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5th (Final year) > Urology > Flashcards

Urology Flashcards

1
Q

Most common causative organism in acute bacterial prostatitis?

A

E.coli

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2
Q

Investigations in acute urinary retention?

A

Urine sample which should be sent for urinalysis and culture.

Serum U&Es and creatinine should also be checked to assess for any kidney injury.

A FBC and CRP should also be performed to look for infection.

PSA is not appropriate in acute urinary retention as it is typically elevated.

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3
Q

What level does a urinary USS become positive for retention?

A

> 300

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4
Q

Management of acute urinary retention?

A

Bladder USS

Catheter

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5
Q

Causes of balanitis?

A

Candidiasis

Dermatitis (contact or allergic, eczema and psoriasis)

Staph spp (and other bugs)

Lichen planus and sclerosus (rarer)

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6
Q

Management of BPH?

A

Watchful waiting

Medication:

First line: alpha-1 antagonists (Tamsulosin),

Then: 5 alpha-reductase inhibitors (finasteride).

The use of combination therapy was supported by the Medical Therapy Of Prostatic Symptoms (MTOPS) trial.

Surgery: transurethral resection of prostate (TURP)

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7
Q

Risk factors for bladder cancer?

A

Smoking

Exposure to aniline dyes in the printing and textile industry: examples are 2-naphthylamine and benzidine

Rubber manufacture

Cyclophosphamide

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8
Q

Causes of hydronephrosis?

A

SUPER - bilateral
Stenosis of the urethra
Urethral valve
Prostatic enlargement
Extensive bladder tumour
Retro-peritoneal fibrosis

PACT - unilateral
Pelvic-ureteric obstruction (congenital or acquired)
Aberrant renal vessels
Calculi
Tumours of renal pelvis

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9
Q

What are the two types of urethral injury?

A

Bulbar rupture (most common)
- Straddle type injury (bike)
- Triad signs: urinary retention, perineal haematoma, blood at the meatus

Membranous rupture
- Can be extra or intraperitoneal
- Commonly due to pelvic fracture
- Penile or perineal oedema/ hematoma
- PR: prostate displaced upwards (beware co-existing retroperitoneal haematomas as they may make examination difficult)

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10
Q

How would a traumatic bladder injury present?

A

Rupture is intra or extraperitoneal

Presents with haematuria or suprapubic pain

History of pelvic fracture and inability to void: always suspect bladder or urethral injury

Inability to retrieve all fluid used to irrigate the bladder through a Foley catheter indicates bladder injury

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11
Q

What are the LUTS?

A

Divide into three categories

Storage
- Urgency
- Frequency
- Nocturia
- Urinary incontinence

Voiding
- Hesitancy
- Poor or intermittent stream
- Straining
- Incomplete emptying
- Terminal dribbling

Post micturition
- Post-micturition dribbling
- Sensation of incomplete emptying

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12
Q

Most common type of prostate cancer?

A

Adenocarcinoma

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13
Q

Where does prostate cancer spread to with regards to lymphatic spread?

A

Lymphatic spread occurs first to the obturator nodes and local extra-prostatic spread to the seminal vesicles is associated with distant disease.

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14
Q

How do you grade prostate cancers?

A

Gleason grading system

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15
Q

Treatment options for prostate cancer?

A

Watch and wait
- Elderly
- Low gleason score

Radiotherapy
- Curative and palliative roles

Radical prostatectomy
- Most common
- Robot is being used
- Erectile dysfunction is a common side effect

Antiandrogen and GnRH agonist medical therapy
- Treatment for metastatic disease
- Can be used for localised advanced cancer
- Cyproterone is an anti-androgen
- Goserelin is an anti-GnRH

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16
Q

Features of prostate ca.?

A

Bladder outlet obstruction: hesitancy, urinary retention
haematuria, haematospermia

Pain: back, perineal or testicular

Digital rectal examination: asymmetrical, hard, nodular enlargement with loss of median sulcus

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17
Q

Age adjusted limits for PSA?

A

50-59
- 3.0

60-69
- 4.0

> 70 years
- 5.0

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18
Q

What can raise the PSA?

A

Benign prostatic hyperplasia (BPH)

Prostatitis and urinary tract infection (NICE recommend to postpone the PSA test for at least 1 month after treatment)

Ejaculation (ideally not in the previous 48 hours)

vigorous exercise (ideally not in the previous 48 hours)

Urinary retention

instrumentation of the urinary tract (e.g. catheter!)

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19
Q

Features of renal cell cancer (adenocarcinoma)?

A

haematuria, loin pain, abdominal mass

Pyrexia of unknown origin

Left varicocele (due to occlusion of left testicular vein)

Endocrine effects: may secrete erythropoietin (polycythaemia), parathyroid hormone (hypercalcaemia), renin, ACTH

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20
Q

Most common type of renal stone?

A

Calcium oxalate (85%)

21
Q

Features of renal stones?

A

Loin pain: typically severe, intermittent ‘colic’ pain. The patient often is restless/moving around

Nausea and vomiting is common

Haematuria

Dysuria

Secondary infection may cause fever

22
Q

Management of renal colic?

A

NSAID
- Diclofenac traditionally used, but watch out for cardiovascular complications

23
Q

Investigation for Renal stones?

A

BOXES

Bloods
- FBC, CRP - look for associated infection
- Clotting if intervention planned

Orifices
- Urine dip and culture
- Us&Es - check renal function
- Calcium/urate - look for underlying causes

X (imaging)
- Non contrast CT KUB, within 14 hours of admission

E
S

24
Q

What is the management for urinary stones?

