Urology Flashcards
What is the term used for urine passing from the bladder to a ureter?
Vesicoureteric reflux
What is the term for abnormal nerve function in the bladder?
Neurogenic bladder
What is the most common cause of urinary retention?
Benign prostatic hyperplasia
What is the presentation of chronic prostatitis?
- Pelvic Pain, which may affect the perineum, testicles, scrotum, penis, rectum, groin or lower back
- LUTS
- Sexual dysfunction such as ED, pain on ejaculation and haematospermia
- Pain with bowel movements
- Tender and enlarged prostate
How does acute bacterial prostatitis present?
More acute presentation of chronic but with systemic symptoms of infection such as fever, myalgia, nausea, fatigue and sepsis
Investigations for prostatitis?
Urine dipstick testing
Urine MC&S
Chlamydia and gonorrhoea NAAT testing on first pass urine
What is the management plan for acute bacterial prostatitis?
Hospital admission for systemically ill patients
Oral antibiotics for typically 2–4 weeks (e.g. ciprofloxacin, ofloxacin or trimethoprim)
- Analgesia
Laxatives for pain during bowel movements
What is the grading score used for prostate cancer?
Gleason grading score
Based on histology from prostate biopsies.
The greater the gleason score the more poorly differentiated the tumour is.
What is the false positive and false negative rate for PSA test?
False +ve 75%
False -ve 15%
What are the top causes for epididymo-orchitis?
Escherichia coli
Chlamydia Trachomatis
Neisseria Gonorrhoea
Mumps
Risk factors for testicular cancer?
Undescended testes
Increased height
Infertility
Family history
Caucasian
Where do testicular cancers metastasise to?
Lymphatics
Lungs
Liver
Brain
Triad of symptoms in Pyelonephritis?
Fever
Loin/back pain
Nausea/Vomiting
Most common type of renal stone?
Calcium oxalate
What is a stag-horn calculi indicative of?
Stag-horn calculi are larger renal stones that can extend from the renal pelvis into the calyces and quickly lead to obstruction. These are made from struvite, also known as ammonium magnesium phosphate). Infection from Proteus species can predispose to struvite stone formation and hence, the formation of a stag-horn calculus as they metabolise urea into ammonia.
What are the risk factors for squamous cell carcinoma of the bladder?
Typically associated with chronic inflammation from indwelling catheters and bladder stones. In developing countries linked to schistosomiasis.
What is the most common form of bladder cancer and what are the risk factors?
Transitional cell carcinoma.
Risk factors include smoking and industrial inhalation of aromatic or chlorinated hydrocarbons which are renally excreted.
What is a colovesicular fistulae and how might it present?
Abnormal connection between bowel and bladder and can be a complication of diverticular disease.
Often presents with pneumaturia, pyuria, frequent UTIs and even faeculuria
Most common pathogen in both complicated and uncomplicated UTI?
E.Coli
How do you differentiate between ischaemic and non-ischaemic priapism?
Doppler USS
Most appropriate class of antibiotics for prostatitis?
Fluoroquinolones
How does renal cell carcinoma present?
Haematuria, loin pain and a loin mass.
Other symptoms can include fatigue, weight loss and a varicocele/
Where does RCC metastasise to?
Adrenal glands, spleen, liver, pancreas, colon, bone and the lungs.
What is the usual first-line oral antibiotic for pyelonephritis?
Cefalexin
What scan can be used for renal damage?
DMSA Scan
What drug can be used in the prevention of calcium renal stones?
Thiazide diuretics (increase distal tubular calcium resorption)
What is the underlying aetiology of hydrocele?
Failure of the processus vaginalis to close
Renal Cell cancer is associated with what paraneoplastic syndrome?
Polycythaemia secondary to erythropoietin production
What is the main contraindication to circumcision in infancy?
Hypospadias as the foreskin is used in the repair
What are some medical indications for circumcision?
Phimosis
Recurrent Balanitis
Balanitis Xerotica obliterans
Paraphimosis
What is the most effective management option for renal cell carcinoma?
Total nephrectomy
RCC is usually resistant to radiotherapy or chemotherapy
What are some of the associations of renal cell carcinoma?
More common in middle aged men
Smoking
Von Hippel-Lindau syndrome
Tuberous Sclerosis
What are some risk factors for testicular cancers?
The peak incidence for teratomas is 25 years, and for seminomas is 35 years. Risk factors include:
- Infertility (increases risk by a factor of 3)
- Cryptorchidism
- Family history
- Klinefelter’s syndrome
- Mumps orchitis
Renal stones treatment?
