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Medicine year 3 TCD > Urology > Flashcards

Urology Flashcards

1
Q

BPH presentation

A

Storage and voiding symptoms

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2
Q

BPH diagnosis

A

History, DRE, urinalysis, PSA

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3
Q

Where is BPH most common

A

Transition zone of prostate around the urethra (why LUTS presents sooner than in cancer)

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4
Q

BPH treatment options

A

alpha blockers - eg tamsulosin, decrease smooth muscle tone of prostate and bladder, First line
5-alpha reductase inhibitors eg finasteride, reduce DHT production
Surgical treatment- Transurethral resection of prostate (TURP)

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5
Q

Type of cancer and location of prostate cancer

A

Adenocarcinoma and peripheral zone of prostate

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6
Q

Risk factors of prostate cancer

A

Age, obesity, anabolic steroids, black origin, family history- BRCA2 and Lynch

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7
Q

Prostate cancer presentation

A

LUTS similar to BPH, haematuria, erectile dysfunction. generalised symptoms of advanced met cancer

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8
Q

Prostate cancer diagnosis

A

PSA, prostate exam, multiparametric MRI (first line for suspected prostate cancer), prostate biopsy (depends on MRI results eg Likert 3 or above and clinical suspicion)

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9
Q

Prostate cancer scoring system

A

Gleason score. Made up of adding 2 numbers. Score of 6 is low risk, 7 is intermediate risk, 8 is high risk.

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10
Q

Localised prostate cancer management

A

watchful waiting
radical prostatectomy if it’s low grade
external beam radiotherapy (can cause proctitis though)

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11
Q

2 WW referral for prostate cancer

A

PSA > 4 ng/mL
abnormal DRE

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12
Q

Bladder cancer risk factors

A

Smoking
Occupational carcinogens (dye, rubber, cable factory work)
Schistomiasis - most common cause of squamous cell carcinoma in countries w/ a high prevalence of the infection

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13
Q

Bladder cancer risk factors

A

Smoking
Occupational carcinogens (dye, rubber, paint, cable factory work)- working w/ aromatic amines
Schistosomiasis - most common cause of squamous cell carcinoma in countries w/ a high prevalence of the infection
Age
Male
Caucasians

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14
Q

Types of bladder cancer

A

95% transitional cell carcinoma
5% squamous cell carcinoma- higher in areas of schistosomiasis

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15
Q

Presentation of bladder cancer

A

Painless haematuria
Voiding symptoms
Or recurrent UTI which doesn’t clear w/ Abx

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16
Q

Diagnosis of bladder cancer

A

Flexible cystoscopy + biopsy

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17
Q

management of bladder cancer

A

trans urethral resection of bladder tumour (TURBT) in non muscle invasive bladder cancer
intravesical chemotherapy is used after TURBT to reduce recurrence risk, eg mitomycin
high risk: TURBt + intravesical BCG
Detrusor muscle involved- radical cystectomy, often use a urostomy for urine drainage after

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18
Q

schistosomiasis presentation

A

fever, urticaria/angioedmea (rash on skin), arthralgia/myalgia

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19
Q

schistosomiasis risk factors

A

contact w/ fresh water, activies eg swimming , fishing etc

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20
Q

increased cancer risk of which type if schistosomiasis

A

squamous cell carcinoma

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21
Q

what is schistosomiasis

A

parasitic flatworms attacking UT/IT

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22
Q

Renal cell carcinoma- type of cancer?

A

adenocarcinoma

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23
Q

renal cell carcinoma subtypes?

A

80% Clear cell
15% Papillary
5% Chromophobe

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24
Q

renal cell carcinoma risk factors

A

Age, male, smoking, hypertension, Acquired cystic disease of the kidney, chronic paracetamol use, Von Hippel Lindau Disease

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25
Q

renal cell carcinoma presentation

A

painful haematuria
flank pain
palpable mass
non-specific cancer symptoms

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26
Q

renal cell carcinoma 2 week wait referral criteria

A

Aged over 45 w/ unexplained visible haematuria, either w/o a UTI or persisting after treatment for a UTI

