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Y3 Surgery > Urology > Flashcards

Urology Flashcards

1
Q

What is the definition of haematuria ?

A

The presence of blood in the urine either visible or non-visible.

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2
Q

What is the classification of haematuria ?

A

Visible - blood is visible in urine colouring it pink, red or dark brown

Non-visible - blood is present in the urine on urinalysis but not visible. This can be separated further for symptomatic and non-symptomatic.

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3
Q

What are some causes of haematuria ?

A

UTI
Renal cancer
Bladder cancer
Renal calculi
Prostate cancer
BPH
Glomerulonephritis
Goodpasture’s disease

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4
Q

What key questions should be asked to assess haematuria ?

A

Quantity ( pink vs dark red )
Presence of clots
Any fever, suprapubic pain, flank pain, weight loss or recent trauma
Drug history and smoking status
Recent foreign travel

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5
Q

What simple investigations should be performed for haematuria ?

A

Urinalysis - the presence of leucocytes and nitrates may suggest UTI

Baseline bloods - FBC, U&E’s and clotting, PSA in men,

Referral to a urologist may be needed

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6
Q

What is the criteria for a urological referral for haematuria ?

A

Aged over 45 with either :
- unexplained visible haematuria with no UTI
- visible haematuria that persists or recurs after successful treatment of a UTI

Aged over 60 with unexplained non-visible haematuria and either dysuria or a raised WCC

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7
Q

What are some specialist investigations that are performed for haematuria ?

A

Flexible cytoscopy is gold standard
USS of renal tract
CT urogram

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8
Q

What is the pathophysiology of RCC ?

A

It is an adenocarcinoma of the renal cortex arising from the proximal convoluted tubule most often appearing in the upper pole of the kidney.
It spreads through direct invasion ( perinephric tissues, adrenal gland or renal vein )and lymphatic system ( nodes ) or haematogenous ( bones, liver, brain and lungs ).

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9
Q

What are some risk factors for RCC ?

A

Smoking
Industrial exposure to carcinogens ( cadmium, lead )
Dialysis
HTN
Diabetes
PCKS

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10
Q

What are some clinical features of RCC ?

A

Haematuria ( visible or non-visible )
Flank pain
Flank mass
Lethargy
Weight loss

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11
Q

What is the classic triad of RCC ?

A

Haematuria
A mass
Flank pain

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12
Q

What may be seen on examination in someone with RCC ?

A

Mass palpated in the flank or hypochondrial region
Left sided masses may also be present with a left varicocoele due to compression of the left testicular vein as it joins the renal vein.

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13
Q

What are some investigations for RCC ?

A

Routine bloods - FBC, U&E’S, LFTs, CRP
Urinalysis
Urine cytology
USS renal tract, kidneys

CT imaging - abdomen pelvis ( pre and post contrast ) is gold standard
Biopsy

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14
Q

What is the management for a localised RCC ?

A

Smaller tumours - partial nephrectomy
Larger tumours - radical nephrectomy ( removal of the kidney, perinephric fat and local lymph nodes )
Not suitable for surgery - percutaneous radio frequency nephrectomy

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15
Q

What is the management of metastatic RCC ?

A

Nephrectomy combined with immunotherapy
Biological agents can be used in combination
Metastasectomy is recommended if resectable
( Chemotherapy is ineffective )

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16
Q

What are some uncommon presentations caused by paraneoplastic syndrome of the RCC ?

A

Polycythaemia duct to erythropoietin
Hypercalcaemia due to increase in PTH
HTN due to increase in renin
Pyrexia

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17
Q

What does a transurethral resection of bladder tumour consist of ?

A

Resection of bladder tissue by diathermy during rigid cytoscopy.
Usually performed under general or regional anaesthesia.
The biopsy samples can aid is assessing the stage of disease.

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18
Q

What are the subtypes of bladder cancer ?

A

Transitional cell carcinoma
Squamous cell carcinoma
Adenocarcinoma ( rare )
Sarcoma ( rare )

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19
Q

What are the 4 layers of the bladder wall ?

A

Inner lining - transitional epithelium or urothelium
Connective tissue layer - lamina propria
Muscular layer - muscularis propria
Fatty connective tissue

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20
Q

What are some risk factors for bladder cancer ?

A

Smoking
Age
Exposure to aromatic hydrocarbons ( industrial dyes or rubbers )
Schistomiasis infection
Previous radiation to the pelvis

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21
Q

What are some clinical features of bladder cancer ?

