Urology Flashcards
Predominant composition of urinary stones
Presentation of Urinary Tract Stones
- acute onset severe 10/10 flank pain that
radiates to the groin - Waxes and wanes.
- Patients will struggle to sit comfortably and will pace/walk around.
- Can be associated with vomiting, nausea or haematuria.
Risk Factors for Urinary Stones
Complications of Urinary Stones
- Recurrent UTI
- Pain
- Urosepsis
- Renal Failure
Investigations for Urinary Stone
Treatment of obstructive ureteric stone + Sepsis?
What is the Sepsis 6?
Give:
- Oxygen (>94%)
- Fluids (30mL/kg of isotonic crystalloid fluid)
- IV Antibiotics
Take:
- Lactate Levels
- Blood Culture
- Urine Output Monitoring
Treatment of obstructive ureteric stone (NOT Spetic)
Treatment of Non-Obstructing Stone (Usually in Kidney)
Basics of Ureteric Stone Prevention
Fluid intake >3 Liters daily
Low Salt Diet
Differential Diagnosis of Acute Urinary Retention?
- Males
- Females
- Both
Complications of Benign Prostatic Hyperplasia (BPH)
Investigations of Benign Prostatic Hyperplasia (BPH)
Medical Treatment of Benign Prostatic Hyperplasia (BPH)
Surgical Treatment of of Benign Prostatic Hyperplasia (BPH)
Most Common metastasis of prostate cancer
Bone (Axial Skeleton)
Investigations for Prostate Cancer
History/exam (DRE)
Labs: PSA blood test
Imaging:
- Multiparametric MRI of prostate: Most useful method to image prostate. Given PIRADS score, rated from 1-5 with 1 being low risk for malignancy with 5 a very high risk of malignancy
- Bone Scan/CT TAP to evaluate for metastatic disease
Classification of Prostate Cancer?
Gleason score used for histological diagnosis and grading of prostate cancer, with the two most common tissue patterns present used to give an overall grade.
■ E.g. 3+4=7
■ However not the same as 4+3=7, which is considered more severe as 4 is the predominant tissue pattern type
Conservative treatment of Prostates Cancer (young vs. Old Man)
Indication for Surgical Treatment of Prostate Cancer?
Procedures?
Complications?
Indication for Radiation Theraoy of Prostate Cancer?
Procedures?
Complications?
Indication for Medical Treatment of Prostate Cancer?
Complications
Rapid Access Prostate Clinics
- Ages Screened
- What is checked
- What are the thresholds for referral
Risk factors for Renal Neoplasms
Differential Diagnosis of Renal Tumors
Paraneoplastic Syndromes Associated with Renal Neoplasm
Anemia
Polycythemia (Ectopic EPO Secretion)
Hypertension (Renin)
Cushing’s Syndrome (ACTH)
Hypoglycemia (Insulin)
Hypercalcemia (PTH-Like Substance)
Complications of Renal Neoplasm
Metastases:
- lung metastases
- bone metastases
- venous involvement can cause lower limb edema
Paraneoplastic Syndromes
- Anemia
- Polycythemia (Ectopic EPO Secretion)
- Hypertension (Renin)
- Cushing’s Syndrome (ACTH)
- Hypoglycemia (Insulin)
- Hypercalcemia (PTH-Like Substance)
Investigations for Renal Neoplasm
Treatment of Renal Neoplasm
Immunotherapy: Interferon Alpha
Surgery:
- Partial Nephrectomy (Nephron-Sparing)
- Radical Nephrectomy
- Cryoablation and Radiofrequency Ablation:
Conservative: Active surveillance can be considered in patients with a tumour <3cm
Risk factors for Urothelial Cell Carcinoma
Smoking
Exposure to ionising radiation or arsenic
Occupational exposure to amines
or hydrocarbons (textile industry)
Investigations for Urothelial Cell Carcinoma
Treatment for Urothelial Cell Carcinoma
Trans urethral resection of bladder tumour (TURBT)
- Needed initially for all for histological diagnosis/grading
- Adequate for patients with non-muscle invasive disease
- need surveillance flexible cystoscopies at
regular intervals to ensure no recurrence.
Radical cystectomy and ileal conduit formation
- Used for muscle invasive disease
- Usually open procedure under GA
Radiotherapy/Chemotherapy: Palliative/ Metastatic setting
Epidemiology of Testicular Tumors
Types of Testicular Tumor
Risk Factors for Testicular Tumor
History of Cryptorchidism (absence of at least one testicle from the scrotum)
Family history
Caucasian
Maternal Estrogen Exposure
HIV
Investigations for Testicular Tumor
Exam of external genitalia
- Exam contralateral testes first
- Assess size, mass, painful or painless. Hard mass arising from testicle is suggestive of malignancy
Labs
- Tumour markers: alpha fetoprotein, HCG, LDH.
Imaging: Urgent ultrasound testes – ~ 100% sensitivity for detection of testicular tumours
Treatment of Testicular Tumor
Radical inguinal orchidectomy +/- insertion of testicular prosthesis
Differential Diagnosis of Acute Testicular Pain
Investigations for Acute Testicular Pain
US testes is best step to investigate pain or swelling of scrotum
However, if suspicion of testicular torsion remember this is a clinical diagnosis – straight to surgical exploration!!
Other investigations: urine culture and STI screen if considering epididymal-orchitis
Treatment of Testicular Tortion
emergent scrotal exploration + orchidopexy (fixation of testicle)
Treatment of Epididymitis/orchitis
antibiotics depending on local protocols and cause (UTI vs STI)
Treatment of Hydrocele
managed conservatively or be offered surgical repair with Jaboulay or Lords procedure
Treatment of Testicular Varicocele
managed conservatively or offered testicular vein embolization or ligation if bothersome.
Treatment of Testicular Trauma
exploration if concerned about testicular rupture, otherwise conservatively managed with rest, elevation, and analgesia.
