Urology Flashcards
What are storage symptoms to ask about in LUTS?
Urinary incontinence - urgency, stress, mixed
Polyuria (passing larger volumes of urine)
Bladder filling symptoms - urgency, increased or reduced sensitivity
Increased frequency (nocturia)
What are voiding symptoms to ask about in LUTS?
Altered flow
Dysuria, haematuria
Hesitancy (difficulty starting or maintaining flow)
Incomplete bladder emptying
LUTS mx
- Conservative
2.Drugs
a. Moderate to severe LUTS -> Alpha-blocker (alfuzosin, doxazosin, tamsulosin)
b. Overactive bladder -> Anti-chollinergic
c. Big prostate -> 5-alpha reductase (finasteride) [shrinks prostate]
d. Loop diuretic or oral desmopressin -> nocturnal polyuria
- Surgery
- BPH -> transurethral resection of prostate
- Detrusor overactivity -> cystoplasty, botox, sacral nerve stimulation
Px of BPH
Urgency
Nocturia
Weak or intermittent flow
Hesitancy
Terminal dribbling
What drug relaxes prostate and what drug shrinks it?
o Alpha blockers (tamsulosin) relax the prostate
o 5-alpha reductase inhibitors (finasteride) shrink the prostate
Mx of acute and chronic prostatitis?
Acute – Antibiotics (ciprofloxacin or trimethoprim), analgesia, laxative
Chronic:
o Alpha-blockers (tamsulosin)
o Analgesia, laxatives
o Antibiotics if symptoms <6mo or hx of infection (trimethoprim or doxy for 4-6w)
What is interstitial cystitis?
Chronic inflammation of bladder -> LUTs + suprapubic pain [bladder pain syndrome]
- Unknown cause, maybe dysfunction of blood vessels, nerves, immune system & epithelium
Mx of interstitial cystitis?
Supportive – avoid bladder irritants, stop smoking, pelvic floor exercises, bladder retraining
Drugs – analgesia, antihistamines, anticholinergics, other (mirabegron, cimetidine, ciclosporin)
Intravesical drugs – lidocaine, others
Surgery – botox, cautirisation of hunner lesions, neuromodulation, ileocystoplasty, cystectomy
Who gets urinary tract infections?
Women (e.coli spread from anus to urethra)
Urinary catheters
Ix for UTI?
Urinalysis
o Nitrites – GM-ve bacteria break down nitrates in urine into nitrites
o Leukocytes
o RBC
Mid-stream urine sample – microscopy, culture and sensitivity
Mx of UTI?
- Trimethoprim
- Nitrofurantoin (avoid if eGFR <45)
Px of pyelonephritis?
Lower UTI px + sudden onset of
o Fever
o Nausea & vomiting
o Flank pain
Ix for pyelonephritis?
Mid-stream urine for microscopy, culture, and sensitivity
- Consider renal ultrasound
Mx for pyelonephritis?
Broad spectrum antibiotics (co-amoxiclav, cefalexin)
What is a renal cell carcinoma?
Adenocarcinoma arising from renal parenchyma/cortex
Types of RCC?
Clear cell (80%), papillary (15%), chromophobe (5%)
Px of RCC?
Often asymptomatic and dx incidentally
Triad: Haematuria, flank pain, palpable mass
Non-specific symptoms – weight loss, fatigue, night sweats
Paraneoplastic symptoms
What are some paraneoplastic symptoms which may accompany a RCC?
Anaemia
Polycythaemia – ^erythropoietin
Hypercalcaemia – ^PTH-like substance or bony mets
Hypertension – ^renin, renal artery compression
Hypoglycaemia – insulin
Cushing’s syndrome – ACTH
Stauffer’s syndrome – fever, anorexia, abnormal LFTs
Common spread from RCC?
Renal vein and IVC
Cannonball metastatic disease in the lung
Staging of RCC?
1 < 7cm
2 >7cm but confined to kidney
3 Local spread to nearby tissues or veins
4 Spread beyond Gerota’s fascia, including mets
Px of prostate cancer?
- Asymptomatic
- LUTs
- Haematuria
- Erectile dysfunction
Ix of prostate cancer?
LUTS initial investigations
1. Multiparametric MRI
2. Biopsy -> Gleason grading, TNM
+ Bone scan
Mx of prostate cancer?
Watchful waiting
External beam radiotherapy
Brachytherapy – metal seed which delivers continuous radiotherapy
Hormone therapy [has s/e]
o Bicalutamide (androgen receptor blocker)
o GnRH agonists – Goserelin
o Bilateral orchidectomy
Surgery (radical prostatectomy)
o s/e -> urinary incontinence & e.d
Rx of bladder cancer?
Dyes, smoker, schistosomiasis, age >65
Px of bladder cancer?
- Painless haematuria (gross or microscopic)
- Dysuria
- Altered urinary frequency
What is the referral criteria with haematuria?
2 week referral if:
- Unexplained visible haematuria + >45
- >60 + microscopic haematuria + dysuria or ^WBC
Bladder cancer mx?
Non-invasive -> TURBT
Invasive -> Radical cystectomy (T2-4)
Intravesical chemotherapy
BCG vaccine into the bladder -> stimulates immune system to attack bladder tumours
+/- chemo & radio
Who is at risk of testicular cancer?
Most common between 15-35 years
Rx – undescended testes, cryptorchidism, male infertility, FH, ^height
Px of testicular cancer?
Painless hard, irregular lump
Ix for testicular cancer?
- Scrotal ultrasound
- Tumour markers – Alpha-ferroprotein (^teratomas), Beta-hCG (^ both), LDH (non-specific)
- Staging CT
Royal Marsden staging system of testicular cancer
1 Isolated to testicle
2 Retroperitoneal lymph nodes
3 Above diaphragm lymph nodes
4 Mets to other organs
Rx of epididymo-orchitis?
Unprotected sex, bladder outflow obstruction, instrumentation of urinary tract
Organism cause of epidymoorchitis?
If:
- Age < 35, increased number of sexual partners
Discharge from urethra
Enteric organism E.Coli Elderly
Organism cause of epidymoorchitis?
If young think STI - Chlamydia, Gonorrhoea
If old think Enteric organism - E.coli
Px of epididymo-orchitis?
Gradual onset over minutes to hours with unilateral:
- Testicular pain
- Dragging sensation
- Swelling of testicle and epididymis
- Pyrexia
- <6 weeks duration
Mx for epididymo-orchitis?
Enteric organism (e.coli) – Ofloxacin, levofloxacin or co-amoxiclav for 10 days
STI – IM Ceftriaxone +/- doxycycline +/- ofloxacin
Who is at rx of testicular torsion?
Bell clapper deformity
Age <25
Px of testicular torsion?
- Acute rapid onset of unilateral testicular pain +/- abdo pain & vomiting
- Firm swollen testicle
- No pain relief upon elevation of the testicle
- Absent cremasteric reflex
Mx of testicular torsion?
Surgical exploration followed by orchiopexy