A

Painless haematuria ( visible or non-visible )
Recurrent UTI’s
Lower urinary tract symptoms ( frequency, urgency or feeling of incomplete voiding ).
Pelvic pain
Weight loss
Lethargy

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22
Q

In TNM what is the T staging ?

A

Tis - in situ ( contained within the basement membrane )

T1 - through lamina propria into sub-epithelial connective tissue

T2 - into muscularis propria layer

T3 - invasion into the perivesical tissues

T4 - direct invasion into adjacent local structures

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23
Q

In TNM what is the N staging ?

A

N0 - no nodal involvement

N1 - single node involvement less than 2cm

N2 - single node involvement 2-5cm or multiple nodes less than 5cm

N3 - one or more nodes greater than 5cm

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24
Q

In TNM what is the M staging ?

A

M0 - no metastases

M1 - metastases present

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25
Q

What are the investigations for bladder cancer ?

A

Urgent cystoscopy - flexible cytoscopy under local ( rigid cytoscopy may be performed for more definitive assessment ).

Biopsy and TURBT

CT staging

Urine cytology

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26
Q

What is the management for bladder cancer in situ or T1 ?

A

Respected via TURBT
High risk disease may require adjuvant intravesical therapy
Radical cystectomy can also be offered for high risk

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27
Q

What is the management for muscle invasive bladder cancer ?

A

Radical cystectomy if fit - complete removal of the bladder
Neoadjuvant chemotherapy

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28
Q

What are some urinary diversions that can be used following a radical cystectomy ?

A

Ileal conduit formation

Bladder reconstruction

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29
Q

What is the management for locally advanced or metastatic bladder cancer ?

A

Chemotherapy
Palliative care should be discussed

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30
Q

What are the causes of LUTS ?

A

BPH
UTI
Bladder cancer
Prostate cancer
Chronic prostatitis

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31
Q

How can you classify LUTS ?

A

Voiding and storage symptoms.

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32
Q

What are some voiding LUTS ?

A

Hesitancy or straining in micturition
Poor flow
Terminal dribble
Feeling of incomplete emptying

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33
Q

What are some storage LUTS ?

A

Increased urinary frequency
Nocturia
Increased sense of urgency to urinate
Urge incontinence

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34
Q

What are some simple investigations for someone presenting with LUTS ?

A

Urinalysis
Bladder diary
Flow rate and post void scanning
Routine bloods ( U&E’s, FBC )
PSA test

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35
Q

What are some specialist investigations which can be performed in a patient with LUTS ?

A

Urodynamic studies
Cystoscopy
USS urinary tract

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36
Q

What is the conservative management for someone presenting with LUTS ?

A

Treat underlying pathology
Regulate fluid intake
Double voiding
In men urethral milking
Pelvic floor exercises
Bladder training

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37
Q

What are some pharmacological management options for people presenting with LUTS ?

A

Alpha blockers - tamsulosin ( BPH )
5 alpha reductase inhibitors - finasteride ( BPH )
Anti-cholinergics - oxybutynin ( OAB )
Mirabegron ( beta 3 agonist ) - OAB

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38
Q

What are some complications of people presenting with LUTS ?

A

Retention - infection and formation of calculi
Overflow incontinence
Bilateral hydronephrosis

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39
Q

What is the pathophysiology of prostate cancer ?

A

Influenced by androgens
Majority are adenocarcinoma as
Arise from the peripheral zone

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40
Q

What are some risk factors of prostate cancer ?

A

Non- modifiable :
. Age
. Ethnicity
. Family history
BRCA1 or BRCA2 gene are at greater risk

Modifiable :
. Obesity
. DM
. Smoking
. Exercise

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41
Q

What are some early symptoms of a localised prostate cancer ?

A

Weak stream
Increased urinary frequency
Urgency

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42
Q

What are some later symptoms of advanced localised prostate cancer ?

A

Haematuria
Dysuria
Incontinence
Suprapubic pain
Loin pain

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43
Q

What are some symptoms indicating a prostate cancer has metastasised ?

A

Bone pain
Lethargy
Anorexia
Fixed irregular mass

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44
Q

what should a DRE be checking for ?

A

Evidence of asymmetry
Nodularity
Fixed irregular mass

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45
Q

What investigations should be performed for someone with prostate cancer ?

A

PSA
MRI scan
Biopsy

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46
Q

Other than prostate cancer what conditions can cause PSA to be raised ?

