urology Flashcards
Which scan gives information about the renal cortex and medulla but not the ureter and draining systems
DMSA scan
What type of info does a MAG3 renogram give
Imaging for patients with pre-existing renal impairment
Gives info on renal function
Which scan gives poor image quality in patients with reduced GFR/ chronic renal impairment
DTPA scan
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
What are the muscles involved in an erection
ischiocarvernosus
bulbocarvenosus
What is priapism
unwanted, sustained erection for >4hours
Causes of priapism
blood: leukaemia/ sickle cell
neuro: spinal cord transection
trauma: causing arteriovenous malformation in the penis
drugs: ED meds
Tx of priapism
-ice/ cold shower
-aspirate blood from carvernosum
-injected cavernus with alpha adrenergic agonists
Investigations for priapism
-blood test for leukaemia/SCA
-aspirate blood from cavernosa to determine if high/low flow priapism
How to alpha adrenergic agonists treat priapism
they cause constriction of blood vessels
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
Commonest type of bladder cancer
Transitional cell carcinoma
Commonest type of penile cancer
SCC
Tx of penile cancer
Orchidectomy via the inguinal approach (not scrotal)
Presentation of a patient with posterior urethral valves
Age: child
PC: urinary hesitancy/ poor flow/ renal scarring
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
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)
