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Year 6 > Urology > Flashcards

Urology Flashcards

1
Q

What is the commonest type of bladder cancer?

A

transitional cell / urothelial bladder cancer

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2
Q

what subtype of bladder cancer does schistosomiasis predispose you to?

A

SCC

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3
Q

What predisposes you to SCC bladder cancer?

A

Carcinogens
- tobacco

Infection: chronic inflammation of the urinary tract that can lead to the transformation of urothelial cells into squamous epithelial cells (squamous metaplasia)
- schistosomiasis
- recurrent / persistent UTIs
- chronic nephrolithiasis and bladder calculi

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4
Q

What are the different types of bladder cancer that you can get?

A

transitional cell (=urothelial) cancer - most common 90%
SCC
adenocarcinoma (rare)

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5
Q

Management of bladder cancer

A

Surgery + neoadjuvant chemotherapy +/- radiotherapy

1st line:

  • radical cystectomy
  • neoadjuvant chemotherapy

If ineligible for cystectomy or wishing to retain bladder:

  • chemotherapy and radiotherapy

Source: Amboss

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5
Q

Investigations in ?bladder cancer

A

Urine dip
- haematuria (may be micro- or macroscopic)

Urinalysis with microscopy
- some features (e.g. red cell casts, proteinuria may indicate glomerular causes of

Cystoscopy
- mass
CT / CT urography
- mass
- +/- metastatic disease

Bloods
- FBC may show anaemia

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6
Q

Symptoms and signs of bladder cancer

A

Symptoms:

  • haematuria
  • SOB/fatigue (due to anaemia)
  • voiding sx (dysuria, urinary frequency, urgency)
  • bladder outlet obstruction (rare)
  • suprapubic/perineal/rectal pain
  • FLAWS (fever, weight loss, malaise, lymphadenopathy, night sweats)

Signs:

  • features of anaemia
  • rarely a mass may be palpable
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7
Q

RF for testicular torsion

A

age 12-25
bell clapper deformity (more horizontal lie to testis, increased mobility)
personal or FHx
cryptorchidism

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8
Q

What is cryptochidism

A

undescended testicle

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9
Q

sx of testicular torsion

A

sudden onset testicular pain
can radiate to abdomen (around umbilicus/groin)
can cause N&V

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10
Q

Signs of testicular torsion

A
  • testicular swelling
  • testicular tenderness (particularly at the top where the cord is)
  • loss of cremasteric reflex (stroke anteromedial thigh, scrotum should elevate - L1 and L2)
  • high riding testis (testicular elevation in comparison to contralateral side)
  • pain not relieved by lifting the testicle
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11
Q

ddx for TT

A

epidydimoorchitis
incarcerated inguinal hernia
torsion of hydatid of Morgagni (remnant of obliterated Mullein duct, blue dot sign)

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12
Q

Ix for testicular torsion

A

-> immediately to theatre for scrotal exploration
(have 6h to save the testicle)

low clinical suspicion
-> USS with doppler
-> urinalysis ?infective cause
->bloods -?infective cause

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13
Q

Prognosis for TT

A

potential for reduced fertility
chronic pain

one more

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14
Q

epidydimoorchitis definition

A

inflammation of the epididymis and testicle

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15
Q

epidydimorchitis causes

A

UTI or STI

(only orchitis: can also be Mumps)

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16
Q

orchitis in the absence of epididymitis - what can cause this?

A

mumps

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17
Q

RF for epididymorchitis

A

UTI: BPH, diabetes, recent catheter, imunosuppression

STI: MSM, unprotected sex, multiple partners, anal sex

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18
Q

sx of epididymoorchitis

A

scrotal pain (typically unilateral)
slower onset than torsion, typically worsening over 24h
scrotal swelling (reactive hydrocele)
fever (rigors if septic)
symptoms related to origin of infection (UTI: dysuria, foul smelling urine; STI: dysuria, discharge)

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19
Q

Mx of testicular torsion

A

urgent surgical exploration

+/- reduction (untwisting)
+/- orchidectomy (only if the testis is grossly necrotic or non-viable)
+/- bilateral orchidopexy

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20
Q

signs in epididymoorchitis

A

erythema
swelling (can develop reactive hydrocele)
tender
cremasteric reflex should be intact
Prehn’s sign positive (raising testicle improves the pain)

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21
Q

Ix for epididymoorhcitis

A

bloods (IFM)
urinalysis
urine culture
clean catch urine NAAT for STI
blood cultures if septic
imaging?