A

BPH
Prostatitis
UTI
Recent urological surgery

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47
Q

What grading system is used for prostate cancer ?

A

Gleason grading system

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48
Q

What is the management of low risk prostate cancer ?

A

Active surveillance - 3 monthly PSA tests, 6 monthly to yearly DRE’s, re-biopsy at 1-3 yearly intervals

Radical treatments for evidence of disease progression

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49
Q

What is the management for high risk prostate cancer ?

A

Radical prostatectomy - removal of the prostate gland and resection of the seminal vesicles along with the surrounding tissue
Performed laparoscopically

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50
Q

What are some side effects of radical prostatectomy ?

A

Erectile dysfunction
Stress incontinence
Bladder neck stenosis

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51
Q

What is the management of metastatic prostate cancer ?

A

Chemotherapy and anti-androgen therapy

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52
Q

What is the Gleason grading score ?

A

A scoring system by which prostate cancers are graded based upon their histological appearance.

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53
Q

What does each stage of the Gleason grading system indicate ?

A

1 - small uniform glands

2 - more stroma between glands

3 - distinctively infiltrative margins

4 - irregular masses of neoplastic glands

5 - only occasional gland formation

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54
Q

What is a transrectal ultrasound guided ( TRUS ) biopsy ?

A

Taking a sample of the prostate transrectally using USS as guidance

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55
Q

What are the possible risks of a TRUS biopsy ?

A

Haematuria
Infection
Pain
Repetition of biopsy due to insufficient amount

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56
Q

What do the majority of upper tract TCC present with ?

A

Visible haematuria

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57
Q

What investigations are used for upper tract TCC ?

A

CT urogram
Ureteroscopy

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58
Q

What is the management of low grade upper tract TCC ?

A

Laser ablation

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59
Q

What is the management of the majority of non-metastatic upper TCC ?

A

Laparoscopic nephro-ureterectomy

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60
Q

What are some issues with urinary continent diversions ?

A

Hyperchloraemic metabolic acidosis
Incontinence
Stones
Mucus
Perforation

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61
Q

What are some problems with screening prostate cancer ?

A

Significant over diagnosis and over treatment
Approx 12 treated to prevent 1 death

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62
Q

what are some pros of prostate screening ?

A

Reduced mortality

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63
Q

What are some germ cell tumours ?

A

Non-seminomatous germ cell tumours

Seminomas

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64
Q

How can testicular cancers present ?

A

A lump - solid

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65
Q

What are some testis tumour markers ?

A

Alpha-fetoprotein - specific to non-seminomatous germ cell tumours

Beta-HCG

LDH

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66
Q

What is the treatment of testicular cancer ?

A

Inguinal orchidectomy
Chemotherapy - metastatic
Radiotherapy can be used for seminomas

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67
Q

What are some risk factors for testicular cancer ?

A

Cryptorchidism - undescended testes
Previous testicular malignancy
Family history
Caucasian ethnicity
Kleinfelter’s syndrome

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68
Q

What are some clinical features of testiclaur cancer ?

A

Unilateral painless testicular lump
Irregular firm and fixed
Weight loss
Back pain

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69
Q

What are the differentials for a scrotal lump ?

A

Epididymal cyst
Haematoma
Epididymitis
Hydrocoele
Testicular cancer

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70
Q

What are some investigations for testicular cancer ?

A

Bloods - tumour markers
Scrotal USS
CT imaging with contrast - staging

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71
Q

What are some complications of testicular cancer ?

A

Those undertaking chemotherapy and radiotherapy have an increased risk of secondary malignancies

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72
Q

What does penile cancer have a strong association to ?

A

HPV

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73
Q

What is the most common type of penile cancer ?

A

Squamous cell carcinoma

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74
Q

What are some risk factors for penile cancer ?

A

HPV infection
Phimosis
Smoking
Untreated HIV

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75
Q

What are some clinical features of penile cancer ?

A

Palpable or ulcerating lesion on the penis - located on the glans
Lesions are often painless - may be discharge or prone to bleeding

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76
Q

What are some differentials for ulcerating lesions of the penis ?

A

Herpes
Syphilis
Psoriasis
Balanitis
Penile cancer

77
Q

What are some investigations for penile cancer ?

A

Penile biopsy
PET-CT - assess inguinal lymphadenopathy
CT imaging of chest-abdomen-pelvis for complete staging

78
Q

What staging system is used for penile cancer ?

