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Finals > Urology > Flashcards

Urology Flashcards

1
Q

What are the causes of acute urinary retention?

A
  • benign prostatic hyperplasia
  • urethral strictures/calculi
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2
Q

What is the presentation of acute urinary retention?

A
  • inability to pass urine
  • lower abdominal discomfort
  • pain
  • confusion in elderly patients
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3
Q

What are the signs of acute urinary retention?

A
  • palpable distended bladder
  • lower abdominal tenderness
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4
Q

Investigation for acute urinary retention

A
  • bladder scan >300cc
  • urine dip and culture
  • UEs
  • creatinine
  • FBC
  • CRP
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5
Q

What is the management of acute urinary retention?

A
  • urinary catheterisation (measure the urine drained in 15 minutes >400cc confirms retnetion, <200 excludes)
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6
Q

What is a complication of acute urinary retention?

A

Post obstructive diuresis - worsening of AKI and volume depletion

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7
Q

What is the cause of chronic urinary retention?

A

High pressure retention: impaired renal function and bilateral hydronephrosis, typically due to bladder outflow obstruction

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8
Q

What are the transient causes of haematuria?

A
  • UTI
  • menstruation
  • vigorous exercise
  • sexual intercourse
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9
Q

What are the causes of non visible haematuria?

A
  • cancer
  • stones
  • BPH
  • prostatits
  • urethritis
  • renal causes e.g. IgA nephropathy
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10
Q

What are the causes of visible haematuria?

A
  • prostate/bladder cancer
  • Stones
  • BPH
  • UTI/acute pyelonephritis
  • trauma
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11
Q

Investigations for haematuria

A
  • urinalysis
  • U+Es
  • Albumin: protein (ACR) or protein: creatinine ratio (PCR)
  • blood pressure
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12
Q

Explain referral to urology

A

Urgent referral
- If age >45: unexplained haematuria without UTI, or persists/recurs after treatment for UTI
- If age>60: unexplained non-visible haematuria and dysuria or increased WCC

Non urgent
- Age>60 with recurrent or persistent UTI

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13
Q

What are the types of testicular cancer?

A
  • 95% are germ cell tumours = seminomas and non seminomas
  • Non seminomas = teratotmas, yolk sac, embryological and choriocarcinoma)
  • non germ cell: leydig tumours and sarcomas
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14
Q

What are the risk factors for testicular cancer?

A
  • infertility
  • cryptorchidism
  • family history
  • klinefelter’s
  • mumps orchitis
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15
Q

What is the peak incidence for teratomas?

A

25

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16
Q

What is the peak incidence for seminomas?

A

35

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17
Q

What is the presentation of testicular cancer?

A
  • painless lump
  • pain
  • hydrocele
  • gynaecomastia (in germ cell and leydig)
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18
Q

Investigations testicular cancer

A
  • ultrasound scan
  • tumour markers: alpha fetoprotein (teratoma); beta hCG (teratoma and seminoma); LDH (non specific)
  • staging CT scan
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19
Q

Explain the royal marsden staging system

A
  • stage 1: isolated to the testicle
  • stage 2: retroperitoneal lymph node spread
  • stage 3: spread to lymph nodes above the diaphragm
  • stage 4: metastasised to other organs
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20
Q

What is the most common metastasis from testicular cancer?

A
  • lymphatics
  • lung
  • liver
  • brain
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21
Q

What is the management of testicular cancer?

A
  • radical orchidectomy
  • chemotherapy/radiotherapy
  • sperm banking
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22
Q

What is testicular torsion?

A

Urological emergency caused by twisting of the testicle on the spermatic cord causing constriction of the vascular supply

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23
Q

What is the presentation of testicular torsion?

A
  • sudden onset testicular pain
  • nausea and vomiting
  • negative prehn’s sign
  • absent cremasteric reflex
  • swollen testes, retracted upwards
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24
Q

What is prehn’s sign?

A

No pain relief on elevation of the scrotum

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25
Q

What is the management of testicular torsion?

A
  • emergency scrotal exploration
  • morphine and ondasetron
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26
Q

What are the causes of testicualr torsion?

A
  • trauma
  • bell clapper testis
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27
Q

What are the complications of testicular torsion?

A

Testicular damage/loss leading to infertility and cosmetic deformity

28
Q

What is the presentation of BPH?

A
  • Storage symptoms: urgency, frequency, urgency incontinence, nocturia
  • voiding symptoms: weak flow, straining, hesitancy, terminal dribbling, incomplete emptying
29
Q

What are the storage symptoms?

A
  • urgency
  • frequency
  • urgency incontinence
  • nocturia
30
Q

What are the voiding symptoms?

A
  • weak flow
  • straining
  • hesitancy
  • terminal dribbling
  • incomplete emptying
31
Q

Investigations for BPH

A
  • urinalysis (should be normal if uncomplicated)
  • prostate specific antigen
  • IPSS -mild 0-7, moderate 8-19, severe 20-35
  • volume charting for at least 3 days
32
Q

What is the management of BPH?

A
  • behavioural management programme
  • alpha blocker: terazosin
  • 5-alpha-reductase inhibitor: finasteride (indicated if large prostate and high risk of progression)
  • anti-cholinergic: tolterodine
33
Q

What are the complications of BPH?

A
  • UTI
  • renal insufficiency
  • bladder stones
  • haematuria
  • sexual dysfunction
34
Q

What is the presentation of renal stones?

