVS disease, diabetes etc.)
Neurogenic (MS, Parkinsons, stroke etc.)
Psychogenic (anxiety/depression/situational)
Anatomical (Peyronies, phimosis, micropenis)
Endocrinological (hypogonadism, prolactinaemia, thyroid)
Traumatic (?post-prostatectomy) [erectile function can return as neuropraxia subsides 6-18 months, Rx w/ penile rehab - early PDE5 inhibitor]
PDE5 inhibitor contraindications (5)
Recent AMI/stroke within last 6 months
Resting hypotension/severe hypertension
Unstable angina
Severe CCF
Nitrate use
Undescended testes - when to refer? (expect descent?)
3 months - (beyond 3mths, spontaneous descent rare)
If no testes palpable at birth - need karyotype, USS, electrolytes (?female w/ CAH)
Retractile testis monitoring frequency
Annual exam
If does not remain in scrotum –> refer. Half improve w/ age but half develop UDT
Investigations for male urinary incontinence (5)
-Urinalysis
-Bladder diary
-Bladder scan for PVR
-eGFR/PSA
-USS renal tract
Urinary incontinence management aspects
Reduce bladder irritants (caffeine/alcohol)
Smoking cessation, weight loss
Pelvic floor physio
Bladder re-training
Antimuscarinic/cholinergics - oxybutynin, solifenacin
Beta3 adrenoceptor agonist - Mirabegron
Botox, electrical stimulation
Haematospermia aetiology (5 categories)
-Idiopathic (most cases! benign/self-limiting)
-Infectious - prostatitis/urethritis/epididymo-orchitis (STI source)
-Iatrogenic (procedures incl. vasectomy, orchidectomy, transrectal biopsy)
-Malignancy (prostate)
-Trauma (coital)
Haematospermia red flags for referral
Age >40 y.o
Persistent/recurrent
Prostate Ca suspicion/risk
Concurrent haematuria
Pain on ejaculation = highly suggestive of (1 condition)
Prostatitis
Haematospermia Ix
Urine MCS/cytology
STI screen
FBE, coags
PSA (if >40 y.o)
Male infertility history questions (10+ categories)
-Age of pt and partner
-Reproductive hx (amt of time trying, previous offspring, previous Ix)
-Sexual practices - frequency, timing w/ ovulation
-Sexual function - libido/erection, ejaculation
-Paeds history - cryptorchidism (empty scrotum), hypospadias (malpositioned urethral opening), testicular torsion
-Previous genital/adbo surgery
-STI history
-Smoking/alcohol, drugs
-FHx of infertility
-Occupational exposures (heat/vibration/pesticides)
Male infertility GP initial investigations (6)
-FSH
-LH
-Testosterone (if low, repeat AM + free levels)
-Prolactin
-Semen analysis (repeat analysis if abnormal, 1-3 months if mild abnormality)
-Scrotal USS (?RFs for testicular Ca)
Nocturia underlying causes (6)
-Bladder (OAB)
-Kidney (water/salt diuresis)
-Hormones (menopause, andropause)
-Sleep (OSA, restless legs)
-Cardiovascular (HTN, heart failure, obesity)
-Intake (polydipsia, salt intake)
PSA elevation - other causes (apart from Prostate Ca) (5)
○ Transiently after sex/ejaculation
○ Heavy exercise (avoid for previous 48 hours prior to testing)
○ Recent UTI
○ BPH
○ Catheterisation/Biopsy (avoid in previous 6 weeks prior to testing)