A

TNM

79
Q

What is the management of penile cancer ?

A

Often a combination of surgery, radiotherapy and chemotherapy.
Topical chemotherapy agents - 5 fluorouracil
Local excision or glansectomy
Invasive penile cancer - partial amputation or total penectomy

80
Q

What are renal stones made of ?

A

Calcium oxalate
Calcium phosphate
Mixed

81
Q

Which type of renal stone is radiolucent ?

A

Urate stones

82
Q

What are the most common sites for ureteric stones ?

A

Pelviureteric junction - renal pelvis becomes the ureter
Crossing the pelvic brim where the iliac vessels travel across the ureter in the pelvis
Vesicoureteric junction where the ureter enters the bladder

83
Q

What are the clinical features of renal stones ?

A

Pain - ureteric colic
Sudden onset, severe radiating from flank to pelvis
Nausea and Vomiting
Haematuria
May have signs of dehydration

84
Q

What are some differentials for flank pain ?

A

Pyelonephritis
Renal stones
Ruptured AAA
Biliary pathology
MSK pain

85
Q

What are some investigations for renal stones ?

A

Urine dip
FBC and CRP
Urate and calcium levels
Non-contrast CT scan of the renal tract
AXR
USS may assess for hydronephrosis

86
Q

What is the initial management of renal stones ?

A

Adequate fluid resuscitation as often dehydrated
Majority will pass spontaneously
Analgesia
Any evidence of infection - IV antibiotics

87
Q

What are definitive management options for renal stones ?

A

Extracorporeal shock wave lithotripsy - sonic waves break up the stone into smaller pieces

Percutaneous nephrolithotomy - larger stones, access to kidney with a nephroscope then the stone is fragmented

88
Q

What are some complications of renal stones ?

A

Infection
Post renal AKI
Recurrent renal stones can cause scarring and loss of kidney function

89
Q

What is a nephrostomy ?

A

A tube is placed directly into the renal pelvis and collecting system relieving the obstruction proximally

90
Q

What is prostatitis ?

A

Inflammation of the prostate gland.

91
Q

What is the pathology of prostatitis ?

A

Most cases of acute bacterial prostatitis are caused by ascending urethral infection although occasionally direct or lymphatic spread from the rectum or haematogenous spread via bacterial sepsis.

92
Q

What are some causative organisms for prostatitis ?

A

E. Coli
Enterobacter
Pseudomonas
Chlamydia
Gonorrhoea

93
Q

what is chronic bacterial prostatitis ?

A

Chronic bacterial infection of the prostate with or without prostatitis symptoms and is thought to be the sequelae of inadequately treated prostatitis.

94
Q

What are the risk factors of acute bacterial prostatitis ?

A

Indwelling catheter
Phimosis or urethral stricture
Recent surgery
Immunocompromised

95
Q

What are some clinical features of prostatitis ?

A

LUTS
Pyrexia
Perineal or suprapubic pain
Urethral discharge

96
Q

What are some investigations for prostatitis ?

A

Urine culture
STI screen
FBC, CRP, U&E’s
PSA

97
Q

What is the management of prostatitis ?

A

Prolonged antibiotics treatment - quinolone
Analgesia
Second line - alpha blocker or 5alpha reductase inhibitor

98
Q

How is chronic prostatitis managed ?

A

Analgesia
4-6 week trial of alpha blocker
6 week course of antibiotics
Consider referral to chronic pain specialist

99
Q

What is definition of bacteruria ?

A

On an MSU more than 105 colony forming units/ml

100
Q

Asymptomatic bacteruria isn’t treated except in these 2 circumstances ?

A

Pregnant women
Prior to urological surgery

101
Q

Why is treating asymptomatic bacteruria actively harmful ?

A

It replaces low virulence organisms with something worse

102
Q

What is the acute investigations and management of an UTI ?

A

Typical symptoms + nitrates / leucocytes on urine dip is enough to start treatment
MSU in case empirical treatment fails

3 days of oral antibiotics for uncomplicated UTI in women

103
Q

When can’t trimethoprim be given ?

A

1st trimester of pregnancy

104
Q

When can’t nitrofurantoin be given ?

A

Not effective in renal failure
Cant be given in final trimester of pregnancy

105
Q

How to manage recurrent UTI’s ?

