Urology Flashcards
what are some types of urinary catheter?
intermittent, foley 2 way, 3 way, suprapubic, coude tip
what is a catheter?
it is a tube that drains into a bag that can be short or long term and has a balloon to stop it from falling out that sits in the neck of the bladder
what are the indications for a catheter?
retention, neurogenic bladder, surgery, output monitoring, bladder irrigations, delivery of medications
what is needed when catheter removed?
post void bladder scan
what is the commonest prostate cancer?
androgen dependent, adenocarcinomas in peripheral zones
what are the risk factors and presentation of prostate cancer?
RFs: increasing age, FHx, black/caribbean origin, tall, steroids
presentation: LUTs, haematuria, ED, mets, weight loss, bone pain, CES, O/E: irregular enlarged prostate
what is PSA?
it is from the epithelial cells and is a glycoprotein in semen to thin it into a liquid - it is increased in prostate cancer but also has a lot of false positives and negatives - BPH, cancer, recent ejaculation or prostate stimulation, exercise
how is prostate cancer investigated?
biopsy - TRUS or transperineal
Gleason grading system
TNM staging
MR for suspicion
how is prostate cancer managed?
surveillance, radio, brachytherapy, hormones, surgery - prostatectomy
complications: proctitis, ED, incontinence, bladder ca, rectal ca, hot flushes, fatigue
what is prostatitis?
it is inflammation of the prostate that can be acute or chronic
what is the presentation of prostatitis?
pelvic pain, LUTS, sexual dysfunction, pain with bowel movement, tender and enlarged prostate, fever, myalgia, nausea, sepsis, fatigue
how is prostatitis investigated and managed?
ix: dipstick, urine M,C and S, NAAT testing
mx - admission if needed, ABx, analgesia, laxatives, alpha blockers such as tamulosin, psychological input
what is obstructive uropathy?
when there is a blockage preventing the outflow of urine - back pressure results in proximal swelling - hydronephrosis - AKI
what is the presentation of obstructive uropathy?
loin to groin flank pain, reduced UO, non specific symptoms such as vomiting, impaired U&Es = upper, lower = inability to void, retention, impaired U&Es
how is obstructive uropathy investigated and managed?
ix: USS
mx: nephrostomy, catheter
what is neurogenic bladder?
it can be caused by MS, spina bifida, DM, stroke, Parkinson’s etc
there is under or overactivity of the detrusor muscle resulting in increased pressure, obstructive uropathy and incontinence
what is hydronephrosis?
swelling of the renal pelvis and calyces - idiopathic is due to PUJ narrowing
mx - pyeloplasty, ureteric stent or nephrostomy
presents with vague renal angle pain, renal mass, investigate with USS and IV urogram and CT
what are the complications of obstructive uropathy?
pain, AKI, CKD, infection, hydronephrosis, retention, distension, overflow incontinence
what is epididymo-orchitis?
it is inflammation of the epididymis and testicle - infection can cause such as E coli
what is the presentation of epididymo-orchitis?
testicular pain, swelling, heaviness or dragging, tenderness on palpation, urethral discharge, systemic sx
R/O TORSION
how is epididymo-orchitis investigated and managed?
ix: STI likely if <35, increased number of partners, discharge
urine M,C&S, NAAT test, USS, saliva swab, serum ABs, charcoal swab
mx: refer to GUM, ABx (co-amoxiclav, ofloxacin, doxycycline, cef), analgesia, supportive underwear, decreased activity, abstain
what are complications of epididymo orchitis?
chronic pain and epididymitis, sub or infertility, testicular atrophy, scrotal abscess
what is BPH?
it is when there is hyperplasia of the stromal and epithelial cells of the prostate that usually occurs over the age of 50
how does BPH present?
LUTS, hesitancy, urgency, incomplete emptying, weak flow, intermittency, terminal dribbling, straining, nocturia
how is BPH investigated?
Ix: DRE, abdominal exam, urinary frequency volume chart, dipstick, PSA
IPSS - severity scoring
how is BPH managed?
alpha blockers, 5 alpha reductase inhibitors, TURP, TU electrovaporisation of prostate, holmium laser enucleation of prostate, open prostatectomy
what are the risks oo TURP?
bleeding, infection, incontinence, ED, retrograde ejaculation, strictures, failure
summarise varicocele?
pampiniform plexus of veins swells - due to increased resistance and incompetent valves - throbbing, dull pain worse on standing, dragging, sub or infertility, bag of worms O/E, more prominent on standing and disappears on lying
Ix: USS, semen analysis, hormone levels
Mx: conservative, surgery, endovascular embolisation
summarise hydrocele?
collection of fluid in tunica vaginalis - soft scrotal swelling
soft, large, fluctuant, palpable testes, irreducible, no bowel sounds, transilluminates
causes: idiopathic, ca, torsion, epididymo-orchitis, trauma
mx: r/o serious cause, conservative, surgery, aspiration, sclerotherapy
summarise epididymal cysts?
in the head of epididymis, spermatocele if contains sperm
soft, round lump in top of testicle, associated with epididymis, separate from testicle, if large may transilluminate
mx: conservative or removal
what is the usual cause and what are the risk factors for lower uti?
usually from E coli from GIT
RFs: sexual activity, poor hygiene, incontinence, catheters, structural abnormalities
how does LUTI present?
dysuria, suprapubic pain, frequency, urgency, incontinence, haematuria, cloudy or foul smelling urine, confusion in elderly
how is LUTI investigated?
nitrites, leucocytes, RBC on dipstick
MSU - M, C&S if pregnant, non responding to mx, recurrent, atypical
how is LUTI managed?
trimethoprim, nitrofurantoin, pivmecillinam, amoxicillin, cefalexin, 3d for women, 5-10d if immunosuppresed, 7d if pregnant, male or catheter
avoid nitro in 3rd trimester and trimethoprim in first - amoxicillin, cefalexin
what are testicular cancers?
they arise from the germ cells which produce gametes - more common in younger men and can be seminoma or non-seminoma
what are the risk factors for testicular cancer and how is it investigated?
