Urology Flashcards
Which LUTS is it important to ask about when suspecting BPH?
Incomplete emptying
Frequency/ nocturia
Intermittency/ weak stream
Urgency
Straining
What are the medical treatment options in BPH?
Mild symptoms = active surveillance
Bothersome symptoms/ IPSS of 7+
- Alpha blocker e.g. Tamsulosin - works on symptoms within one week! but no effect on prostate size or progression. Can cause retrograde ejaculation
- If large prostate/ PSA > 1.4/ high risk of progression, use 5ARI e.g. Dutasteride, Finasteride - reduces size of prostate and slows disease progression. Can cause reduced libido and ED.
(Can give both :))
Storage symptoms/ overactive bladder
- Anticholinergic e.g. oxybutynin
- +bladder training, advice on fluid intake
Voiding symptoms
- Offer intermittent catheterisation if in retention, before having indwelling catheter
What are the surgical treatment options for BPH?
Voiding symptoms: TURP (trans-urethral resection of prostate)
Storage symptoms: botox injections into bladder, or percutaneous posterior tibial nerve stimulation (before offering more invasive treatments)
What is the typical presentation of ureteric calculus? How is it diagnosed?
Loin-to-groin pain
CT KUB
What is the classic triad in presentation of RCC?
Flank pain, palpable mass + haematuria
What are the risk factors for RCC?
Male sex
Smoking
Hypertension
Obesity
Renal failure
Von Hippel Lindau syndrome
What are the risk factors for bladder cancer?
Male sex
Older age
Smoking
Occupation - rubber, paint, dye manufacture
Schistosomiasis
What are the surgical options for bladder cancer?
TURBT
Can have radical cystectomy
What are the risk factors for prostate cancer?
Smoking
High-fat diets
What are the symptoms of prostate cancer?
Mostly asymptomatic
Haematospermia/ haematuria
LUTS
Perineal discomfort
Lower limb swelling
Anaemia
Which investigation is done to classify prostate cancer?
Trans-rectal ultrasound-guided biopsy
& Gleason score
What are the treatment options for prostate cancer?
Localised:
- Radical prostatectomy
- External beam radiotherapy or brachytherapy
Advanced:
- Androgen deprivation therapy - medical castration (GnRH analogue e.g. Goserelin)
What are the risk factors for testicular cancer?
White ethnicity
1st-degree relative
Undescended testis
HIV
What are the testicular tumour markers?
LDH
alpha-fetoprotein
Beta-hCG
What do results of an MSU mean?
Nitrites + leucocytes + = UTI
Nitrites + leucocytes - = UTI
Nitrites - leucocytes + = check MC&S
Protein ++ = renal issues e.g. glomerulonephritis, pre-eclampsia, renal failure
Glucose = diabetes
Ketones = DKA, ketone diet, dehydration/ starvation