A

Exclude structural cause with USS +/- cystoscopy
Advise fluid intake
Post-coital single dose of antibiotic
Low dose finite 3-6 month prophylactic abx course

106
Q

What is the definition of pyelonephritis ?

A

Inflammation of the kidney parenchyma and renal pelvis typically due to bacterial infection.

107
Q

What is the most common causative organism of pyelonephritis ?

A

E.coli

108
Q

What is the classical triad for pyelonephritis ?

A

Fever
Unilateral loin pain
Nausea and vomiting

109
Q

What are some differentials for pyelonephritis ?

A

Renal calculi
Ectopic pregnancy
Pelvic inflammatory disease
Diverticulitis

110
Q

What are some investigations for pyelonephritis ?

A

Urinalysis - nitrates and leucocytes
Urinary beta-hCG
Urine culture
Routine bloods - FBC, CRP
Renal US scan for evidence of obstruction
Non contrast CT imaging if obstruction is suspected

111
Q

What is the management of pyelonephritis ?

A

Start empirical antibiotics and IV fluids
Consider admission if complicated

112
Q

what are the complications of pyelonephritis ?

A

Severe sepsis
Multi-organ failure
Renal scarring leading to CKD
Pyonephrosis
Chronic pyelonephritis

113
Q

What is the epididymitis ?

A

Inflammation of the epididymis

114
Q

What is the epididymo-orchitis ?

A

Local extension of infection from the lower urinary tract either via enteric ( classic UTI ) or non-enteric ( STI ) organisms

115
Q

What is the most common cause of Epididymo-orchitis in men under 35 ?

A

STI - gonorrhoea and chlamydia

116
Q

What is the most common cause of Epididymo-orchitis in men over 35 ?

A

Enteric organism from a urinary tract infection - E. coli

117
Q

What are some risk factors for Epididymo-orchitis ?

A

Non-enteric - males who have sex with males, multiple sexual partners

Enteric - recent catheterisation, bladder outlet obstruction or immunocompromised

118
Q

How does epididymitis present ?

A

Unilateral scrotal pain
Swelling
Fever
Rigors
Dysuria
LUTS
Urethral discharge

119
Q

What are some investigations for epididymitis ?

A

Urine dipstick
Urine culture ( MC & S )
First void urine - NAAT
STI screen
FBC, CRP
Blood cultures
USS - Doppler

120
Q

What is the management of epididymitis ?

A

Antibiotic therapy -
- Enteric : ofloxacin 200mg
- STI : ceftriaxone 500mg
Sufficient analgesia
Abstain from sexual activity until abx course is finished

121
Q

What are the complications of epididymitis ?

A

Hydrocoele formation
Abscess formation
Testicular infarction

122
Q

What is testicular torsion ?

A

Occurs when the spermatic cord and its contents twist within the tunica vaginalis compromising the blood supply to the testicle.
It is a surgical emergency

123
Q

What is the pathophysiology of testicular torsion ?

A

Occurs when mobile testes rotate on the spermatic cord. This leads to reduced arterial blood flow, impaired venous return, venous congestion, resultant oedema and infarction to the testis.
Bell clapper deformity

124
Q

What are the risk factors for testicular torsion ?

A

Age
Previous testicular torsion
Family history
Undescended testes

125
Q

Sudden onset severe unilateral testicular pain
Nausea and vomiting - secondary to the pain
Swollen testes
Cremasteric reflex is absent

A
126
Q

What are some investigations for testicular torsion ?

A

Clinical
Doppler USS
Urine dipstick

127
Q

What is the management of testicular torsion ?

A

Surgical emergency with 4-6 hours window
Analgesia
Urgent surgical exploration
Bilateral orchidoplexy
Where the testis are non-viable an orchidectomy may be warranted

128
Q

What are the complications of testicular torsion ?

A

Testicular infarction
Infertility

129
Q

What is a scrotal lump ?

A

An abnormal mass or swelling within the scrotum. They can originate from either testicular or extra-testicular sources.

130
Q

What are the clinical features to ask about when someone presents with a scrotal lump ?

A

Time of onset
Associated symptoms
Previous episodes

131
Q

On inspection of a scrotal lump what should be looked for ?

A

Site
Size
Shape
Symmetry
Skin changes
Scars

132
Q

On palpating a scrotal lump what should be assessed ?

A

Tenderness
Temp
Transillumination
Consistency
Mobility
Pulsation
Irreducibility

133
Q

What are the investigations for scrotal lumps ?