RFs: undescended tests, male infertility, FHx, increased height
Ix: USS, AFP, bhCG, LDH, CT
how does testicular cancer present?
painless, non tender, arising from testicle, hard, irregular, non fluctuant, non transilluminating, gynaecomastia
how is testicular cancer managed?
Royal Marsden staging
radical orchidectomy, chemo, radio, sperm banking
can result in infertility, hypogonadism, peripheral neuropathy, hearing loss, risk of future cancer
what is testicular torsion?
it is twisting of the spermatic cord and rotation of testicle resulting in ischaemia, necrosis and can be triggered by sports
what is a risk factor for testicular torsion?
Bellclapper deformity
how does testicular torsion present?
unilateral testicular pain, abdominal pain, nausea and vomiting, firm, swollen, retracted testicle with absent cremasteric reflex, abnormal lie, rotation
how is testicular torsion investigated and managed?
ix: do not delay mx, USS
mx: surgical exploration, NBM, analgesia, orchidopexy, orchidectomy
what are kidney stones?
they are hard stones that form in renal pelvis before travelling down ureters - commonly get stuck in VUJ - obstruction and infection
what are the types of kidney stone?
calcium based most common
oxalate and phosphate
uric acid, struvite and cystine
staghorn calculus - in shape of renal pelvis - seen on XR, mostly struvite
what is the presentation and kidney stones and how are they investigated?
presentation: asymptomatic or renal colic, pelvic pain, unilateral loin to groin pain, colicky, haematuria, N&V, reduced UO, sx sepsis
ix: dipstick, bloods, AXR, CT KUB, USS KUB
how are renal stones managed?
NSAIDs (IM diclofenac), IV paracetamol, antiemetics, ABx, tamulosin, watchful waiting, surgical interventions - extracorporeal shockwave lithotripsy, uteroscopy and laser lithotripsy, percutaenous nephrolithotomy, open surgery
increase oral intake, avoid carbonated drinks, reduce salt intake, potassium citrate, thiazide diuretics
what is interstitial cystitis?
chronic inflammation in bladder - LUTS and suprapubic pain, bladder pain syndrome and hypersensitive bladder syndrome
how does interstitial cystitis present?
LUTS, suprapubic pain, frequency, worse during menstruation
how is interstitial cystitis investigated?
urinalysis, swabs, cytoscopy, prostate exam
how is interstitial cystitis managed?
dietary, pelvic floor exercises, bladder retraining, TENS, CBT
analgesia, antiemetics, anticholinergics, mirebegrom, cimetidine, ciclosporin, intravesical lidocaine, pentosan, hyaluronic acid, hydrodistention
cauterisation of hunner lesions, neuromodulation, butulimim toxin, augmentation of bladder, cystectomy
what is pyelonephritis?
it is inflammation of the kidney - renal pelvis and parenchyma
what are the risk factors and causes for pyelonephritis?
RFs: female, structural abnormalities, DM, VUR
causes: E coli, klebsiella, pseudomonas
how does pyelonephritis present?
LUTS, N&V, fever, loin or back pain, systemic illness, loss of appetite, haematuria, renal angle tenderness
CKD - chronic
how is pyelonephritis investigated?
dipstick, MC&S, bloods, USS, CT
how is pyelonephritis managed?
7-10d of ABx - cef, coamox, trimeth, cipro
sepsis 6
if no response consider stones or abscess
what is bladder cancer and what are the risk factors?
it arises from the endothelial lining - urothelium
types: transitional cell, squamous cell, adeno, sarcoma and small cell
RFs: aromatic amines for TCC, smoking, increased age and schistosomiasis for SCC
how does bladder cancer present?
painless haematuria, dysuria
how is bladder cancer investigated and managed?
cytoscopy
TNM staging
mx: transurethral resection of tumour, intravesical chemo, intravesical BCG, radical cystectomy, radio, chmo
urostomy, continent urinary diversion, neobladder reconstruction, uterosigmoidostomy
what is renal cell carcinoma?
it is the most common type of renal cancer - adenocarcinoma of renal tubules resulting in haematuria, mass, flank pan, non specific symptoms
types: clear cell, papillary, chromophobe
what are the risk factors for renal cell carcinoma?
smoking, obesity, HTN, CKD end stage, VHL, tuberous sclerosis
what are the paraneoplastic features of renal cell carcinoma?
polycythaemia, hypercalcaemia, stauffers syndrome
how is renal cell carcinoma managed?
partial or radical nephrectomy, arterial embolisation, percutaneous cryotherapy, radiofrequency ablation, chemo, radio
what is the indication for renal transplant?
end stage failure - adds ten uaers
how is a renal transplant done?
HLA matching A,B, C
leave kidneys in place, connect donor kidney to EI vessels and anastamose ureters with bladders
hockey stick incision
what is needed post renal transplant?
life long immunosuppressants such as tacrolimus, prednisolone or mycophenolate
what are side effects of immunosuppression?
seborrhoeic warts, skin cancers, tremor, gum hypertrophy, Cushings syndrome
what are complications of renal transplant?
rejection, failure, electrolyte imbalance, IHD, T2DM, infection, NHL, skin cancer, PCP, CMV, TB
