Urology Flashcards
Renal colic:
- Definition
- Types
- Risk factors
- Symptoms
- Signs
- Red flag signs for urosepsis
- Investigations
- Management
- Prevention
- Complications
Renal colic:
- Definition: stones in kidney or ureter
- Types: ca oxalate, stuvite (ammonium phosphate mg - can form staghorn calculus via proteus mirobilis, high ph!!), urate (radiolucent means can’t see on axr), cystine
- Risk factors: dehydration, hypercalc, previous, male, horseshoe shape, ibd, quinolone
- Symptoms: colicky flank pain radiating to groin, n+v, fever, haematuria
- Signs: tender
- Red flag signs for urosepsis
- Investigations: preg test/urine dip, fbc/crp/U+es/creatinine, ct kub (non contrast) within 24 hours, uss if preg/child
- Management:
acute: IM diclofenac, antiemetics, fluid resus, abx, jj stent, nephrostomy if hydronephrosis
definitive: let pass by itself if <5mm, shock wave lithrotripsy if 5-20mm (not if preg/aaa/bleed disorder), if >20 then percut nephrolitomy. If ureteric if <10mm lithrotripsy/alpha blocker, if >10cm ureteroscopy
- Prevention: for hypercalc (thiazide diuretics, lemon juice, inc h2o, dec salt, if recurrent k citrate), if oxalate (pyridoxine, cholestyramine), if urate allopurinol, if cystine h20 + penicillamine chealator
- Complications: hydronephrosis, recurrent, aki
Prostate cancer:
- Function of prostate
- Definition
- Risk factors (6)
- Symptoms
- Investigations
- Other times psa is inc
- Management
- Function of prostate: contains proteolytic enzymes to break down clotting factors in semen (clotting factors help keep semen in fem repro tract) and contains zinc to stabilise the spermatozoa
- Definition: adenocarc
- Risk factors (6): brca1/2, anabolic steroids, black, age, obesity
- Symptoms: luts, haematuria, b symptoms, bone/loin pain
- Investigations: dre, urine dip, fbc/crp/u+es/psa, multiparametric mri, trus (transrectal uss), ct (gleason grading)
- PSA: bph, prostatitis, ejac, vig ex - can test if suspect ca or >50 who request
- Management: watchful waiting, active surveillance (psa 3 monthly, dre 6 monthly, biopsy 1-3 yrs). If local then radical prostatectomy (ED)/ ext beam radiotherapy (proctitis), brachytherapy. If mets then androgen deprivation therapy (bicalutamide blocks androgen receptors)/ castration/ ghrh agonists goserelin (dec LH via overstimualation)
Cystitis:
- Definition
- DD
- Risk factors (7)
- Causes
- Symptoms (7)
- Investigations
- Management + prevention
- Complications
causes: ecoli, staph saprohyticus (+ leucs only), + cocci epidermis
mx: 7 days if complic: male, preg, >65, child + send for msu also
nitro (egfr <45, <1 month, t3)
trimeth (premature, t1)
advice: pee sex, wipe front to back, don’t hold wee, no scented soap
Pyelonephritis:
- Definition
- DD (4)
- Symptoms
- Investigations
- Management
- Complications
- What is pyonephrosis
- What is asymptomatic bacteriuria
- symptoms: cystitis, n+v, rigors, loin pain
- mx: coamox/ cipro 7 days (cefalaxin if preg), hospital if severe
- assymp bact: only treat if preg/urolog procedures
Fourniere’s gangrene:
- Definition
- Risk factors (6)
- Causes (5)
- Organisms
- Symptoms
- Investigations
- Management
Fourniere’s gangrene:
- Definition: nec fasc of perineum
- Risk factors (6): diab, alc, poor nutrition, steroids, immunocomp
- Causes (5): abscess, uti, surgery, diverticulitis
- organisms: ecoli, group a strep
- Symptoms: pain, fever, crepitus, haemorrhagic bullae, sepsis
- Investigations: cultures, ct
- Management: debridement, abx, skin graft
Peyronie’s disease:
- Definition + pathophysiology
- Risk factors
- Symptoms
- Management
Peyronie’s disease:
- Definition + pathophysiology: upward curvature of penis due to tunica albuginea fibrosis
- Risk factors: trauma, dupt, diab, htn
- Symptoms: sexual dysfunction, ED, pain
- Management: PDE5 inhibt finasteride, mech traction, surgery
Scrotal lumps:
- Hydrocoele
- Indirect hernia
- Testicular cancer
- Epididymal cyst
- Varicocoele
Scrotal lumps:
- Hydrocoele: can be after trauma/infection/idiopathic/tumour - transilluminates, painless + fluctuant - need to ix for underlying tumour
- Indirect hernia: cough exacerbates, can’t get above
- Testicular cancer
- Epididymal cyst: transilluminates, above testes, smooth
- Varicocoele: is dilation of pampiform plexus, worm, worse end of day, msotly left, disappears lying down, reduces fertility
Urinary incontinence:
SUI:
- Definition
- Risk factors (4)
- Management
UUI:
- Definition
- Risk factors (4)
- Management
Overflow UI:
- Definition
Continuous UI:
- Definition
Functional UI:
- Definition
- Investigations
mx:
uui: bladder retraining, m3 antag oxybutynin, b3 adrenorec agonist mirabegron, botulin injection, cystoplasty, ileal conduit
