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
suffers from an injury to the anterior bulbar urethra. Where will the extravasated urine tend to collect
connective tissue ofscrotum
This portion of the urethra is contained between the perineal membrane and the membranous layer of the superficial fascia
signs of bulbar rupture?
Commonly straddle injury
TRIAD:
urinary retention, perineal haematoma, blood at the meatus
Signs of membranous rupture?
Commonly pelvic trauma:
Penile or perineal oedema/ hematoma
- PR: prostate displaced upwards (beware co-existing retroperitoneal haematomas as they may make examination difficult)
Commonest cause of poor stream and urinary hesitancy in children?
posterior urethral valves
Drugs causing haematuria?
Cause tubular necrosis or interstitial nephritis: aminoglycosides, chemotherapy
Interstitial nephritis: penicillin, sulphonamides, and NSAIDs
Anticoagulants
Types of seminoma?
- Spermatocytic: tumour cells resemble spermatocytes. Excellent prognosis.
- Anaplastic
- Syncytiotrophoblast giant cells: β HCG present in cells
Best course of action for acute haematocele?
scrotal exploration
What is a DMSA scan?
Dimercaptosuccinic acid (DMSA) scintigraphy
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.
What is a DTPA scan?
Diethylene-triamine-penta-acetic acid
This is primarily a glomerular filtration agent. It is most useful for the assessment of renal function. Because it is filtered at the level of the glomerulus it provides useful information about the GFR. Image quality may be degraded in patients with chronic renal impairment and derangement of GFR.
what is a MAG3 renogram?
Mercaptoacetyle triglycine is an is extensively protein bound and is 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).
What is a MCUG scan?
This scan provides information relating to bladder reflux and is obtained by filling the bladder with contrast media (via a catheter) and asking the child to void. Images are taken during this phase and the degree of reflux can be calculated
Unilateral causes of hydronephrosis?
Pelvic-ureteric obstruction (congenital or acquired)
Aberrant renal vessels
Calculi
Tumours of renal pelvis
Bilateral causes of hydronephrosis?
SUPER
Stenosis of the urethra
Urethral valve
Prostatic enlargement
Extensive bladder tumour
Retro-peritoneal fibrosis
Which renal cancer is associated with polycythaemia?
renal adenocarcinoma
Which imaging technique is used to assess renal function in failing transplant patients?
MAG3
Which stones are associated with inborn errors of metabolism?
uric acid (radio lucent)
cysteine (semi opaque)
which stones are associated with RTA?
Calcium phosphate
Which renal tumour appears pink?
Transitional cell carcinoma
Finding this mandates a nephroureterectomy.
Causes of hydrocele?
Causes include trauma, infection and tumour
Which condition is associated with angiomyolipoma?
tuberous sclerosis
Memory aid for erection
p=parasympathetic=points
s=sympathetic=shoots
Parasympathetic stimulation causes erection. Sympathetic stimulation will produce ejaculation, detumescence and vasospasm of the pudendal artery
What is priapism?
Prolonged unwanted erection, in the absence of sexual desire, lasting more than 4 hours.
Causes of priapism?
Intracavernosal drug therapies (e.g. for erectile dysfunction>
Blood disorders such as leukaemia and sickle cell disease
Neurogenic disorders such as spinal cord transection
Trauma to penis resulting in arterio-venous malformations
Management of priapism?
Ice packs/ cold showers
If due to low flow then blood may be aspirated from copora or try intracavernosal alpha adrenergic agonists.
Delayed therapy of low flow priapism may result in erectile dysfunction.
Tests for priapism?
Exclude sickle cell/ leukaemia
Consider blood sampling from cavernosa to determine whether high or low flow (low flow is often hypoxic)
By which age are 95% of all foreskins retractile
16
What is balanitis?
This is inflammation of the glans penis. It may occur in both circumcised and non-circumcised individuals.
What is posthitis?
This is inflammation of the foreskin. It may occur as a result of infections such as gonorrhoea and other STD’s.
May progress to phimosis
what is balanitis xerotica obliterans?
This is a dermatological condition in which scarring of the foreskin occurs leading to phimosis.
intervention of choice for renal pelvis stones greater than 20mm
percutaneous nephrolithotomy
Therapy for renal stones?
Less than 5mm and asymptomatic Watchful waiting
Less than 10mm ESWL
10 20mm ESWL or ureteroscopy
Greater than 20mm (including staghorn calculi) PCNL
Therapy for ureteric stones?
Less than 5mm Watchful waiting
5-10mm ESWL (if upper ureter)
10-20mm Ureteroscopy
Gold standard test for renal scarring?
DMSA
What are sperm granulomas?
common sequelae of vasectomy
smooth round lumps adherant to the vas. They may be safely left alone.
What is a Rhabdomyosarcoma ?
paratesticular tumours with a bimodal distribution
Features of rhabdomyosarcoma?
mass felt separate to the testes
5% of testicular tumors
Most often arises in distal portion of spermatic cord and may invade testis of surrounding tissues
60% occur in the first 2 decades of life
Bimodal age distribution - 3-4 months - 16 years
Arises from mesenchymal tissue - 90% embryonal variant (better prognosis) - 30% - 50% have metastasis (usually lymph node) at diagnosis
What may be compromised and cause impotence in rectal cancer surgery?
nervi erigentes (autonomic nerves to penis)