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22
Q

treatment of epididymoorchitis

A

analgesia and abx as per trust guidelines

NICE:
- if any STI, ceftriaxone 1g IM single dose plus 100 mg doxycycline BD for 10-14days
- if no RF for gonorrhoea, then just the doxy or ofloxacin 200 mg BD for 14d

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23
Q

at what locations do stones cause obstruction?

A

PUJ
pelvic brim
VUJ

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24
Q

RF for renal calculi

A

(depend on type of stone)

dehydration
high levels of meat in the diet
obesity
hyperparathyroidism
drugs: HIV ART, furosemide

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25
Q

presentation of renal stones

A

renal colic, loin to groin pain (due to ureteric peristalsis)
N&V
O/E flank tenderness, pain in renal angle

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26
Q

Ix for renal calculi

A

urinalysis
U + E ?creatitine rise due to obstruction
uric acid and calcium levels (won’t change management)
CT KUB (unless very young and want to avoid radiation)

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27
Q

best analgesia for renal calculi

A

diclofenac suppository

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28
Q

mx of renal calculi

A

analgesia (diclofenac suppository)
fluids
if evidence of obstructive nephropathy:
- stent insertion (retrograde)
- nephrostomy

definite mx:
- PCNL for very large stones (percutanoes access to kidney, then laser)
- ESWL (sonic waves for small stones)
- ureteroscopy (scope into urether, then…)

29
Q

what is a nephrostomy

A

a tube put in the kidney by IR with US (this gives an alternate route for urine to pass, reduces the risk of AKI, relieves the hydronephrosis)
antegrade stent put a few days later
then get treatment for stone

30
Q

Infection in renal calculi

A
  • renal calculi become more complicated with a superimposed infection
  • higher risk of sepsis
  • becomes severe very quickly

additional clinical features are rigors, fever 40+… -? sepsis 6 them (most need amino glycoside + other broad spectrum0

31
Q

Fournier’s gangrene

A

necrotising fasciitis of the scrotum/genitals/perineum

usually polymicrobial

can be lethal or very debilitating, requires a lot of debridement

32
Q

RF

A
  • older men
  • diabetes
  • immunocompromised
  • obesity
  • smoking
33
Q

presentation of Fournier’s gangrene

A
  • scrotal pain, swelling, ulceration
  • erythema
  • fever
  • sc gas -> crepitus when pressing on skin
  • pain in excess of clinical appearance
34
Q

Ix in Fournier’s gangrene

A

primarily a clinical dx
Bloods (IFM)
CT scan - aid in surgical planning, extent of disease, confirms dx
blood cultures and swabs
plain radiograph may show free air

35
Q

management of Fournier’s gangrene

A

urgent surgical debridement
plastics will do reconstruction and grafting
antibiotics
ITU

36
Q

paraphimosis - definition

A

inability to pull a retracted foreskin back over the glans

part of the prepuce acts as tight band which reduces venous return causing oedema, ischaemia, necrosis, infection / Fournier’s gangrene

37
Q

RF for paraphimosis

A

catheter
phimosis
forgetting to put foreskin back in place after intercourse

38
Q

Paraphimosis -

A
  • Foreskin cannot be returned to its original position
  • Edema and pain of the glans penis
39
Q

paraphimosis - management

A

emergency
needs urgent reduction!

analgesia (can be a penile nerve block, LA injected into the base of the penis)

Reduction techniques:
- principle: need to recuse oedema in glans to size that can fit through the tight band
- manual pressure to glans using dextrose soaked gauze
- hypodermic needle puncture of glans to remove oedema (?clinicaly?

if ineffective:
-> insert

40
Q

Varicocoele signs and symptoms

A
  • aching, dragging pain
  • may see visible, dilated veins

-> caused by dilatation of the pampiniform plexus

41
Q

what can right sided varicocele be associated with?