A

USS
Bloods

134
Q

What are some differentials for scrotal lumps ?

A

Hydrocoele
Varicocoele
Epididymal cyst
Epididymitis
Inguinal hernia
Testicular tumour
Testicular torsion
Orchitis

135
Q

What is a hydrocoele ?

A

An abnormal collection of peritoneal fluid between the parietal and visceral layers of the tunica vaginalis enveloping the testis.

136
Q

How do hydrocoeles usually present ?

A

Painless fluctuations swelling that will transilluminate either unilateral or bilateral.
They can grow very large and cause discomfort when sitting or walking.

137
Q

If a male between 20-40 presents with a hydrocoele what should be performed urgently ?

A

USS

138
Q

What is transillumination ?

A

It involves using a pen torch to shine light from behind a scrotal lump to observe whether the light travels through and illuminates the lesion.
The technique is used to assess whether a mass is fluid filled.

139
Q

What scrotal lumps tend to transilluminate ?

A

Hydrocoeles and large epididymal cysts

140
Q

What is a varicocoele ?

A

An abnormal dilation of the pampiniform venous plexus within the spermatic cord.

141
Q

how do varicocoeles present ?

A

It often presents as a lump and is described as a bag do worms.
Disappears on lying flat

142
Q

What can varicocoeles cause ?

A

Infertility
Testicular atrophy

143
Q

What are some red flags for varicocoeles ?

A

Acute onset
Right sided
Remain when lying flat

144
Q

What is the surgical management of varicocoeles ?

A

Embolisation by interventional radiologist and surgical approaches either open or laparoscopic approach for ligation of the spermatic veins.

145
Q

What is an epididymal cyst ?

A

A benign fluid filled sac arising from the epididymis. They present as a smooth fluctuations nodule.

146
Q

How do inguinal hernias cause scrotal lumps ?

A

They pass into the scrotum via the external inguinal ring entering the inguinal canal initially at the internal ring ( indirect )or through hesselbach’s triangle ( direct ). They pass into the scrotum and run alongside the spermatic cord.

147
Q

How is an inguinal hernia causing a scrotal lump assessed on examination ?

A

You can’t get above the hernia - can’t palpate the superior surface
A cough may exacerbate the swelling and it may disappear when lying flat.

148
Q

What is the most common malignancy in men aged 20-40 ?

A

Testicular cancer

149
Q

What are some examples of benign testicular lesions ?

A

Leydig cell tumours
Sertoli cell tumours
Lipomas
Fibromas

150
Q

What is Peyronie’s disease ?

A

A condition characterised by an acquired curvature of the penis due to fibrosis of the tunica albuginea

151
Q

What are the groups of Peyronie’s disease ?

A

Asymptomatic - doesn’t limit sexual function

Moderate to severe curvature causing pain or impeding sexual function

Erectile dysfunction

152
Q

What is the pathophysiology of peyronie’s disease ?

A

Acute phase - pro-inflammatory cytokines lead to acute inflammation of the tissue. A fibrotic healing process occurs disrupting the normal tissue of the penis.
Fibrotic plaques develop at the dorsum of the penis and cause painful shortening and curvature. This limits sexual intercourse. The scarring can reduce blood flow and lead to erectile dysfunction.

153
Q

What are some risk factors for Peyronie’s disease ?

A

Age
DM
HTN
Certain medications - beta blockers

154
Q

What are some clinical features of Peyronie’s disease ?

A

Significant curvature
Shortening
Erectile dysfunction
Painful erection

155
Q

What is the management of Peyronie’s disease ?

A

Phosphodiesterase 5 inhibitors such as sildenafil
Intracaervnosal injections
Surgical

156
Q

What is fournier’s gangrene ?

A

A form of necrotising fasciitis that affects the perineum. It is a urological emergency.
Rapidly spreading necrosis of the subcutaneous tissue and fascia

157
Q

What are the most common causative organisms for fournier’s gangrene ?

A

Group A streptococcus
C. Perfringes
E. Coli

158
Q

What are risk factors of fournier’s gangrene ?

A

DM
Excess alcohol intake
Poor nutritional status
Excess steroid use
Haematologial malignancies
Recent trauma

159
Q

What are some clinical features of fournier’s gangrene ?

A

Severe pain
Pyrexia
Crepitus
Skin necrosis
Haemorrhagic bullae
Rapidly deteriorate

160
Q

What are some investigations for fournier’s gangrene ?

