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Satia's MRCS copied decks > Urology > Flashcards

Urology Flashcards

1
Q

Commonest stone type

A

Calcium oxalate (85%)

hypercalciuria, hypercalcaemia, hyperoxaluria or hypocitraturia

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2
Q

Magnesium ammonium phosphate (struvite) stones

A

Secondary to UTI that breakdown urea into CO2 and ammonia
–> Alkalising urine

Proteus

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3
Q

Stone <0.5cm

A

Should pass conservatively

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4
Q

Pelviureteric junction obstruction (idiopathic hydronephrosis)

A

Moderate hydronephrosis causes ill-defined renal pain or ache that may be exacerbated by drinking large volumes of liquid (Dietls’ Crisis).

May produce a large painless mass in the loin;

Severest form: volume of urine in the hydronephrotic sac may simulate free fluid in the peritoneal cavity

Mx:
Either laparoscopic or open pyeloplasty

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5
Q

Retroperitoneal fibrosis

A

May cause ureteric obstruction and hydronephrosis
-Ureter often difficultto define on imaging

Causes:
Idiopathic
-Mediastinal fibrosis and Dupuytren’s contracture may coexist
-RAISED ESR

Malignant infiltration

Reactive fibrosis
-Radiotherapy, resolving blood clot, or extravasation of sclerosants

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6
Q

Innervation for detrusor contraction

A

S2- S4

Reach the sphincter either by the pelvic plexus or via the pudendal nerves

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7
Q

Intra-peritoneal rupture of bladder

A

Dome rupture –> intra-peritoneal leak

Ileus
Abdominal distension

Trauma with full bladder i.e. alcohol-fuelled fights

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8
Q

Management of bladder rupture

A

Intra-peritoneal
-laparotomy and repair

Extra-peritoneal
-Catheter to relieve any tension
-Conservative management, catheter in for minimum 6-10 days

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9
Q

Cancer of the bladder

A

Most common = transitional cell

Then: squamous cell carcinoma due to chronic inflammation e.g. schistomsomiasis

Rarely: Adenocarcinoma in urachal remnant in dome of bladder or form colorectal metastasis

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10
Q

Transitional cell carcinoma

A

Most common bladder and ureter cancer

Papillary tumours are less aggressive superficial cancers

Ulcerating are much more aggressive.

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11
Q

Management of superficial bladder tumours Ta, T1

A

Transurethral resection of the bladder tumour down to detrusor muscle is desired

If not endoscopic diathermy possible

Intra-vesical mitomycin C useful for multiple lesions

Regular check cystoscopies requried

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12
Q

Treatment of carcinoma in situ bladder cancer

A

Intra-vescial bacille Calmette-Guerin

BCG

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13
Q

Management of invasive bladder cancer T2-T3

A

<70 years –> Radical cystectomy

> 70 years –> Radiotherapy

Cystectomy always necessitates urinary diversion. Where the urethra can be retained, it may be possible to construct a new bladder from colon or small bowel
(orthotopic bladder replacement),

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14
Q

Treatment of T4 bladder cancer with fixed organ invasion

A

Palliative

Resection not possible

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15
Q

Mitomycin C

A

Single intra-vesical dose of mitomycin C post transurethral resection of superficial bladder cancer improves outcomes

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16
Q

Management of organised/localised prostate cancer

A

If patient young / life expectancy >10 years –> treat with curative intent

If Gleeson >/7, indicates high risk of progress so should be treated

If elderly, watchful waiting as most tumours take 10-15 years to be clinically relevant

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17
Q

Management of locally advanced prostate cancer

A

External beam radiotherapy

AND

Hormonal therapy

Surgery is not curative

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18
Q

Management of metastatic prostate cancer

A

Androgen suppression through orchiectomy or through gonadal axis suppression using GnRH