A
  • renal colic: unilateral loin to groin pain
  • haematuria
  • nausea and vomiting
  • decreased urine output
35
Q

Investigations for stones

A
  • Non-contrast helical CT scan/renal USS if CT is contraindicated
  • urinalysis
  • FBC: increased WCC may suggest infection
  • UEs - any hypercalcaemia? or hyperuricaemia?
36
Q

What is the management of renal stones?

A
  • NSAID, anti-emetics (metoclopramide), antibiotics, tamsulosin
  • watch and wait if <5mm it is likely to pass without intervention
  • surgery if large stone, infection or renal abnormality
37
Q

What is the urgent management of renal stones?

A
  • decompression
  • ureteric stent or percutaneous nephrostomy tube
38
Q

Surgery if renal stone <10mm

A

Shock wave lithotripsy

39
Q

Surgery if renal stone 10-20mm

A

Shock wave lithotripsy or ureteroscopy

40
Q

Surgery if renal stone >20mm or staghorn

A

Pecutaneous nephrolithotomy

41
Q

Management of recurrent renal stones

A
  • increase oral intake (2.5-3L a day)
  • add fresh lemon juice to water
  • avoid carbonated drinks
  • reduce dietary salt
  • maintain normal calcium intake
  • thiazide (if calcium stones) or potassium citrate (calcium oxalate stones)
42
Q

What are the types of renal stone?

A
  • Calcium oxalate
  • cysteine
  • uric acid
  • calcium phosphate
  • struvite
43
Q

Which of the renal stones are visible on x ray?

A
  • calcium oxalate
  • cysteine
  • calcium phosphate
  • struvite
44
Q

Which type of renal stone can form a staghorn shape?

A

Struvite

45
Q

Which drugs increase the risk of calcium renal stones?

A
  • loop diuretics
  • acetazolamide
  • theophylline
  • steroids
46
Q

Which stones are more likely with a high urinary pH?

A

Calcium phosphate

47
Q

Which stones are more likely with a low urinary pH?

A

uric acid

48
Q

What is the management of hydronephrosis?

A

If an upper obstruction:
- acute: percutaneous nephrostomy tube
- Chronic: ureteric stent

If lower obstruction:
- urinary or suprapubic catheter

49
Q

What are the risk factors for bladder cancer?

A
  • Smoking
  • age
  • aromatic amines
  • schistosomiasis (squamous cell)
50
Q

What are the types of bladder cancer?

A
  • transition cell
  • squamous cell
  • adenocarcinoma
51
Q

What is the presentation of bladder cancer?

A

Painless haematuria

52
Q

What is the investigation for bladder cancer?

A
  • Cystoscopy: flexible or rigid
53
Q

T staging of bladder cancer

A
  • T0: no evidence of tumour
  • Ta: non-invasive papillary carcinoma
  • T1: invades the sub epithelial connective tissue
  • T2: a: superficial/b: deep invasion of muscularis propria
  • T3: perivesical fat
  • T4a: prostatic stroma, seminal vesicle, uterus, vagina
  • T4b: pelvic sidewall/abdominal sidewall
54
Q

N staging of bladder cancer

A
  • N0: no nodal disease
  • N1: single regional lymph node
  • N2: Multiple regional lymph nodes
  • N3: common iliac lymph nodes
55
Q

M staging of bladder cancer

A
  • M0: no distant mets
  • M1: distant mets
56
Q

What is the management of bladder cancer?

A
  • Transurethral resection of bladder tumour (TURBT): if non muscle invasive
  • Intravesicle chemotherapy
  • Intravesicle BCG
  • Radical cystectomy
57
Q

What is the presentation of prostate cancer?

A
  • asymptomatic
  • lower UTI symptoms
  • Haematuria
  • erectile dysfunction
  • symptoms of advanced disease or metastasis (weight loss, bone pain, cauda equina)
58
Q

What are the causes of a mildly raised PSA?

A
  • prostate cancer
  • BPH
  • prostatitis
  • UTI
  • vigorous exercise
  • Recent ejaculation or prostate stimulation
59
Q

What should a prostate normally feel like?

A
  • smooth
  • symmetrical
  • slightly soft
  • central sulcus
60
Q

What should an infected prostate feel like?

A
  • enlarged
  • tender
  • warm
61
Q

What should a cancerous prostate feel like?

A
  • firm/hard
  • asymmetrical
  • craggy/irregular
  • loss of central sulcus
62
Q

Investigation for prostate cancer

A
  • multiparametric MRI
  • prostate biopsy (transrectal ultrasound guided biopsy)
  • isotope bone scan
63
Q

What are the investigations that should be carried out in someone presenting with erectile dysfunction?

A
  • free testosterone (measured between 9 and 11am)
  • lipid and fasting glucose levels to calculate 10 year cardiovascular risk
64
Q

What are the features of renal cell carcinoma?

A

Classical triad:
- Haematuria
- loin pain
- abdominal mass

Plus:
- fever of unknown origin
- varicocele (due to tumour compressing veins)
-

65
Q

What are the features of epididymo-orchitis?

A
  • unilateral testicular pain and swelling
  • urethral discharge
66
Q

Investigation for epidiymo-orchitis

A
  • STI (Chlamydia trachomatis and Neisseria gonorrhoeae)
  • MSU microscopy and culture (E.coli)
67
Q

What are the causes of scrotal swelling?

A
  • inguinal hernia
  • testicular tumour: discrete testicular nodule
  • acute epididymo-orchitis: tender swelling, phren’s sign may be positive
  • epididymal cysts: painless, can ge behind cysts
  • hydrocele: transilluminate
  • testicular torsion: severe onset testicular pain
  • varicocele: typically on the left

Finals (37 decks)

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