Urology Flashcards
Features of seminomas?
Commonest subtype (50%)
Average age at diagnosis = 40
Even advanced disease associated with 5 year survival of 73%
Tumour markers of seminomas?
AFP: normal
HCG: elevated in 10%
Lactate dehydrogenase; elevated in 10-20%
Pathology of seminomas?
Sheet like lobular patterns of cells with substantial fibrous component. Fibrous septa contain lymphocytic inclusions and granulomas may be seen.
Types of Non seminomatous germ cell tumours ?
Teratoma
Yolk sac tumour
Choriocarcinoma
Mixed germ cell tumours (10%)
Features of non seminomatous germ cell tumours?
Younger age at presentation =20-30 years
Advanced disease carries worse prognosis (48% at 5 years)
Retroperitoneal lymph node dissection may be needed for residual disease after chemotherapy
tumour markers of non seminomatous germ cell tumours?
AFP: elevated in up to 70%
HCG: elevated in up to 40%
Other markers rarely helpful
Pathology of non seminomatous germ cell tumours?
Heterogenous texture with occasional ectopic tissue such as hair
RF for testicular cancer?
Cryptorchidism
Infertility
Family history
Klinefelter’s syndrome
Mumps orchitis
Diagnosis of testicular cancer?
Ultrasound is first-line
CT scanning of the chest/ abdomen and pelvis is used for staging
Tumour markers (see above) should be measured
Management of testicular cancer?
Orchidectomy (Inguinal approach)
Chemotherapy and radiotherapy may be given depending on staging
Abdominal lesions >1cm following chemotherapy may require retroperitoneal lymph node dissection.
Prognosis of testicular cancer
generally excellent
5 year survival for seminomas is around 95% if Stage I
5 year survival for teratomas is around 85% if Stage I
Non infective causes of epididymitis?
amiodarone
Treatment of hydrocele?
Treatment in adults is with a Lords or Jabouley procedure [both via scrotal approach].
Treatment in children is with trans inguinal ligation of PPV.
Likely organism infection if stag horn calculus?
Proteus mirabilis(urease producing - gives struvite stone)
commonest cause of infravesical outflow obstruction in males?
posterior urethral valves
Types of malignant renal neoplasms?
- Renal cell carcinoma
- clear cell carcinoma (70%)
- papillary renal cell carcinoma(15%)
- chromophobe renal cell carcinoma (5%)
- rare types - transitional cell carcinoma (10%) - Nephroblastoma
which drug may cause haemorrhage cystitis?
cyclophosphamide
Causes of haematuria?
Trauma
Infection
Malignancy
Renal disease
Stones
structural abnormalitis
coagulopathies
Drugs
Benign
Gynaecological
Iatrogenic (catheter)
Pseudo (beetroot)
What is BPH?
hyperplasia of the periurethral glands in the transitional zone of the prostate
Gold standard therapy for BPH?
TURP
Lymphatic spread of prostate cancer?
first to the obturator nodes and local extra prostatic spread to the seminal vesicles
What type of cancer is prostate cancer?
95% adenocarcinoma
Standard treatment for localised prostate cancer?
Radical prostatectomy
Erectile dysfunction is a common side effect
who is active surveillance for prostate cancer suitable for?
clinical stage T1c, Gleason score 3+3 and PSA density < 0.15 ng/ml/ml who have cancer in less than 50% of their biopsy cores, with < 10 mm of any core involved