sui: pelvic floor ex, duloxetine na reuptake inhib inc sphincter, vag tape, intramural bulking agents
Acute urinary retention:
- Residual volume
- Causes
- Risk factors
- Symptoms
- Investigations
- Management
- Complications
Acute urinary retention:
- Residual volume: 300-1500ml
- Causes: uti, stones, bph, strictures, prostate ca, spinal anaesthesia, anticholinergics/tcas
- Risk factors: age, preg, constipation, inflammation
- Symptoms: pain, can’t urinate, distended bladder
- Investigations: dre, post void bladder scan, uss diagnostic >300ml, fbc/crp/u+es/creatinine
- Management: catheter keep in place if >400ml - if >1L observe for post obstructive diuresis leading to aki (iv fluids), TWOC 48 hours after x3 max, treat cause
- Complications: diuresis, aki, ckd
Chronic urinary retention:
- Residual volume
- Risk factors
- Symptoms
- Management
- Complications
Chronic urinary retention:
- Residual volume: 300-4000ml
- Risk factors: bph, stricutres, cancer, fibroids, neurological
- Symptoms: painless, voiding luts, overflow incont
- Management: only catheter if high pressure (bad renal function, bilat hydronephrosis), treat underlying cause, normal to have decompressive haematuria
- Complications: utis, calculi, hydroneph, ckd
Renal cell carcinoma:
- Definition
- Risk factors
- Symptoms
- Investigations
- Management
Renal cell carcinoma:
- Definition: renal parenchyma esp PCT - most common is clear cell
- Risk factors: smoking, obesity, htn, horseshoe, dialysis
- Symptoms: assymp, haematuria, loin pain, flank mass, left varicoele, paraneoplastic syndrome (hypercalcaemia, htn, polycythaemia), stauffer syndrome
- Investigations: urine dip, fbc/crp/u+es, uss, mri urogram biopsy, cxr cannonball mets
- Management: if <7cm (t1) partial nephrectomy, if >7 then full. Or percut radiofreq ablation, or if mets immunotherapy tyrosine kinase inhibitors
Upper transitional cell cancer:
- Definition
- DD
- Risk factors
- Symptoms
- Investigations
- Management
Upper transitional cell cancer:
- Definition: renal calyx to baldder, 2nd most common ca
- DD utis, stones, prostate cancer
- Risk factors: smoking most common, aromatic aniline dyes, rubber, cyclophosphamide, schistosomiasis (scc)
- Symptoms: painless haematuria, b symptoms, mass, luts, pelvic pain, recurrent utis
- Investigations: urine dip, fbc/crp/psa/u+es, ct urogram with contrast, flexible cystoscopy to rigid + biopsy
- Management: if not muscle invasive then turbt + bcg if high risk. If invasive cystectomy (ileal conduit or urostomy), adj chemo if adeno, neoad for scc
LUTS:
- Definition
- Risk factors (5)
- Voiding symptoms + causes
- Storage symptoms + causes
- Investigations
- Management
- Complications (4)
- Red flags
LUTS:
- Definition
- Risk factors (5)
- Voiding symptoms + causes: hesitation, terminal dribble, incomplete emptying, weak stream - bph, strictures, uti, phimosis
- Storage symptoms + causes: urgency, nocturia, frequency, incontinence - tumour, stones, utis, prostatitis, pelvic floor dysfunction
- Investigations: abdo + pelvic + dre ex, psa, 3 day bladder freq + vol diary, urine dip, uroflowmetry, post residual vol, cystometry, cystoscopy, pad test
- Management: for BOO - prostate meds, indwelling catheter. For OAB: bladder retraining, oxybutynin (m3 antag relaxes sm), mirabegron (b3 adrenorec agonist contracts sphincter), botulin injections, cystoplasty
- Complications (4): retention, calculi, hypertrophy, hydronephrosis
- Red flags
Testicular cancer:
- Definition
- Risk factors
- Symptoms
- Investigations
- Management
- Complications
Testicular cancer:
- Definition; mostly GC (seminoma, NSGCT embryonal/yolk sac/teratoma/choriocarc), ngct (sertoli, leydig)
- Risk factors: fx, crytochordism, klinefelters
- Symptoms: painless irreg lump firm, gynaecomastia (hcg -> leydig cell dysfunction -> inc oest)
- Investigations: uss, tumour markers (yolk sac afp, embryonal afp/hcg)
- Management: <55 sperm banking, ing orchiectomy, if nscgt ajd chemo if seminoma chemo
- Complications: infert, peripheral neuropathy
Prostatitis:
- Definition
- Risk factors
- Symptoms
- Signs
- Investigations
- Management
- Complications
Prostatitis:
- Definition: inflammation of prostate due to bacteria (ecoli, , c trach) acute <3 months, chronic >3
- Risk factors: uti, catherisation intermittent, recent prostate biopsy, cystoscopy
- Symptoms : voiding luts, sexual dysfunction, fever, discharge, perineum pain
- Signs: tender boggy prostate, ing lymphaden
- Investigations: dre, urine dip, sti test, fbc/crp/u+es/psa/cultures, trus, ct (abscess)
- Management: if acute 14 days quinolone, if >6 weeks finasterid
- Complications: abscess, sepsis, retention, chronic
