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Finals HH > Urology > Flashcards

Urology Flashcards

1
Q

What are storage symptoms to ask about in LUTS?

A

Urinary incontinence - urgency, stress, mixed

Polyuria (passing larger volumes of urine)

Bladder filling symptoms - urgency, increased or reduced sensitivity

Increased frequency (nocturia)

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2
Q

What are voiding symptoms to ask about in LUTS?

A

Altered flow

Dysuria, haematuria

Hesitancy (difficulty starting or maintaining flow)

Incomplete bladder emptying

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3
Q

LUTS mx

A
  1. 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

  1. Surgery
    - BPH -> transurethral resection of prostate
    - Detrusor overactivity -> cystoplasty, botox, sacral nerve stimulation
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4
Q

Px of BPH

A

Urgency
Nocturia
Weak or intermittent flow
Hesitancy
Terminal dribbling

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5
Q

What drug relaxes prostate and what drug shrinks it?

A

o Alpha blockers (tamsulosin) relax the prostate
o 5-alpha reductase inhibitors (finasteride) shrink the prostate

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6
Q

Mx of acute and chronic prostatitis?

A

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)

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7
Q

What is interstitial cystitis?

A

Chronic inflammation of bladder -> LUTs + suprapubic pain [bladder pain syndrome]
- Unknown cause, maybe dysfunction of blood vessels, nerves, immune system & epithelium

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8
Q

Mx of interstitial cystitis?

A

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

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9
Q

Who gets urinary tract infections?

A

Women (e.coli spread from anus to urethra)
Urinary catheters

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10
Q

Ix for UTI?

A

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

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11
Q

Mx of UTI?

A
  • Trimethoprim
  • Nitrofurantoin (avoid if eGFR <45)
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12
Q

Px of pyelonephritis?

A

Lower UTI px + sudden onset of
o Fever
o Nausea & vomiting
o Flank pain

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13
Q

Ix for pyelonephritis?

A

Mid-stream urine for microscopy, culture, and sensitivity
- Consider renal ultrasound

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14
Q

Mx for pyelonephritis?

A

Broad spectrum antibiotics (co-amoxiclav, cefalexin)

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15
Q

What is a renal cell carcinoma?

A

Adenocarcinoma arising from renal parenchyma/cortex

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16
Q

Types of RCC?

A

Clear cell (80%), papillary (15%), chromophobe (5%)

17
Q

Px of RCC?

A

Often asymptomatic and dx incidentally

Triad: Haematuria, flank pain, palpable mass

Non-specific symptoms – weight loss, fatigue, night sweats

Paraneoplastic symptoms

18
Q

What are some paraneoplastic symptoms which may accompany a RCC?

A

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

19
Q

Common spread from RCC?

A

Renal vein and IVC

Cannonball metastatic disease in the lung

20
Q

Staging of RCC?

A

1 < 7cm
2 >7cm but confined to kidney
3 Local spread to nearby tissues or veins
4 Spread beyond Gerota’s fascia, including mets

21
Q

Px of prostate cancer?

A
  • Asymptomatic
  • LUTs
  • Haematuria
  • Erectile dysfunction
22
Q

Ix of prostate cancer?

A

LUTS initial investigations
1. Multiparametric MRI
2. Biopsy -> Gleason grading, TNM
+ Bone scan

23
Q

Mx of prostate cancer?

A

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

24
Q

Rx of bladder cancer?

A

Dyes, smoker, schistosomiasis, age >65

25
Q

Px of bladder cancer?

A
  • Painless haematuria (gross or microscopic)
  • Dysuria
  • Altered urinary frequency
26
Q

What is the referral criteria with haematuria?

A

2 week referral if:
- Unexplained visible haematuria + >45
- >60 + microscopic haematuria + dysuria or ^WBC

27
Q

Bladder cancer mx?

A

Non-invasive -> TURBT
Invasive -> Radical cystectomy (T2-4)

Intravesical chemotherapy

BCG vaccine into the bladder -> stimulates immune system to attack bladder tumours

+/- chemo & radio

28
Q

Who is at risk of testicular cancer?

A

Most common between 15-35 years

Rx – undescended testes, cryptorchidism, male infertility, FH, ^height

29
Q

Px of testicular cancer?

A

Painless hard, irregular lump

30
Q

Ix for testicular cancer?

A
  • Scrotal ultrasound
  • Tumour markers – Alpha-ferroprotein (^teratomas), Beta-hCG (^ both), LDH (non-specific)
  • Staging CT
31
Q

Royal Marsden staging system of testicular cancer

A

1 Isolated to testicle
2 Retroperitoneal lymph nodes
3 Above diaphragm lymph nodes
4 Mets to other organs

32
Q

Rx of epididymo-orchitis?

A

Unprotected sex, bladder outflow obstruction, instrumentation of urinary tract

33
Q

Organism cause of epidymoorchitis?

A

If:
- Age < 35, increased number of sexual partners
Discharge from urethra

Enteric organism E.Coli Elderly

34
Q

Organism cause of epidymoorchitis?

A

If young think STI - Chlamydia, Gonorrhoea
If old think Enteric organism - E.coli

35
Q

Px of epididymo-orchitis?

A

Gradual onset over minutes to hours with unilateral:
- Testicular pain
- Dragging sensation
- Swelling of testicle and epididymis
- Pyrexia
- <6 weeks duration

36
Q

Mx for epididymo-orchitis?

A

Enteric organism (e.coli) – Ofloxacin, levofloxacin or co-amoxiclav for 10 days

STI – IM Ceftriaxone +/- doxycycline +/- ofloxacin

37
Q

Who is at rx of testicular torsion?

A

Bell clapper deformity
Age <25

38
Q

Px of testicular torsion?

A
  • Acute rapid onset of unilateral testicular pain +/- abdo pain & vomiting
  • Firm swollen testicle
  • No pain relief upon elevation of the testicle
  • Absent cremasteric reflex
39
Q

Mx of testicular torsion?

A

Surgical exploration followed by orchiopexy

Finals HH (21 decks)

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