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27
Q

renal cell carcinoma diagnosis

A

CT contrast abdomen +/- MRI and image guided biopsy

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28
Q

how do we classify/stage renal cell carcinoma

A

TNM staging
Bosniak classification

29
Q

Paraneoplastic features of renal cell carcinoma

A

Polycythaemia- high RBCs due to secretion of unregulated EPO
Hypercalcaemia - due to secretion of a hormone that mimics the action of parathyroid hormone
HTN- due to increased renin
Stauffer’s syndrome- abnormal LFTs (raised ALT, AST, ALP and bilirubin) w/o liver metastases

30
Q

renal cell carcinoma management

A

surgery is first line- may involve partial nephrectomy or radical nephrectomy. nephrectomy is recommended even in metastatic disease.
When unsuitable for surgery- can use arterial embolisation, percutaneous cryotherapy, radiofrequency ablation

31
Q

Kidney stones common formation points

A

Ureteropelvic junction (ureter coming into the renal pelvis)
Pelvic brim
Vesico-ureteric junction

32
Q

kidney stones causes:

A

Hypercalcaemia
High salt intake
Dehydration
male
white ancestry
eating anything brown/red (tea/coffee/coke/rhubarb/strawberries/radish)
Hyperparatyhroid

33
Q

kidney stones presentation

A

Colicky pain
Loin to groin
N/V
Haematuria
Reduced urine output
symptoms of infection

34
Q

Diagnosis of kidney stones

A

Non contrast CT KUB is first line and gold standard
USS if pregnant or hydronephrosis
AXR shows calcium based stones
urine dipticks will show haematuria
U&Es- reduced eGFR, inflammatory markers

35
Q

Management of kidney stones

A

Analgesia- NSAIDs eg IM diclofenac, ibuprofen. IV paracetamol
Symptom control- antiemetics eg metoclopramide, antibiotics
Watchful waiting in stones less than 5mm
Surgical intervention required in larger stones, stones that don’t pass spontaneously or where there’s complete obstruction or infection- eg Extracorporeal shockwave lithotripsy, Ureteroscopy + laser lithotripsy, Percutaneous nephrolithotomy, open surgery

36
Q

types of kidney stone?

A

Calcium oxalate (85%) on CT is radiopaque + spiky, can reduce risk by low protein/salt diet/ thiazide diuretics
Calcium phosphate - CT is radiopaque and white/smooth. risk factor is alkaline urine.
Uric acid - CT is radiolucent + brown/smooth. Not visible on x ray. Caused by excess tissue breakdown.
Struvite- produced by bacteria so associated w/ infection. CT - slightly radiopaque, staghorn calculus

37
Q

Management of localised advanced prostate cancer

A

hormonal therapy
radical prostatectomy
radiotherapy- external beam and brachytherapy

38
Q

Management of metastatic prostate cancer

A

hormonal therapy- reduce androgen therapy
give synthetic GnRH agonist eg Goserelin. Initially cover this w/ an anti androgen to prevent a rise in testosterone eg, bicalutamide, cyproterone acetate
abiraterone
bilateral orchidectomy
chemotherapy w/ docetaxel

39
Q

Management of recurrent kidney stones

A

increase oral fluid intake (2.5-3 litres daily)
add fresh lemon juice to water
avoid carbonated drinks
reduce salt intake
maintain normal calcium intake
potassium citrate in patients w/ calcium oxalate stones
thiazide diuretics eg indapamide in pts w/ calcium oxalate stones

40
Q

UTI is more common among?

A

Females due to shorter urethra

41
Q

most common UTI bacteria

A

E. Coli

42
Q

UTI Symptoms

A

Increased frequency and urgency
Dysuria (pain when passing urine), burning
suprapubic pain
maybe haematuria

43
Q

UTI diagnosis

A

urine dip:
leukocyte esterase
Nitrites- gram negative bacteria like e coli break down nitrates to nitrites.
RBCs show haematuria
Presence of nitrites or leukocytes + RBCs = patient likely to have UTI
nitrites + leuocytes = requires UTI treatment
only nitrites are present- treat for UTI

44
Q

UTI management

A

3 days of Abx for a simple lower UTI in women - Trimethoprim or Nitrofurantoin
5-10 days for immunosuppressed women, w/ abnormal anatomy or impaired kidney function
7 days of Abx for men, pregnant women or catheter related UTIs:
for men - trimethoprim or nitrofurantoin offered first line under prostatitis is suspected. for pregnant women: first line- nitrofurantoin (avoid in 3rd trimester), second line - amoxicillin or cefalexin