A

<5mm will pass spontaneously. Lithotripsy and nephrolithotomy for more serious cases.

If <5mm but there are features such as
- Ureteric obstruction
- Horseshoe kidney (or other developmental abnormality)
- Previous renal transplant

Then need more intense treatment

If there is ureteric obstruction then you need to decompress, this can include:
- Nephrostomy tube placement
- Ureteric catheters
- Ureteric stent

If non-emergency
- Shockwave lithotripsy
- Uretoscopy (when shockwave is inappropriate e.g. preggers)
- Percutaneous nephrolithotomy (lithotripsy but from within)

Summary:

Stone burden of less than 2cm in aggregate
- Lithotripsy

Stone burden of less than 2cm in pregnant females
- Ureteroscopy

Complex renal calculi and staghorn calculi
- Percutaneous nephrolithotomy

Ureteric calculi less than 5mm
- Manage expectantly

25
Q

How can you prevent renal stones?

A

Oxalate stones
- Cholestyramine reduces urinary oxalate secretion
- Pyridoxine reduces urinary oxalate secretion

Calcium stones:
- High fluid intake
- Low animal protein
- Thiazide diuretics

Uric acid stones
- Allopurinol
- Urinary alkalinization e.g. oral bicarbonate

26
Q

Drugs that can cause stones?

A

Drugs that promote calcium stones:
- Loop diuretics
- Steroids
- Acetazolamide
- Theophylline.

27
Q

Risk factors for urinary stones?

A
  • Dehydration
  • Hypercalciuria, hyperparathyroidism, hypercalcaemia
    cystinuria
  • High dietary oxalate
  • Renal tubular acidosis
  • Medullary sponge kidney, polycystic kidney disease
    beryllium or cadmium exposure
28
Q

What are the features of epididymal cysts, associated conditions?

A
  • Swelling
  • Separate from the body of the testicle
  • Found posterior to the testicle

Associated conditions
- Polycystic kidney disease
- Cystic fibrosis
- Von Hippel-Lindau syndrome

29
Q

What is a hydrocele and what types are there?

A

Accumulation of fluid within the tunica vaginalis

Communicating
- Patent processus vaginalis
- Congenital

Non-communicating
- Excessive fluid in tunica vaginalis

Features
- Soft, non-tender swelling of the hemi-scrotum. Usually anterior to and below the testicle

  • The swelling is confined to the scrotum, you can get ‘above’ the mass on examination
  • Transilluminates with a pen torch
  • The testis may be difficult to palpate if the hydrocele is large
30
Q

Management of hydroceles?

A

Infantile repaired if they do not resolve by 1/2

Conservative otherwise, USS to exclude underlying tumour.

31
Q

What is a varicocele, features?

A

Abnormal enlargement of testicular veins

Features
- Normally on left hand side (80%)
- like a ‘bag of worms’
- Usually asymptomatic, but associated with subfertility

32
Q

Investigation and management of varicoceles?

A

Diagnosed with doppler USS

Managed conservatively usually, surgery if pain.

33
Q

Types of testicular malignancy?

A

95% are germ cell tumours, either:

Seminomas

Non-seminomas
- Embryological
- Yolk sac
- Teratoma
- Choriocarcinoma

34
Q

Features of testicular malignancy?

A

Painless lump (although some are painful)

May also have Hydrocele or gynaecomastia

35
Q

Management of testicular malignancy?

A

Orchidectomy generally for all

Maybe radio/chemo depending on grade

Prognosis is atl 85%

36
Q

Tumours markers in testicular malignancy?

A

AFP and b-HCG

Seminomas
- b-HCG in 10% of seminomas
- AFP not raised.
- (may have raised LDH)

Non-seminomas
- 70% raised AFP
- 40% raised b-HCG

37
Q

Features of testicular torsion?

A

Features
- Pain is usually severe and of sudden onset

  • The pain may be referred to the lower abdomen
  • Nausea and vomiting may be present
  • On examination there is usually a swollen, tender testis retracted upwards. The skin may be reddened
  • Cremasteric reflex is lost and elevation of the testis does not ease the pain. In torsion of the testicular appendage, the cremaster reflex can be preserved.
38
Q

What is TURP syndrome?

A

TURP syndrome is a rare and life threatening complication of transurethral resection of the prostate surgery.

  1. Hyponatraemia: dilutional
  2. Fluid overload
  3. Glycine toxicity
39
Q

Before a man can have unprotected sex post-vasectomy, what needs to be done?

A

Semen analysis twice, usually 16 and 20 weeks.

40
Q

Staghorn calculi are usually what type of stone/

A

Struvite

41
Q

Schisotosoma is a risk factor for what type of bladder cancer?

A

SCC of bladder

42
Q

Which stones are radio-lucent on xray?

A

Xanthine and urate stones

43
Q

Drugs to use in OAB (overactive bladder)?

A

Antimuscarinics

44
Q

How long might finasteride treatment take to work?

A

Up to 6 months

45
Q

How to tell apart hydrocele and inguinal hernia?

A

Cannot get above inguinal hernia

46
Q

What drug can you use to prevent tumour flare when prastate ca. being treated with goserelin?

A

Flutamide

47
Q

Exposure to textile, plastic and rubber industry chemicals, is a risk factor for which type of renal cancer?

A

Transitional

48
Q

What is teh action of goserelin?

A

GnRH agonist

49
Q

Struvite (staghorn calculus) usually associated with what infective organism?

A

Proteus mirabilis

5th (Final year) (34 decks)

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