A

renal cancer

if suspicious -> CT AP with contrast

42
Q

management of small urinary stones

A

can discharge home with analgesia +/- tamsulosin

(e.g. 2mm )

43
Q

if you are manually detorting a testicle, which direction do you do it in?

A

turn laterally

44
Q

What happens in testicular torsion and why is it an emergency?

A

the spermatic cord twists on itself within the scrotum

there is a risk of ischaemia and possible infarction of the testis

45
Q

What is the most important differential of epididymoorchitis?

A

testicular torsion

46
Q

What is the Prehn sign? give a condition where it is +ve and -ve

A

it is when there is reduced pain when the affected hemiscrotum is liften

+ve in epididymitis (reduced pain)
-ve in testicular torsion (still have pain)

47
Q

What are possible complications of epididymitis?

A

epidydimal abscess
testicular infarction
infertility

48
Q

Why would you go for a nephrostomy rather than a ureteric stent first line for hydronephrosis due to ureteric stent?

A
  • easy to put in
  • does not require GA

you would then place a stent later down the line and remove it about 2/12 later›››

no difference in outcome according to studies

if you have access to a theatre right away you could also go for a nephrostomy

49
Q

Ddx for renal colic pain

A

kidney stones
AAA
non-specific abdominal pain

therefore urologists often won’t accept a patient without a scan

50
Q

What is the 1st line ix for ?prostate ca?

A

multiparametric MRI

51
Q

What is the best pain relief for renal colic? (incl doe and route)

A

IM diclofenac 75 mg

52
Q

What are the medical indications for a circumcision?

A
  • phimosis
  • recurrent balanitis
  • balanitis xerotica obliterans
  • paraphimosis
53
Q

2nd line pain relief for renal colic

A

IV paracetamol

Renal colic: if NSAIDs are contraindicated or not giving sufficiency pain relief NICE recommend IV paracetamol

54
Q

Which type of renal cancer is associated with exposure to chemicals?

A

renal transitional cell cancer

TCC is a rare form of renal cancer, accounting for approximately 7% of all renal tumours. Risk factors include exposure to chemicals in the textile, plastic and rubber industry.

55
Q

most common renal tumour in children?

A

Wilm’s tumour / nephroblastoma

56
Q

Which renal mass is tuberous sclerosis associated with?
Is it benign or malignant?

A

angiomyolipoma (benign)

57
Q

renal angiomyolipoma - which condition is it associated with?

Is it benign or malignant?

A

tuberous sclerosis

angiomyolipoma is usually benign

58
Q

What cancer would you suspect in a testicular mass in >60yo?

A

lymphoma a

59
Q

What are the causes of haematuria?

A
  • Infection (UTI, schistooomiasis)
  • trauma
  • nephritic syndrome
  • urothelial cancer
    …
  • abx/beetroot - fake
60
Q

How can you differentiate between a stoma and an ileal conduit?

A

look at the contents

stool -> stoma
urine -> ileal conduit

61
Q

common causes of LUTS

A
62
Q

Is BPH hyperplasia or hypertrophy

A
63
Q

which drugs cause retrograde ejaculation?

A

finasteride
tamsulosin

64
Q

Surgical management of prostate cancer

A
65
Q

reasons to admit pt with renal colic

A
  • pain not controlled
  • significantly impaired renal function
  • single kidney
  • pyrexia/sepsis
  • stone >5mm
66
Q

Pain mx in renal colic and AKI?

A

not NSAID
-> IV paracetamol, WHO pain ladder

67
Q

Contraindications for lithotripsy

A
  • aneurysm
  • infection
  • anticoagulation
68
Q

How are stag horn stones managed?

A

PCNL

(if the kidney I functioning well. may need multiple attempts)

staghorn calculi can be very damaging to the kidneys

69
Q
A

The indications for antibiotics with a catheter
change include neutrophils 1 x 109/L, multiple attempts or traumatic insertion, post
trans-urethral urological surgery, previous episode of catheter change related sepsis,
frank pus at the urethral meatus or in critical care patients.

Year 6 (37 decks)

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