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 (transperineal 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) (also prescribe cyproterone acetate 3 days before bc risk tumour flare)
Cystitis:
- Definition
- DD
- Risk factors (7)
- Causes
- Symptoms (7)
- Investigations
- Management + prevention
- Complications
causes: ecoli, staph saprohyticus (+ leucs only), + cocci epidermis
mx:
- haematuria, male, preg, >65, child - send for msu
- normal woman: 3 days trimeth/nitro
- preg: 7 days nitro, cefalexin (including if assymp bacteruria)
- men: 7 daus trimeth/nitro
- catheter: 7 days trimeth/nitro, if catheter been in >7 days consider changing, do not treat assymp bacteruia
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: ceftriaxone/ciproflox 10-14 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: undescended tests, fx, infertility, mumps orchitis, 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
Penile cancer:
- Definition
- DD
- Risk factors
- Symptoms
- Management
Penile cancer:
- Definition: scc
- DD: herpes, syphilis, psoriasis
- Risk factors: hpv16/18, lichen sclerosis, phimosis, smoking, age, psoralen
- Symptoms: ulcerating lesion, painless, ing lymph, LUTS, ED
- Management: if superficial topical 5 fluorouracil, local excision, penectomy
Erectile dysfunction:
- Vasculogenic causes (5)
- Neurogenic causes (6)
- Anatomical causes (2)
- Hormonal (3)
- Drug causes (6)
- Psychological causes (4)
- Investigations
- Management
Erectile dysfunction:
- Vasculogenic causes (5): smoking, atheroscl, htn, diab
- Neurogenic causes (6): ms, parkinsons, cycling, alcohol, sc injury
- Anatomical causes (2): hypospadias, peyronies
- Hormonal (3): hypogonas, thryoid
- Drug causes (6): ssris, b blockers, diuretics, anti htn, antichol, antiepil
- Psychological causes (4): mental health
- Investigations: bp, hba1c, hormone profile, cvs assess
- Management: sildenafil pde5 inhib inc cgmp which inc sm vasodil + relax, vacuum erection. if young refer to urology
Phimosis:
- Definition
- Causes
- Symptoms
- Management
- Complications
Paraphimosis:
- Definition
- Causes
- Management
Phimosis:
- Definition: when can’t retract foreskin
- Causes: idiopathic, scarring, infection, balantitis xerotica obliterans
- Management: if child should resolve, steroids, circumcision
- Complications: stis, sexual dysfunction, balantitis, retention, penile ca
Paraphimosis:
- Definition: can’t pull foreskin back over glans penis
- Causes: phimosis, catheter, scc
- Management: dorsal slit, manual reduction
circumcision benefits: reduces risk penile ca + risk uti + stis
Indications: phimosis, paraphimosis, recurrent balantitis, balantitis xerotica obliterans
Testicular torsion:
- Definition
- Risk factors
- DD
- Symptoms
- Signs
- Investigations
- Management
- Complications
Testicular torsion:
- Definition: twisting of the testes around its spermatic cord causing venous congestion hence decreasing arterial supply causing ischaemia
- Risk factors: bell clapper deformity, trauma, fx, crytochordism
- DD: epididymo-orchitis, testic cancer, hydrocoele, hernia
- Symptoms: severe pain, n+v
- Signs: left testes (most common) higher than the right, cremasteric reflex +, phrens sign -, swollen, tender
- Investigations: urgent doppler uss, urine dip
- Management: urgent surgical exploration within 6 hours (orchidoplexy bilateral), analgesia, antiemetics, nbm
- Complications: infertility, chronic pain
Epididymo-orchitis:
- Definition
- Risk factors
- Causative organisms
- Symptoms
- Investigations
- Management
- Complications
Epididymo-orchitis:
- Definition: inflammation of epididymis and testes
- Risk factors: sexually active, mumps, catheter, immunocompromsed
- Causes: chlamydia trachomatis, neisseria gonorrhoeae, ecoli
- Symptoms: pain relieved by lifting (phrens sign +), fevers, discharge, luts symptoms, swelling (lasts 6 weeks)
- Investigations: fbc/crp, urine dip + midstream msu, sti screen, uss doppler
- Management: if uti then ofloxacin 14 days, if sti IM ceft then 2 weeks deoxy
- Complications: reactive hydrocoele, abscess, infarction
Haematuria:
- Causes
- Investigations
- When to refer to urology
- UTI, cancer renal/bladder/prostate, calcul, BPH, trauma, glomerulonephritis
- urinalysis, fbc/u+es/clotting/psa, flexible cystoscopy , uss kub if non visible, ct urogram if visible
- > 45yrs and unexplained
non urgent if >60 w recurrent utis
VISIBLE = CT UROGRAM
NON VISIBLE = USS
Benign prostatic hyperplasia:
- Symptoms
- Complications
- Ix
- Mx
Benign prostatic hyperplasia:
- Symptoms: voiding symptoms, storage symptoms
- Complications: retention, uti, hydronephrosis
- Ix: ipss, urine dip, fbc/crp/psa, urine freq + vol chart
- Mx: watchful waiting, if ipss equal to or 8 then start alpha blocker tamsulosin which relaxes sm of prostate (SE: postural hypotension, dry mouth, depression). Or finasteride (5a reductase inhibitor stops test -> dihydrotest reducing prostate vol but takes 6 months to work, SE: ED, reduced libido, gynaecomastia), TURP transurethral resection prostate (SE: urinary incontinence, turp sydrome hyponat/hyperammonia/vision changes)
Balantitis:
- definition
- causes
- ix
- mx
Balantitis:
- definition: inflamm of penis
- causes: candidiasis, dermatitis, bacterial (discharge, staph), lichen sclerosis (white plaques), circinate (painless erosions, assoc with RA)
- mx: saline wash, hydrocort, specific treatment for cause
Urethral stricture:
- causes
- mx
Urethral stricture:
- causes: sti post, idiopathic, penile fractures, iatrogenic, lichen sclerosis
- mx: dilatation, endoscopic urethrotomy
Hydronephrosis:
- causes
- ix
- mx
Hydronephrosis:
- causes: calculi, tumours, stenosis urethra, prostate enlarged, fibrosis
- ix: uss
- mx: nephrostomy, if chronic ureteric stent or pyeloplasty