45
Q

Haematuria differentials

A

Bladder cancer (usually painless)
Renal cancer
UTI
Stones
Nephrological disease eg glomerulonephritis
Prostate disease
Systemic disease eg SLE, GPA

46
Q

2 week wait referral criteria for haematuria

A

45+ w/
a) unexplained visible haematuria w/o UTI - RCC
b) visible haematuria persisting/recurring after UTI treatment - bladder cancer
c) 60+ w/ unexplained non-visible haematuria and dysuria or raised WCC - bladder cancer
d) non urgent referral for bladder cancer if 60+ w/ recurrent or persistent unexplained UTI

47
Q

testicular torsion risk factors

A

10-30 y/o
Bell Clapper Deformity- testicle not attached to tunica vaginalis at posterior, higher chance of torsion.

48
Q

testicular torsion presentation

A

sudden sharp unilateral testicular pain
abdo pain
N&V

49
Q

testicular torsion signs

A

firm swollen testicle
retracted upwards (elevated)
loss of cremasteric reflex
abnormal testicular lie (often horizontal)
Rotation of epididymis
Can diagnose based on clinical signs, on USS whirlpool sign tho

50
Q

testicular torsion management

A

analgesia
orchidopexy - fixation of testicle within scrotum, usually bilateral.
Orchidectomy if delayed surgery/ presence of necrosis

51
Q

testicular cancer risk factors

A

20-30 year old male
Infertility
Undescended testes
family history
Klinefelters

52
Q

testicular cancer types

A

Germ cell (produce gametes) - 95%; Seminoma, Non-seminoma (embryonic, yolk sac, teratomas)
Non-Germ Cell - 5%; Leydig Cell Carcinoma, Sarcoma

53
Q

testicular cancer presentation

A

painless testicular lump
Hard + irregular
Non Translucent
Gynaecomastia in Leydig Cell cancer

54
Q

Testicular cancer investigation first line

A

Scrotal USS

55
Q

testicular cancer markers

A

AFP: raised in teratomas
Beta-HCG raised in teratomas + seminomas
Lactate dehydrogenase : non specific tumour marker

56
Q

testicular cancer staging

A

Royal Marsden Staging

57
Q

testicular cancer management

A

depends on whether seminoma or non-seminoma
Orchidectomy
Chemotherapy
Radiotherapy
Sperm banking

58
Q

Prognosis of testicular cancer

A

seminomas have a slightly better prognosis, both over 95% 5 year survival.

59
Q

Testicular cancer long term side effects

A

infertility, hypogonadism, peripheral neuropathy, hearing loss

60
Q

hydrocele presentation

A

painless
soft scrotal swelling
palpable testicle
transilluminable
no bowel sounds

61
Q

varicocele- what is it?

A

pampiniform plexus veins become swollen, most common on the left due to increased resistance in the left testicular vein. left sided varicocele can indicate an obstruction of the left testicular vein caused by a RCC. Can cause impaired fertility due to raising temperature, testicular atrophy

62
Q

varicocele presentation

A

dragging sensation
throbbing/dull pain, worse on standing
sub/infertility

63
Q

varicocele signs

A

scrotal mass feels like a bag of worms
more prominent on standing
disappears when lying down, if not then raises concerns about retroperitoneal tumours obstructing drainage of the renal vein

64
Q

epididymal cysts what are they

A

occur at head of epididymis. fluid filled sac. v common around 30% incidence. usually harmless and not associated w/ infertility or cancer

65
Q

epididymal cysts- symptoms

A

may be asymptomatic, or painless swelling in upper testicle

66
Q

epididymal cysts signs

A

soft fluctuant mass separate to testicle, typically at the top
may be able to transilluminate large cysts

67
Q

indirect inguinal hernia what is it

A

bowel herniates thru the inguinal canal and into the scrum

68
Q

indirect inguinal hernia symptoms

A

soft fluctunat bulge in the scrotum. painless swelling in upper testicle

Medicine year 3 TCD (10 decks)

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