Urology Flashcards
What are the risk factors for prostate cancer?
Age, Fhx, african-american, BRCA gene, hereditary breast/ovarian cancer syndrome and lynch syndrome
What confunders can influence a PSA level?
Ejaculation <48hr, strenuous exercise, UTI/prostatitis, recent biopsy.
What is empirical therapy for acute prostatitis?
Trimethoprim 300mg OD for 2 weeks. 2nd line: cephalexin 500mg q6h for 2 weeks.
How do you test for and treat chronic prostatitis?
Elevated leukocyte count pre and post prostatic massage, only treat if culture positive. Ciprofloxacin 500mg BD 4 weeks
2nd line: norflox 400mg BD or trimethoprim 300mg OD for 4 weeks.
What are the risk factors for malignancy in the setting of haematuria?
Age >50, smoking, gross haematuria, prev pelvic radiotherapy, occupational exposures, recurrent UTI
What is intravesical BCG used for and what are its side effects?
Immunotherapy to reduce recurrence and invasion into muscle. Acute: frequency, dysuria, low grade fever. Late: sepsis, rash (BCG-osis)
What are empirical cystitis treatment options?
Trimethoprim 300mg D for 3 days. 2nd line: nitro 100mg q6h for 3 days.
Alternative: cefalexin 500mg BD for 5 days. Don’t change therapy if improving symptoms.
What features necessitate treating a UTI in a RACF resident?
Acute dysuria OR fever/confusion WITH NEW urgency/frequency/haematuria/pelvic pain/flank pain/incointence OR catheter + fever/confusion/flank pain/rigors.
Take cultures and stop treatment if negative.
Klinefelter syndrome - karyotype, features, test and treatment.
XXY, small testes/taller height/reduced hair/breasts/osteoporosis, 2 morning fasting testosterone levels, testosterone replacement.
What are the causes of haematospermia? What are the red flags?
UTI/STI, prostatitis, abstinence or prolonged sex, anticoagulation, TB. Age >40, persistent, constitutional symptoms, prostate cancer RF.
What are the requirements for effective semen analysis?
Abstinence 2-3d prior, analysis within 1 hour and keep at room temperature. If mild derangement, repeat in 1-3mo. If severe, repeat in 2-4 weeks.
Consider FSH, testosterone level then LH and prolactin.
When is PSA used in screening? How is an elevated result managed?
2 yearly from age 50-69 (earlier if high risk). If >3, repeat in 6 weeks. If repeat is >5.5 refer. If repeat >3 and free to total ratio < 25% , refer.
What are 8 categories of risk factors for erectile dysfunction?
Age, CV disease, endocrine, neurological, medications, prostate cancer treatment, penile disorders, drugs/alcohol.
What are some examples of conditions which increase someones risk with intercourse? What are 2 alternatives to PDE5 inhibtors for ED?
Severe AS, HOCM, ICD in situ, poorly controlled AF. Vacuum erection device, intracavernosal injection.
What medication can be used for priapism? What meds can be used for premature ejaculation?
Pseudoephedrine 120mg stat. Emla cream 10-20min prior, dapoxetine 1-3hr prior, paroxetine 20mg daily.
What are causes of male infertility - pretesticular (3), testicular (3), post testicular (2)
Pre: prolactinoma, kallmman syndrome (hypogonadism), drugs. T: infection, chemo/radio/surgery, klinefelter. Post: ejaculatory or sexual dysfunction.
How is asymptomatic bacteruira managed in pregnancy and why? What abx are used for UTI in pregnancy?
Risks of pyelo + low birth weight. Confirm on 2nd culture, treat and check for cure in 2 weeks. Nitro 1st line, keflex 2nd. Trimethoprim ok in late pregnancy. If Group B strep, may need intrapartum prophylaxis.
What are 4 voiding and 4 storage symptoms? What are the likely and red flag diagnoses?
Hesitancy, intermittency, straining, dribbling. BPH, risk prostate ca. Nocturia, urge, incontinence, frequency. Overactive bladder, risk bladder ca.
What are 6 differentials of BPH? What tests are indicated?
UTI, cancer, urethral stricture, meatal stricture/phimosis, constipation, overactive bladder. MCS, UEC, consider PSA and urine cytology and U/S.
What medications treat voiding symptoms in males? What are their side effects?
Alpha blockers (tamsulosin or prazosin). Dizziness, nasal congestion, anejaculation, postural hypotension. Take 4-6 weeks. 5a reductase blockers - finasteride, dutasteride - reduce libido, gynaecomastia, erectile dysfunction.
What are the risks of a TURP
Retrograde ejaculation, reduced fertility, erectile dysfunction 10%, urinary incontinence, urethral strictures.
What scrotal conditions cause diffuse pain vs local pain? What are 4 painless swellings?
D: torsion, epididymo-orchitis, fournier’s gangrene. L: torsion of appendix, epididymitis. Painless: hydrocoele, epidiymal cyst, varicocoele, cancer.
What are 3 risk factors for testicular cancer? What blood test are indicated? What are 2 future considerations when treating?
Cryptoorchidism, HIV, down syndrome. bHCG and aFP elevated. Sperm banking, increased CVD risk in future.
What are 5 indications for urology input for renal colic? What are 3 tests used in long term ix of renal colic?
Sepsis, stone >7mm, single kidney or CKD, significant AKI, complete obstruction. Calcium level, uric acid level, PTH.
What are 6 lifestyle factors to reduce risk of renal colic?
Healthy BMI, hydration for clear urine, low sodium (reduces calcium in urine), low oxalate diet, low animal protein diet, reduce sugar sweetened beverages.
What are 3 risks of a vasectomy? 2 points of aftercare.
Infection, bleeding, failure (1 in 2000). No sex for 1 week, need 3mo or 20 ejaculations after and confirm w spermanalysis.
What are 6 differentials of nocturia?
OSA, CKD, CCF, urological cancer, BPH, overactive bladder syndrome.
How are paraphimosis and priapism managed?
Oral analgesia, firm compression bandage 15-20min. Cold shower, gentle job, pseudoephedrine, consult urology - corporal aspiration.
How is acute epididymitis treated in young men vs old men?
STI related - ceftriaxone 500mg STAT + doxy 14d OR azith 1g now and in 1 week. UTI: trimethoprim 300mg 2 weeks or keflex.
