Urology Flashcards
True or false; prostate cancer always presents with a raised PSA
False - can be normal
State whether the following renal stones are opaque or radiolucent
1 Calcium oxalate 2 Mixed oxalate/phosphate 3 Triple phosphate 4 Urate 5 Cysteine 6 Xanthine
1 Opaque 2 Opaque 3 Opaque 4 Radiolucent 5 Semiopaque 6 Radiolucent
What is the cremasteric reflex and when is it lost?
Stroking the inner thigh causes ipsilateral testicular retraction.
Absent in torsion
Which drugs commonly cause erectile dysfunction?
SSRIs
Beta blockers
What is the best investigation for hydronephrosis?
Ultrasound of the renal tract
What is the first line management of hydronephrosis?
Nephrostomy
What are the causes of hydronephrosis?
Unilateral - PACT Pelvic ureteric obstruction Aberrant vessels Calculi Tumour
Bilateral - SUPER Stenosis of urethra Urethral valve Prostate Extensive bladder tumour Retroperitoneal fibrosis
WHat are staghorn calculi typically composed of?
Mangeium ammonium phosphate (triple phosphate Struvite) stones
Which infection is most commonly associated with staghorn calculi?
Proteus mirabilis
Renal cancer with exposure to textiles industry?
TCC
What type of renal cancer is associated with Tuberous Sclerosis?
Angiomyolipoma
How might a lower UTI precipitate urinary retention?
Urethritis _> oedema -> retention
What is the use of a PSA in urinary retention?
None - it is generally raised due to compression
How do you diagnose acute retention?
Bladder scan with >300ml volume
What is the first line investigation in suspected prostate cancer?
Multiparametric MRI (NOT TRUS guided biopsy)
What is the most common type of prostate cancer?
Adenocarcinoma
What is the first line investigation for any testicular lump?
Ultrasound
What complication may occur after acute urinary retention, and how should it be monitored for?
AKI
Cr
What should be done for a patient with an unresolved varicocele?
Renal tract USS
What is the commonest infective agent of epididimo orchitis in a patient with a low vs. high STI risk?
E coli in low risk
Chlamydia in high risk
What is the commonest cause of scrotal swelling seen in primary care, and what are its features?
Epididymal cysts
Separate from body of testicle on the posterior aspect
What are the features of a hydrocele?
Soft non tender swelling antero-inferior to the testicle
You can get above the mass
Transluminates
What are the side effects of tamsulosin?
Dizziness
Postural hypotension
Dry mouth
Depression
What are the side effects of finestaride?
ED
Reduced libido
Ejaculation problems
Gynaecomastia
What is the first step in the management of patients with chronic urinary retention and hydronephrosis?
Intermittent self catheterisation
WHich has the better prognosis, seminoma or teratoma?
Seminoma
What investigation should be done in the event of priapism and why?
Cavernosal blood gas analysis to distinguish between ischaemic and non ischaemic priapism
Which type of renal calculus is associated with an inherited metabolic disorder?
Cystine
What type of renal stone would you see in a patient undergoing chemo?
Urate (radiolucent)
What are the features of a nephroblastoma (WIlm’s tumour)
Early (first 4 years)
Haematuria with mass
50% have pyrexia
Lung mets
What does periureteric fat stranding indicate?
Recent stone passage
What testicular pathology may occur after a urological intervention?
Epidydimo orchitis
WHat are some common complications following radical prostatectomy?
Incontinence
ED
Urethral stenosis
What might occur in the early stages of treatment with 5alha reducatas inhibitors, and how can this be prevented?
A transient rise of prostate symptoms known as the ‘flare effect’ due to increase in LH production prior to receptor down regulation
Flutamide is a synthetic antiandrogen which can be used to attenuate this flare
Measurement of PSA should be deferred for how long after prostatitis?
1 month
True or false, the cremasteric reflex is present in torsion of the testicular appendage
True
What is the commonest type of renal carcinoma?
Adenocarcinoma
Which urological malignancy (other than RCC) metastasises to the lungs?
Teratoma - common in younger males
What are the prophylactic benefits of circumcision?
Reduced risk of penile cancer
Reduced risk of UTI
Reduced risk of STIs including HIV
What is the strongest risk factor for testicular cancer?
Infertility (3x higher)
Manageme4nt of renal calculi with signs of infection?
Surgical decompression
What is a contraindication to circumcision?
Hypospadias
A 75-year-old man presents with a swelling in his right scrotum. On examination a large, non-tender swelling is found in the scrotum. You cannot palpate above the swelling during the examination.
Inguinal hernia, as you cannot palpate above the swelling
WHat are the commonest causes of organic erectile dysfunction?
Vascular - e.g. CVD, HTN, DM etc
What cancer are patients with schistosomiasis at risk of?
Squamous cell carcinoma of the bladder
What is the preferred management of urolithiasis in pregnant women?
Ureteroscopy
What is the management of a stone burden <2cm?
Shock wave lithotripsy with urinary alkalinization
Prostate cancer radiotherapy puts patients at increased risk of which cancers?
Bladder
Colon
Rectal
How long does finestaride take to work?
6 months
AFP and HCG are typically normal and raised in whicy types of t esticular cancer?
Normal in seminomas
Raised in teratomas and yolk sac tumours
WHich type of testicular lump is associated with infertility?
Varicoceles
What is recommended as pain management in renal colic?
75 IM diclofenac
What should be prescribed in the first 3 weeks of goserelin treatment?
Cyproterone acetate (anti-androgen)
Balanitis xerotica obliterans may cause…?
Phimosis
Schistosomiasis is a risk factor for which type of renal cancer?
Squamous cell carcinoma of the bladder
What are the complciations of TURP?
TURP
Turp syndrome: Dilutional hyponatraemia Fluid overload Glycine toxicity Occurs due to irrigation fluid entering the systemic circulation
Urethral stricture/UTI
Retrograde ejaculation
Perforation of the prostate
What is a normal post void bladder volume in under and over 65 year olds?
<65 - <50ml
>65 - <100ml
What is the mechanism of Goserelin?
GnRH agonist
