Urology Flashcards
What is paraphimosis?
Inability to return retracted foreskin of penis
What is priapism?
Prolonged rigid erection
What is the commonest cause of hesitancy and poor stream in young children?
Posterior urethral valves
Simple differences between neuroblastoma and nephroblastoma
Neuroblastoma - originates from adrenal gland, calcified
Nephroblastoma - Originates from the renal apex, non-caclified. Associated with hypertension. More common
What part of the kidney does a renal cell carcinoma arise from?
It is an adenocarcinoma of the proximal convoluted tubule
What type of renal tumour appears pink?
Transitional cell carcinoma
What type of renal stone occurs with raised urinary pH and is associated with recurrent infections?
Struvite
What are struvite renal stones made up of?
magnesium, ammonium and phosphate
What type of stone precipitates in acidic conditions?
Uric acid
What type of renal stone is most common?
Calcium oxalate
Which type of stone is associated with an inherited metabolic disorder?
cystine stone
What bacteria is associated with struvite stones?
proteus mirabilis
What is the surgical procedure for testicular cancer?
Orchidectomy via inguinal approach
Which lobe of the prostate does carcinoma usually occur and which lobe tends to be enlarged in BPH?
Carcinoma - posterior
BPH - median
What are the features of a seminoma?
Age = 40
AFP normal
HCG mostly normal, elevated in 10%
LDH mostly normal, elevated in 10-20%
What are the feature of non-seminomatous germ cell carcinomas?
Age 20-30
Worse prognosis
May need retroperitoneal lymph node dissection
AFP elevated in 70%
HCG elevated in 40%
Risk factors for testicular cancer?
Cryptorchidism
Infertility
Family history
Klinefelter’s syndrome
Mumps orchitis
Features of an acute haematocele?
Tender
Non transilluminating
Testis not palpable
Secondary to trauma
Difference between a bulbar urethral rupture and a membranous urethral rupture?
Bulbar - More common, due to straddle type injuries, Triad signs: urinary retention, perineal haematoma, blood at the meatus
Membranous - Associated with pelvic fractures, penile/perineal oedema or haematoma, prostate displaced upwards
What type of renal stones are radiolucent?
Uric acid stones
Hydrocele in children is most commonly due to what?
Persistant processus vaginalis
Which type of testicular cancer is most likely to cause gynaecomastia?
Leydig cell tumours
Why should an abdominal ultrasound be done when a varicocele is diagnosed?
Because it might be a symptom of a renal tumour occluding the left renal vein, in which the left testicular vein drains
Which type of stone is due to a familial disorder?
Cysteine
Inherited recessive disorder of transmembrane cystine transport leading to decreased absorption of cystine from intestine and renal tubule
Which nerves cause erection and which cause ejacultation?
Parasympathetic = points = erection = S2-S4
Sympathetic = shoots = ejaculation = T11-L2 (inferior mesenteric ganglion)
Where does the testicular artery arise from?
Aorta
What is the primary site of venous drainage of the urinary bladder?
vesicoprostatic venous plexus
What nerves innervate the skin of the scotum?
Anterior scrotum - ilioinguinal L1 and genitofemoral L1-L2
Posterior scrotum - posterior scrotal branches -> perineal nerve -> pudendal nerve S2-S4
What is the lymphatic drainage of the male spongy urethra?
deep inguinal nodes
Features of nephroblastoma
AKA Wilm’s Tumour
Mass, lethargy, loin pain, haematuria
Pyrexia in 50%
Metastasise early to lung
Usually affect children aged 2-5 years
Assuming the renal function is normal, what proportion of calcium filtered at the glomerulus will be reabsorbed by the renal tubules?
95%
What type of bladder malignancy is due to chronic inflammation from schistosomiasis?
SCC
What is transurethral resection syndrome?
TUR syndrome occurs when irrigation fluid enters the systemic circulation. The triad of features are:
- Hyponatraemia: dilutional
- Fluid overload
- Glycine toxicity
What is the most common cause of a hard painless ulcer of the penis?
Syphilis - Treponema Pallidum
What is the blood supply of the ureters?
Blood supply is segmental; renal artery, aortic branches, gonadal branches, common iliac and internal iliac
What type of epithelium lines the urethra?
Stratified columnar
What is the blood supply of the urethra?
Prostatic - Inferior vesical artery, branch of internal iliac artery
Membranous - Bulbourethral artery, branch of the internal pudendal artery
Spongey - Branches of the internal pudendal artery
Where is most resistance felt when inserting a male catheter?
Membranous urethra
What is the lymphatic drainage of the urethra?
Prostatic and membranous portions - internal iliac lymph nodes
Spongey urethra - Deep inguinal lymph nodes
What is the histology of a seminoma?
Sheet like lobular patterns of cells with fibrous septae. Fibrous septa contain lymphocytic infiltration +/- granulomas
Where do the left and right testicular veins drain into?
Left testicular vein - Left renal vein
Right testicular vein - IVC
How does prostate cancer metastasise to vertebral column and brain?
Prostate venous drainage is to the vesicoprostate venous plexus which communicates with inferior vesicular vein and the internal vertebral venous plexus posteriorly.
The internal venous plexus of baston communicate with the intracranial venous sinuses.
Which renal stone contains sulphur
Cysteine
Which stones are most radio dense and radiolucent?
Very radio dense - Calcium phosphate
Relatively radio dense - Cysteine
Radio-opaque - Calcium Oxalate
Slightly radio-opaque - Struvite
Radiolucent - Uric acid
What type of renal cancer is associated with long term staghorn calculus?
SCC
What is the management of an infant with a hydrocele?
Likely due to persistent processus vaginalis so management is surgical ligation of persistent processus vaginalis via inguinal approach
What is the most common paratesticular tumour?
Rhabdomyosarcoma
What antibody is involved with hyperacute rejection of renal transplant?
IgG
What conditions are associated with adult polycystic kidney disease?
Liver cysts
Berry aneurysms
Pancreatic cysts
Renal calculi
Hypertension
Haematuria
Mitral valve prolapse
Recurrent UTIs
What type of epithelium lines the ureter?
Transitional
What bony landmark do the ureters lie over?
Tips of transverse processes L2-5
Which of the renal artery, renal vein and ureter lies most anteriorly and most posteriorly?
Anterior - renal vein
Posterior - ureter
Which nerve is most likely to be damaged during resection of bladder?
Obturator
What genetic condition is associated with renal angiomyolipomata?
Tuberous sclerosis
What anatomical plane separates the prostate from the rectum?
Denonvilliers fascia
Polycythaemia is a recognised feature of which urinary tract cancer?
Renal cell carcinoma (adenocarcinoma of the kidney)
What are the contents of the deep perineal pouch in a male
- Urethral sphincter
- Transversus perinei
- Dorsal nerve of penis, muscular branches of the perineal nerve
- Deep and dorsal arteries of penis, stem of origin of artery to the bulb of penis, urethral artery.
What is onuf’s nucleus?
Located in anterior horn of S2
It is the origin of the nerves that supply the external urethral sphincter
What renal lesion is associated with tuberous sclerosis?
Angiomyolipoma.