A

Largely clinical
FBC, CRP, U&E’s, LFT’s
Blood cultures
HbA1c
CT imaging to assess fascial swelling and soft tissue gas

161
Q

What is the management of fournier’s gangrene ?

A

Urgent surgical debridement - often extensive
Broad spectrum abx
May require skin grafts

162
Q

What is paraphimosis ?

A

The inability to pull forward the retracted foreskin over the glans of the penis.

163
Q

What is the pathophysiology of paraphimosis ?

A

There is a presence of a tight restriction band preventing retraction. This causes the glans to become increasingly oedematous due to reduced venous return causing engorgement. If untreated it can cause penile ischaemia and infection.

164
Q

What are some risk factors for paraphimosis ?

A

Phimosis
Indwelling urethral catheter
Poor hygiene
Prior paraphimosis

165
Q

What is the typical presentation of paraphimosis ?

A

Progressive pain and swelling
Unable to retract their foreskin

166
Q

What is the management of paraphimosis ?

A

Reduction
Analgesia

167
Q

what are some risk factors of erectile dysfunction ?

A

Vascular - ischaemic heart disease
Neurological - DM, spinal injury
Hormonal - low testosterone
Medications - anti-depressants
Pyschogenic

168
Q

What are some investigations for erectile dysfunction ?

A

Address vascular risk - BP, lipids, glucose and smoking status
Early morning testosterone levels
Prolactin, LH , FSH levels

169
Q

What is the management of erectile dysfunction ?

A

Pyschosexual counselling
PDE5 inhibitors
Treat low testosterone
Intracavernosal prostaglandin injections
Penile prosthesis

170
Q

What is phimosis ?

A

Tight foreskin
There is scarring of the foreskin opening leading to non-retractibility

171
Q

What are the management options for phimosis ?

A

Topical steroids
Circumcision

172
Q

What is nocturnal polyuria ?

A

1/3 of urine output is produced at night

173
Q

What contributes and worsens nocturia ?

A

Chronic deep venous insufficiency
Congestive HF
COPD
Sleep apnoea
DM
CKD

174
Q

What are the pressures like in urodynamics ?

A

Slow gentle rise in pressure during the filling phase

High pressure in the voiding phase

175
Q

What is the treatment for BPH ?

A

Lifestyle advice - fluid intake and caffeine

Medical - alpha blockers ( tamsulosin ) , 5 alpha reductase inhibitor ( finasteride ) or anticholinergics

Surgical - TURP

176
Q

How do alpha blockers work in the treatment of BPH ?

A

Relax the prostatic / bladder neck smooth muscle
Uro-selective
Improves symptoms only

177
Q

What are some side effects of alpha blockers ?

A

Retrograde ejaculation
Postural hypotension

178
Q

How do 5 alpha reductase inhibitors work ?

A

Reduce conversion of testosterone to DHT
Reduce prostatic volume

179
Q

What are some side effects of 5 alpha reductase inhibitors ?

A

Erectile dysfunction
Decreased libido
Rash

180
Q

What is TURP syndrome ?

A

Irrigation for standard TURP is glycine not saline which absorption of during a long resection can lead to dilutional hyponatraemia

181
Q

What are some features of TURP syndrome ?

A

Confusion
Fits
Visual symptoms
Coma

182
Q

What is overactive bladder syndrome ?

A

Urgency with or without incontinence often accompanied by frequency and nocturia

183
Q

What is the treatment of OAB ?

A

Weight loss, stop smoking, pelvic floor training
Anti-cholinergics
Beta 3 agonist - mirabegron
Botulinum toxin injections
Sacral nerve stimulation
Ileocystoplasty

184
Q

What are some treatment options for stress incontinence ?

A

Weight loss
Pelvic floor exercises
Autologous fascial sling
Artificial urinary sphincter

185
Q

What are the 2 types of urinary retention ?

A

Acute - painful inability to void

Chronic - painless and may still void

186
Q

What are some causes of urinary retention in men ?

A

BPH
Prostate cancer
UTI
Constipation
Recent surgery
Drugs
Urethral stricture

187
Q

What are some causes of urinary retention in women ?

A

UTI
Constipation
Recent surgery
Drugs
Urethral stricture or stenosis
Pelvic mass

188
Q

What are some examinations and investigations for acute urinary retention ?

A

Catheterise and record residual volume
Abdo exam, DRE and external genitalia
Urine dip
U&E’s

Y3 Surgery (8 decks)

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