Urology Flashcards
Bloods for testicular cancer
AFP, FBC, bHCG, LDH, U+E
Tumour markers in each testicular cancer
AFP- non seminomas GC 60%
hCG- teratoma 40%, choriocarcinoma, seminoma 10%
LDH- seminomas 20%- so seminomas can essentially have normal markers
Differential for lump in testicles
Skin- sebaceous cyst
Tunica vaginal- hydrocele, epidymitis, epi cyst
Testes- cancer, orchitis
Initial investigations for lump
Bloods
USS
USS highly suspicious of testicular cancer what do you do next
Orchidectomy - send of for histor
and maybe CT
What approach are testicles removed
Inguinal approach- since tunica vaginalis surrounds (part of peritoneum)
Offer prosthesis
After testicle removed what do you do next?
CT TAP
?Chemo
Differentials for hameaturia
Renal, bladder, prostate cancer
GN
Trauma
Infection
Renal stone
Ix for painless haematuria
CT urogram- visible haem, non- USKUV
MSU
Bloods
Urine dip
Flexible cystoscopy
Tx of bladder cancer
Transurethral bladder tumour resection
Stoma in RIF producing urine
If urine out of it- ileal conduit
Had cystostescemy
What can’t you do before psa testing
6 weeks of a prostate biopsy
4 weeks following a proven UTI / prostatitis
1 week of DRE
48 hours of vigorous exercise AND/OR ejaculation
Indications for circumcision
Phimosis
Recurrent balantitis
Investigation for kidney stones
Non contrast CT KUB
Mx for pain for kidney stones
PR/IM diclofenac- do not give in CVS
Mx of kidney stones
<0.5cm- expectant
<2cm- lithotripsy
<2cm and pregnant- uteroscopy
Complicated/staghorn- nephrolithotomy
Hydronephrosis/infection- percutaneous nephrostomy + ABx
Which size catheter for men and women
16-18 French for men
12-14 women
Mx of BPH and their SE
A1 antagonist- if urinary sx -tamsulosin- dizziness, dry mouth, depression
5a reductase inhibitors- if prostate enlarged- fiansteride- ED, reduced libido, ejaculation problems, gyane
Ix for prostate cancer
PSA testing
Multi parametric MRI
TRUS guided biopsy
Mx of prostate cancer
Localised- T1/2- depends on life expectancy- active monitoring, prostatectomy
Advanced- T3/4- hormonal, radical prostateectomy- causes ED
Metastatic- GnRH agonist- Goserelin + 3w cover of anti androgen- flutamide
How does acute urinary retention present
Suprapubic tenderness
Dull to percuss
Can present with acute confusional state in elderly
What can cause acute urinary retention
Large prostate- in men usually due to BPH
Can also be due to urethral strictures, calculi, cystocele
Pelvic fracture- urethral trauma – suprapubic catheter s
Drugs- anticholinergics, TCA, antihistamines, opioids
How renal tumours can present
Haematuria, loin pain, loin mass
Varcocele
Can also present with paraneoplastic syndrome- polycythaemia, bushings, high calcium
Cannon ball mets in lungs
What one thing must you not do as in Ix for testicular cancer
Biopsy
Ix for testicular torsion
-ve cremasteric reflex- stroke leg- raise
Prehns test -ve- elevation relives pain
RF for ED
CVD RF- metabolic syndrome
ETOH
Drugs- SSRI, BB, finasteride
Mx of ED
PDE-4 inhibitors- sildenafil
What occurs in a vasectomy
Local
Cut the vas deferens
Complications of vasectomy
Bruising
Haematoma
Infection
Chronic pain
Sperm granuloma
Doesn’t work immediately
Failure-1/2000
Interpretation of MC&S results
Single organism- >10^5
E coli or staph saprophytic - >10^3
White cells- inflammation
Epithelial- failed
Sterile pyuria MC&S results
Prior Abs
Catheter
TB
STI
Mx of UTI
Non pregnant- 3 days trimethoprim/nitro
Pregnant- asymptomatic- 7 days- nitro but avoid at term
Men- 7 days
Cathererised- asymptomatic- none, symptoms- 7 days
Sx of prostatitis
Referred pain- perineum, panic, rectum
Voiding symtoms
+- fever
RF- recent UTI, catheterisation, biopsy
Ix for prostatitis
DRE- tender, boggy prostate
Screen for STI
Mx of prostatitis
Quinilone 14d
Incontinence Ix
Urine dipstick and MC&S to rule out DM and UTI
Bladder diaries
Urodynamic testing - 2nd
Mx of incontinence
Stress- WL if BMI >30- pelvic floor
2nd- surgical or duloxetine
Urge- bladder train for 6 weeks
Anti muscarinic- oxybutinin- increases risk of falls so not to elderly
Ix for varicocele
Doppler USS
Mx of varicocele
Conservative
Surgical
What is bubbly urine a sign of
Enterovesiular fistula
Complication of TURP
TURP syndrome
Irrigation into system
causing triad of hyponatraemia
Fluid overload and glycine toxicity
Why don’t you remove catheter in someone who’s hasn’t moved bowels
Since constipation can cause urinary retention, especially in elder ladies
Balantis Xerotica obliterans sx
Painful itchy white spots - lichen sclerosis
Hyperkeratotic
Associated with phimosis
Ix of priapism
Cavernosal blood gas
Shows ischaemic vs non ischaemic
Types of urethral injury
Bulbar- straddle injury - most common
Urinary retention, perineal haematoma
Membranous
Pelvic fracture
Prostate displaced upwards, oedema
CI to circumcision
Hypospadias
When not to use nitro
GFR lower than <45
Near term of pregnancy
Use amoxicillin instead
Hydrocele vs inguinal hernia
Cant get above hernia
When should you be allowed to have unprotected sex after vasectomy
Use additional contraception until semen analysis reveals azoospermia- 2x
What should you measure after acute urinary retention
Serum creatinine
If medical doesn’t work for BPH what should you offer
TURP
Deciding tx of prostate cancer
Gleason >7 is high grade
Life expectancy
Can- laparoscopic prostatectomy if Gleason is high and young
How RCC can cause oedema
IVC obstruction
Constant Incontinence after childbirth
Vesicovaginal fistula
When is there irreversible necrosis in testicular torsion
4-6 hours after sx start
What are patients who’ve received radiotherapy for prostate cancer at risk of
Colon cancer
Bladder cancer
Rectal cancer
Biggest RF for testicular cancer
Infertility
Types of renal stones
Calcium oxalate
Calcium phosphate- most opaque-
Uric- malignancy- high breakdown- radio Lucent
Cystine- metabolic- Lucent
Struvite- staghorn
Stones may form after illness due to dehydration
How Renal cell carcinoma may be seen on CT
A mass contains solid and liquid components, and is septated.
Organism causing staghorn calculus
Proteus Miribalis
Tx of torsion
Bilateral orchidopexy
Ix of hydronephrosis
USS of renal tract
Goserelin SE
Bone pain
Urinary retention
What medication can help with High calcium and stones formation
Thiazides
If suspect hydrocele what should you do next
Urgent USS
Signs of renal colic and high temperature tx
IV ABx and renal decompression
Bilateral hydronephrosis tx
Catheter can be sufficient- for urethral problems
Conditions associated with epididymal cysts
Von hippel Lindau
CF
PKD
Test to assess whether suture in bladder has healed
Cystogram
Tuberous sclerosis With renal mass
Angiomyolipoma
Renal cancer associated with textiles
Renal transitional cell carcinoma