Treatment
Stone <5mm = expectant treatment
Stone <2cm = lithotripsy (wave to break stone)
Stone <2cm + pregnant = uteroscopy
Stone complex = nephrolithotomy (invasive)
hydronephrosis/infection = nephrostomy
What is the most common organism causing prostatits?
E.Coli
What investigations would you do for Prostatitis?
Urine dipstick+/- culture
Blood culture
DRE
STI screen
Focussed history
What findings would you see on urine dipstick for Prostatitis?
NAD- Unless UTI is also present
Which of tumour markers would you use for testicular cancer?
Alpha fetoprotein B-hCG
What is the classification used for grading bladder cancer?
TNM
What are the most common sites of metastasis for bladder cancer?
Lymph nodes, Liver, Lung, Bone
Differentials for painless gross haematuria?
Bladder cancer
Renal cancer
Nephritic syndrome
Cystitis
BPH
How do you diagnose bladder cancer?
Cystoscopy
Risk factors for stress incontinence?
Increased age
Postmenopausal status
Increase BMI
Previous pregnancies and vaginal deliveries
Pelvic organ prolapse
Pelvic floor surgery
MS
What is the first line medical management for stress incontinence?
Duloxetine
What are the surgical options for stress incontninence?
- Tension-free vaginal tape
- Autologous sling procedures
- Colposuspension
- Intramural urethral bulking
What medications can be used for urge incontinence?
Oxybutynin, tolterodine, solifenacin, mirabegron
What is a torsion of hydatid of Morgagni?
Torsion of the appendix testis is the most common cause of an acute painful hemiscrotum in a child
What is the most common type of stone?
Calcium oxalate stones
Modifiable risk factors for renal stones?
Obesity
Diet rich in oxalate
Dehydration
Conditions causing to increased renal stone formation
- Hyperparathyroid
- Renal tubular acidosis
- Chronic diarrhoeal conditions
- Myeloproliferative disorders
What increased your risk of pyelonephritis?
- Recurrent UTIs
- Vesico-Ureteric reflux
- Catheter in situ
- Diabetes
- BPH
- Calculi
What does pyelonephritis appear like on CT-KUB?
Kidneys can often appear normal
Hydronephrosis or stones
What are some luminal causes of acute urinary retention?
- Stone
- Blood clot
- Tumour
- UTI
What are some mural causes of acute urinary retention?
- Stricture
- Neuromuscular dysfunction
What are some extra-mural causes of acute urinary retention?
- Abdominal/Pelvic mass/tumours
- Retroperitoneal fibrosis
What investigations could you do for acute urinary retention?
- Bladder scan/USS renal tract
- DRE
- Urinalysis and urine MCS
- Blood tests (FBC, renal profile, CRP)
- Consider non-contrast CT KUB if stones suspected
What is the first like management for acute urinary retention?
Catheterisation
What is Balanoposthitis?
A condition characterised by the inflammation of the glans penis and prepuce, often attributed to infectious agents but also prevalent in various dermatological, pre-malignant or malignant conditions.
What causes Balanoposthitis?
Bacterial infections (e.g., Streptococcus, Staphylococcus)
Fungal infections, predominantly Candida species
Viral infections, such as human papillomavirus (HPV) or herpes simplex virus (HSV)
Other potential causes include:
Dermatological conditions such as psoriasis, lichen planus, or lichen sclerosus
Chemical irritants
Poor hygiene
Phimosis (tight foreskin)
What are the signs and symptoms of Balanoposthitis?
- Redness and swelling of the glans penis and prepuce
- Pain or discomfort
- Itching
- Presence of a foul-smelling discharge
- Difficulty retracting the foreskin
What investigations can you do for Balanoposthitis?
To establish a diagnosis, a swab should be taken for culture, followed by the administration of appropriate antibiotics based on the identified infectious agent.
What is the pathophysiology of BPH?
BPH is characterised by the nodular overgrowth of prostatic tissue, predominantly in the transition zone. This growth impinges on the prostatic urethra, causing dynamic and static obstruction, leading to urinary symptoms.
How can you classify Chronic urinary retention?
Low or high pressure and by the presence of detrusor activity
What can cause Chronic Urinary retention?
- Benign prostatic hyperplasia (most common)
- Prostate cancer
- Certain medications such as antihistamines, anticholinergics, or antispasmodics
- Congenital conditions such as posterior urethral valves
What are the management strategies for Chronic Urinary Retention?
- Alleviate the obstruction (often with catheterization)
- Address the underlying cause
- Pt may require IV fluids to manage post-obstructive diuresis
What complications can result from chronic obstructive diuresis?
- Post-obstructive diuresis
- Chronic Kidney disease
- Hydronephrosis
- Bladder Diverticula
When does post-obstructive diuresis occur?
