Urology Flashcards
can you get above an inguinal hernia
no
severe and sudden onset testicular pain radiating to the abdomen in a young male with a unilaterally swollen and retracted testicle
testicular torsion
what is testicular torsion
twisting of the spermatic cord
what is prehns sign in torsion
elevation of the testicle does NOT ease the pain
what happens to the cremasteric reflex in torsion
it is lost
management of testicular torsion
orchidopexy to BOTH testicles
abnormal enlargement of the testicular veins which feels like a bag of worms
varicocele
which side is most common to get a varicocele
left (due to vessel drainage)
complications of varicocele
infertility
renal cell carcinoma
management of varicocele
generally conservative but if unresolving in left then USS for RCC
soft, non tender fluctuant swelling that is confined to the scrotum and TRANSILLUMINATES
hydrocele
can you get above a hydrocele on examination
yes
two types of hydrocele and management
communicating: self resolve in newborns
non communicating: adults, USS to exclude cancer
painless cysts above and behind the testis in over 40’s which do NOT transilluminate
epididymal cysts
can you get above epididymal cysts on examination
yes
tender and swollen testis with dysuria and discharge
pain eased by elevating testis
epididymo-orchitis
investigations for epididymo-orchitis
young sexually active male: NAAT for chlamydia
older male: MSUS for e.coli
management of prostatitis in young man
screening for STI
14 day ciprofloxacin
main histology for renal cell cancer
adenocarcinoma/clear cell
cause of transitional cell renal cancer
textile industry
paraneoplastic syndrome, cholecystitis and hepatosplenomegaly in renal cell cancer
stauffer syndrome
staging for renal cell cancer
1: less than 7cm
2: more than 7cm
3: to gerota
4: beyond
management of renal cell cancer
nephrectomy
tyrosine kinase - NIB
RF for renal cell and bladder cancer
smoking
presentation of bladder cancer
painless frank haematuria
most common histology for bladder cancer
transitional
management of bladder cancer
cystoscopy/biopsy/TURB/chemo/radio
RF for prostate cancer
afrocaribbean
most common histology for prostate cancer
adenocarcinoma
how is prostate cancer graded
gleason score (10 is aggressive)
1st line investigation for prostate cancer
MRI
medical management of prostate cancer
goserelin (GnRH)
TURP
transurethral resection of the prostate
complications of TURP
Tur syndrome (irrigation fluid enters circulation causing fluid overload, low Na and glycine toxicity - treat with fluid restriction)
Urethral stricture / UTI
Retrograde ejaculation
Perforation of the prostate
most common histology of penile cancer
SCC
discrete testicular nodule with hydrocele or gynaecomastia
testicular cancer
4 RF for testicular cancer
mumps, kleinfelters, infertility, FHx
histology of testicular cancers
Germ cell tumours
- seminomas in over 35 (hCG)
- non-seminomas e.g. teratoma in 25 (AFP)
investigation for testicular cancer
beta hCG and AFP
USS
management of testicular cancer
orchidectomy / chemo /radio
1st and 2nd line management for BPH
1st: Tamsulosin (alpha 1 antagonist)
2nd: Finasteride (5 alpha reductase inhibitor)
which drug causes the side effects of dizziness, hypotension, depression and dry mouth
tamsulosin
which drug causes the side effects of ED, reduced libido, gynaecomastia and can take 6m to take effect
finasteride
investigation for erectile dysfunction
morning testosterone
most common organic cause of ED
vascular issues
2 drugs which can cause ED
SSRI and BB
investigation after vasectomy
2 semen analysis
complication after vasectomy
5% left with chronic pain
2 medication indications for circumcision
phimosis and balantitis
1 contraindication for circumcision
hypospadias in infancy as foreskin used in the repair
loin to groin pain
renal stones
dipstick in renal stones
blood and leukocytes
main investigation for renal stones
non contrast CTKUB
pain relief for renal stones
IM diclofenac
management of renal stones under 5mm
pass spontaneously
management of obstructive renal stones
decompress with nephrostomy
management of renal stones in pregnancy
ureteroscopy
which stones are radio opaque
calcium oxalate
calcium phosphate
struvite
which stones are radio dense
cystine (sulphur)
which stones are radio lucent
uric acid
xanthine
prevention of oxalate stones
cholestyramine and pyridoxine
which stone does increased citrate increase the risk of
calcium oxalate
cause of cystine stones
inherited disorder causing reduced cystine absorption
prevention of urate stones
allopurinol
uric acid is a product of purine metabolism
staghorn calculus due to urease producing bacteria causes which stones
struvite
what does periureteric fat stranding indicate
recent stone passage
investigation for bladder voiding
urodynamic studies
post void volumes in over 65’s
under 50 is normal
diagnosis of urinary incontinence in man with a history of gonorrhoea
urinary stricture
2 things which retention can precipitate
AKI and delirium
what can retention be precipitated by
LUTI
management of overactive bladder
antimuscarinics (oxybutynin, tolterodine, darifenacin)
catheter in a pelvic fracture
suprapubic
pelvic fracture and highly displaced prostate
membranous urethral rupture
scan for hydronephrosis
USS
what is priapism
persistent penile erection not associated with sex commonly caused in sickle cell and requiring cavernous blood gas analysis