Bone pain can be treated with external beam radiotherapy or strontium

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19
Q

Benign prostatic hyperplasia

A

Hyperplasia of peri-urethral tissues

Forms adenomas in transitional zone

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20
Q

Complications of bladder diverticula

A

Drain poorly causing stasis

Leading to:
Infection
Stones
Tumour

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21
Q

Small prostate benign hyperplasia obstruction management

A

Alpha-blockers

Tamulosin

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22
Q

Large prostate benign hyperplasia obstruction management

A

5alpha-reductase inhibitors

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23
Q

Management of acute retention

A

Catheter

Alfuzosin

TWOC 12 hours later

if fails –> TURP

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24
Q

Dribbling incontinence in a child

A

Ectopic ureter

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25
Detrusor-sphincter dyssynergia
UMN lesion Injury between the sacral segment and the pontine micturition centres Develops a reflex bladder with impaired or absent cortical control; that is, the bladder loses the coordination imposed by the pontine micturition centre. Detrusor becomes overactive and attempted voiding results in detrusor contraction occurring synchronously with that of the external sphincter (detrusor-sphincter dyssynergia) Result is poor bladder emptying and the development of a thick, trabeculated bladder wall
26
Atonic myogenic bladder
Caused by prolonged outlet obstruction and is found in the late stages of bladder decompensation. Most common cause is silent prostatic obstruction, where progressive loss of the desire to void results in overflow incontinence
27
Nerve innervation for micturation
Parasympathetic innervation S2 - S4 to the detrusor Sympathetic innervation T10 - L2 to bladder neck and proximal urethra Somatic innervation S2 - S4 to the bladder, pelvic floor and urethra
28
Spinal cord damage and micturation
Below / at the level of T12 -L1 --> Flaccid bladder with overflow Above T12 -L1 = UMN --> Overactive bladder with poor coordination, causes poor bladder emptying
29
Seminomas
Arise from Seminiferous tubules Often low-grade Sensitive to radiotherapy
30
Teratoma
(non-seminomas) Arise from primitive germinal cells Not sensitive to radiotherapy
31
Treatment of hydronephrosis
acute: nephrostomoy tube chronic: ureteric stent or pyeloplasty
32
Signs of bulbar urethral injury
most common - straddle type injury e.g. bicycles - triad signs: urinary retention, perineal haematoma, blood at the meatus
33
Signs of membranous urethral injury
prostate displaced upwards (beware co-existing retroperitoneal haematomas as they may make examination difficult
34
Investigation for damaged urethra
Ascending urethrogram
35
Management for ruptured urethra
Suprapubic catheter
36
Mx of renal stone
Less than 5mm and asymptomatic: Watchful waiting Less than 10mm: ESWL 10 20mm: ESWL or ureteroscopy Greater than 20mm (including staghorn calculi): PCNL
37
Mx of ureteric stones
Less than 5mm Watchful waiting 5-10mm ESWL (if upper ureter) 10-20mm Ureteroscopy
38
Autonomic nerves of erection
Sympathetic nerves originate from T11-L2 and parasympathetic nerves from S2-4 join to form pelvic plexus.
39
Most common location of prostate cancer
Peripheral zone
40
Best and worst Gleason score
2 and 10
41
First nodes that prostate cancer spreads to
Obtruator
42
Most common renal cancer
Adenocarcinoma
43
Paraneoplastic syndrome commonly seen in renal cancer
Polycythaemia and HTN
44
How does renal adenocarcinoma spread?
Haematogenous
45
Tx for renal adenocarcinoma
radical or partial nephrectomy
46
Treatment of nephroblastoma
Vincrystine Actinomycin D Doxorubicin
47
Ix for Nephroblastoma
USS and CT
48
Most common lower urinary tract carcinoma
Transitional cells
49
RFs for TCC of LUT
Dyes Rubber
50
Common PC of TCC in lower urinary tract
painless haematuria
51
Treatment for TCC
Nephroureterectomy
52
What type of cancer does schistosomiasis cause?
Squamous
53
Why does cysteine produced a radio-opaque stone?
Contains sulphur
54
Describe staghorn calculus
involve the renal pelvis and extend into at least 2 calyces. They develop in alkaline urine and are composed of struvite (ammonium magnesium phosphate, triple phosphate)
55
What bacteria result in staghorn calculus?
Ureaplasma urealyticum and Proteus infections predispose to their formation
56
How are testicular tumours treated?
Testicular malignancy is always treated with orchidectomy via an inguinal approach
57
What is the difference in management of a hydrocele between adults and children?
in children where the underlying pathology is a patent processus vaginalis and therefore an inguinal approach is used in children so that the processus can be ligated. In adults a scrotal approach is preferred and the hydrocele sac excised or plicated
58
What is the most common type of testicular tumour?
Seminoma
59
How to differentiate between seminoma and non seminoma tumour?
AFP is normal in seminoma, raised in non-seminoma
60
What drug can cause non-infective epididymo orchitis?
Amiodarone - stop the drug
61
What is DMSA scan used for?
DMSA localises to the renal cortex with little accumulation in the renal papilla and medulla. It is useful for the identification of cortical defects and ectopic or aberrant kidneys. It does not provide useful information on the ureter of collecting system.
62
What is MAG 3 scan used for?
primarily secreted by tubular cells rather than filtered at the glomerulus. This makes it the agent of choice for imaging the kidneys of patients with existing renal impairment (where GFR is impaired). to assess for failing transplants
63
Causes of unilateral hydronephrosis
PACT Pelvic-ureteric obstruction (congenital or acquired) Aberrant renal vessels Calculi Tumours of renal pelvis
64
Causes of bilateral hydronephrosis
SUPER Stenosis of the urethra Urethral valve Prostatic enlargement Extensive bladder tumour Retro-peritoneal fibrosis
65
Which fascia separates prostate from rectum?
Deonvilliers
66
What fascia does bucks surround?
spongiose part of urethra
67
How do alpha blockers work on the prostate?
These block the action of noradrenaline on prostatic smooth muscle causing relaxation and improved bladder emptying.
68
Added benefit of finasteride
reduction in urinary retention
69
Which specific infection can cause haematuria
TB
70
Management of hydronephrosis
Acute upper urinary tract obstruction: Nephrostomy tube Chronic upper urinary tract obstruction: Ureteric stent or a pyeloplasty
71
Most common type of priapism and causes
low flow venous occlusion Often painful Often low cavernosal flow If present for >4 hours requires emergency treatment
72
Post renal tumour resection tx
Patients with completely resected disease do not benefit from adjuvant therapy with either chemotherapy or biological agents
73
How are epididymal cysts removed?
Excision using scrotal approach

Satia's MRCS copied decks (32 decks)

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