- Occurs when there is >200ml/hr for two consecutive hours or
- Production of >3L of urine in 24 hours
Why does post-obstructive diuresis occur?
- Due to hydronephrosis there is loss of medullary concentration gradient in nephrons.
Results in massive loss of water and salt through polyuria.
In these patients there is a severe risk of hypovolaemia and hyponatraemia/other electrolyte imbalances.
How do you manage post obstruction diuresis?
Urine osmolarities should be taken as this will determine management.
- Iso-osmolar urine indicate the kidneys do not need to concentrate the urine and is consistent with physiological diuresis and it generally self-limiting.
- Hyper-osmolarity indicates the kidneys are concentrating urine so post-obstructive diuresis has, or is resolving.
- Hypo-osmolarity indicates salt wasting and the inability for the kidneys to concentrate urine. This is pathological and patients should have fluids replaced like for like.
Which of the urethral sphincters is under voluntary control and what is its innervation?
External Urethral sphincer is under voluntary control through the pudendal nerve
What are the investigations for Erectile Dysfunction?
QRISK3
Free testosterone (should be measured in the morning between 9am and 11am)
- If free testosterone is low or borderline then should be repeated along with follicle-stimulating hormone, luteinizing hormone and prolactin levels.
What medication can be considered for the prevention of renal stones?
Potassium Citrate
What is the first-line pain relief for acute renal colic?
IM Diclofenac 75mg
What are the causes of Urethral stricture?
- Idiopathic
- Iatrogenic
- STIs e.g. Gonorrhoea
- Penile fractures
- Hypospadias
- Lichen Sclerosis
What are the features of Urethral stricture?
- Decreased urinary stream
- Incomplete bladder emptying
- Less common symptoms including spraying of urinary stream and dysuria
What are the investigations of Urethral stricture?
- Uroflowmetry
- Ultrasound postvoid residual measurement
What is the management of Urethral stricture?
- Dilation
- Endoscopic Urethrotomy
What is the next appropriate treatment for a man with Erectile dysfunction were Sildenafil is contraindicated?
If there is an insidious presentation and normal libido then it is likely to be an organic cause.
If Sildenafil contraindicated (due to nitrate use) then give intracavernosal prostaglandins
In terms of LUTS ask what voiding and storage symptoms could you ask about?
Voiding: hesitancy / weak or intermittent urinary stream / splitting / spraying / straining
/ incomplete emptying / terminal dribbling
Storage: urgency / frequency / nocturia / urinary incontinence / feeling the need to
urinate again immediately after (Any
What imaging is used as the first-line investigation for suspected prostate
cancer?
Multiparametric MRI
Which zone of the prostate is primarily affected in prostate cancer?
Peripheral zones
Prostate cancer is diagnosed through biopsies of prostatic tissue, which are
used to calculate a ‘Gleason score’. How is the Gleason score calculated?
The two most common tumour patterns across all samples are graded based on their
differentiation.
The sum of the two grades is the Gleason score.
What is Peyronie’s dosease?
Peyronie’s disease is a condition characterised by an acquired curvature of the penis due to fibrosis of the tunica albuginea
What is the most common type of testicular cancer?
Germ cell tumour
How do you stage testicular cancer?
Royal Marsden classification
To what lymph nodes do the testis drain to?
Para-aortic
What is the most important risk factor for Penile cancer?
HPV infection
What signs would you see on examination for testicular torsion?
Retracted, cord is most tender, absent cremasteric reflex, transverse lie
What signs would you see on examination for epididymo-orchitis?
Erythema, warmth, scrotal sac involvement, positive Prehn’s sign
Stones are most likely to impact in the narrowest parts of the urinary tract.
What are the 3 naturally narrowed points?
- Pelviureteric junction/where renal pelvis becomes ureter
- Crossing the pelvic brim
- Vesicoureteric junction
What is the preferred management option for a large staghorn calculi, which
fills the renal pelvis?
Percutaneous nephrolithotomy
What is a hydrocele?
A collection of fluid within the tunica vaginalis that surrounds the testes.
What are potential causes of hydrocele?
Idiopathic
Testicular cancer
Testicular torsion
Epidiymo-orchitis
TraumaW
What is a Varicocele?
Where the veins in the Pamipiniform plexus become swollen
How might a varicocele present?
Throbbing/Dull pain, or discomfort, worse on standing
Dragging sensation
Sub-fertility
What are the examination findings of varicocele?
A scrotal mass that feels like a bag of worms
More prominent on standing
Disappears when lying down
Asymmetry in testicular size if the varicocele has affected the growth of the testicle
