urology Flashcards by Anjali Yapa

Which scan gives information about the renal cortex and medulla but not the ureter and draining systems

DMSA scan

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What type of info does a MAG3 renogram give

Imaging for patients with pre-existing renal impairment

Gives info on renal function

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Which scan gives poor image quality in patients with reduced GFR/ chronic renal impairment

DTPA scan

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Describe the nervous control of an erection

Erection is controlled by both Autonomic (sym/parasympathetic) and somatic nerves

Autonomic- nervi erigentes/ pelvic splanchnic nerves S2-4:
-para= causes erection
-symp= causes ejaculation/ detumescence

Somatic:
-onufs nucleus- origin of pudendal nerve in the anterior horn of the sacral part of the spinal cord (S2-4)
[controls muscles of continence + orgasm]

-dorsal penile nerve

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What are the muscles involved in an erection

ischiocarvernosus
bulbocarvenosus

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What is priapism

unwanted, sustained erection for >4hours

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Causes of priapism

blood: leukaemia/ sickle cell

neuro: spinal cord transection

trauma: causing arteriovenous malformation in the penis

drugs: ED meds

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Tx of priapism

-ice/ cold shower
-aspirate blood from carvernosum
-injected cavernus with alpha adrenergic agonists

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Investigations for priapism

-blood test for leukaemia/SCA
-aspirate blood from cavernosa to determine if high/low flow priapism

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How to alpha adrenergic agonists treat priapism

they cause constriction of blood vessels

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What is high vs low flow priapism

High= priapism due to unregulated arterial flow into the cavernosa, PAINLESS

Low= due to veno-occlusion, high intra-cervenosal pressures, PAINFUL, needs emergency tx

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Commonest type of bladder cancer

Transitional cell carcinoma

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Commonest type of penile cancer

SCC

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Tx of penile cancer

Orchidectomy via the inguinal approach (not scrotal)

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Presentation of a patient with posterior urethral valves

Age: child
PC: urinary hesitancy/ poor flow/ renal scarring

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What investigations would you carry out for an incidental adrenal lesion found on CT

Hormonal assay includes:
-serum morning and midnight cortisol levels
-serum K, aldosterone + renin
-24hr urine cortisol excretion
-24hr urine catecholamine excretion
-dexamethasone suppression test

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What determines the likelihood of malignancy in adrenal lesions

likelihood = size of lesion

lesions >4cm have 25% chance of being malignant

Causes of hydronephrosis

unilateral=PACT

-PUJ obstruction
-abherrant renal vessels
-calculi
-Tumour of renal pelvis

bilateral=SUPER

-stenosis of urethra
-urethral valve
-prostatic enlargement
-extensive bladder tumour
-retroperitoneal fibrosis

Ix for hydronephrosis

-IV urogram (position of obstruction)
-pyelogram (retro/ antegrade)
-non contract CT (renal calculi)

Mx of an acut vs chronic upper ureteric obstruction

acute= nephrostomy
chronic= ureteric stent

Which medications cause pseudohaematuria

rifampicin
quinine
methyldopa
levadopa
phenytoin

Which foods cause pseudohaematuria

beetroot
rhubarb
blackberries

Side effect of the drug cyclophosphamide

haemorrhagic cystitis

Drugs that can cause interstitial nephritis/ tubular necrosis (haematuria)

aminoglycosides
sulphonamides
quinine
penicillins
NSAIDs

What is the optimal operative procedure for a testicular cancer and why

orchidectomy via inguinal approach (prevent spread to other lymphatic fields)

What is the management of a hydrocele in a child vs adult (which surgical approach)

CHILD: ligation of the patent processus vaginalis via an INGUINAL approach ADULT: Jaboulay/ lords procedure via SCROTAL approach (hydrocele sac excision/ plication)

Features associated with adult polycystic kidney disease

other cysts= liver/ pancreas/ berry aneurysms HTN/ haematuria/ renal calculi (urea)/ renal mass

What type of tumour is found in the kidney and is pink coloured on dissection

TCC

Which presentations of renal colic would require more urgent management

Obstruction/ structural abnormalities (eg horseshoe kidneys), recent renal transplant obstruction + infection= surgical emergency (needs decompression!)

Renal colic: when would mx included watchful waiting

renal OR ureteric calculi <5mm

When would you use ESWL to treat renal/ureteric calculi

renal calculi <10mm ureteric calculi 5-10mm

When would you use ureteroscopy to treat renal/ureteric calculi

renal/ ureteric calculi 10-20mm

When would you use percutaneous nephrolithotomy to treat renal/ureteric calculi

renal calculi >20mm

Difference between ESWL/ ureteroscopy and PCNL

ESWL (not going through urinary tract or skin, lithotripsy but stones cant be extracted) ureteroscopy (ureteroscope inserted through urethra and shockwaves sent, stones extracted) PCNL (through skin and stones extracted)

What are the types of medical mx of BPH

5 alpha reductase inhibitors (finasteride) alpha blockers (tamsulosin)

What is the MOA of the medications used to treat BPH

5 alpha reductase inhibitors= prevent conversion of testosterone- dihydrotestosterone (hence prostate doe not increase in size) alpha blockers (relax smooth muscles of the prostate and the bladder, prostate may continue to grow)

Which medical therapy used in the treatment of BPH does NOT reduce the risk of urinary retention

alpha blockers

Which bacteria increase the risk of getting staghorn calculi

Proteus mirabilis urease producing bacteria

what is the most radiodense type of renal calculi

calcium phosphate

What are staghorn calculi made of

Struvite

Family history of stones and metabolic disorders- what type of stones form?

Cystine

At what age does foreskin become retractile

at puberty (approx 16 y/o)