Urology Flashcards
Investigations for ED
- Bloods - glucose, testosterone, lipids
- Neuro exam
- Duplex - to evaluate blood flow
- Thorough hx about psych/stress causes
Testicular cancer
Presentation:
- Painless lump (sometimes pain)
- Hydrocele or varicoele
- Gynaecomastia
Investigations:
- US
- Chest exam - mets go to lungs
- AFP, bHCG, LDH while waiting for 2WW
Management:
- Orchidectomy
- ?Chemo/radio
Epididymo-orchitis
Caused by spread of infection to epididymis or testes
Presentation:
- Unilateral pain/swelling
- May have urethral discharge
- May have systemic symptoms
- Positive Prehn’s sign - lifting testicle relieves pain
Investigations:
- If young - investigate for STIs
- If older - other cause is UTI
Management:
- Antibiotics depending on sensitivity. Ceftriaxone 500mg IM plus doxycycline for 10-14 treats STIs empirically
Hydrocele
Accumulation of fluid within the tunica vaginalis
Common in new borns - leave until 1-2yrs
Presentation:
- Transluminating swelling around testicle
Investigation:
- US to exclude torsion, tumours
Managment:
- Nothing if manageable
- Drain (if not surgically fit)
- Surgical repair - better results and less infection
- No
Renal stones
Presentation:
- Severe loin to groin pain
- Nausea and vomiting
Investigations:
- Urine dip and culture
- FBC, U+Es, CRP, calcium/urate
- Non-contrast CT-KUB
Management:
- NSAIDs for pain relief - IM diclofenac
- If v small - less than 5mm, leave to pass spontaneously
- If smaller than 2cm - shock wave lithotripsy
- If larger/more complex - percutaneous nephrolithotomy
- If pregnant - uteroscopy and stent
- If risk of urosepsis - urgent surgical decompression using a nephrostomy tube and put in a stent
Risk factors for renal stones
- Dehydration
- Hyper calcaemia
- Renal tubular acidosis
- ADPKD
- Loop diuretics
- High dietary oxalate
BPH
80% of 80 year olds
Presentation:
- LUTS e.g. voiding symptoms, storage issues
- Complications - UTIs, retention
Investigations:
- Urine dip (infection)
- U+Es (retention)
- PSA
- International Prostate Symptom Score to classify how severe LUTS are
Management:
- Alpha-1-antagonists - e.g. tamsulosin to reduce tone of prostate and bladder to make voiding easier
- 5 Alpha reductase inhibitors - e.g. finasteride - blocks conversion of testosterone to dihydrotestosterone which acts on prostate and increases its size
- Trans urethral resection of the prostate (TURP)
Side evffects of alpha 1 antagonists
Postural hypotension
Varicocele
Enlargement of testicular veins. Can be associated with renal cancer as L testicular veins drain into renal veins and cancer can obstruct this.
Presentation:
- Uncomfortabel ‘bag of worms’
Investigation:
- Doppler
- Check for renal cancer, testicular cancer
Management:
- Nothing if okay
- Surgery
Prostate cancer
Adenocarcinoma.
Presentation:
- May have LUTS (although mostly found in peripheral zone which means it’s not necessarily pressing on urethra)
Investigation:
- DRE
- PSA
- MRI
- Trans perineal biopsy - Gleason grading based on histology
- Bone scan for staging
Management:
- T2N0M0 is curable
- Radiotherapy
- Radical prostatectomy
- Hormone treatment - LHRH agonists, anti-androgens
- Active surveillance
Side effects of prostatectomy/TURP
Incontinence
Strictures
ED
Retrograde ejaculation
Epididymal cyst
Presentation:
- Testicular swelling that feels separate from the testicle
Investigation:
- Confirm no underlying involvement with testicle e.g. tumours with US
Management:
- None
- Surgery
Bladder cancer
Most common - TCC
Presentation:
- Painless haematuria
Investigation:
- Flexible cystoscopy
- US
Management:
- If superficial - trans-urethral removal of bladder tumour (TURBT) and adjunct intravesicle chemotherapy
- If high grade - radical cystectomy/radical radiotherapy
Complication of draining after chronic urinary retention
- Decrompression haematuria due to rapid decrease in pressure
- Diuresis - which can lead to AKI due to fluid loss
Differentials for haematuria
Infection, stones, cancer
