Urology Flashcards
What marker is associated with testicular seminomas?
hCG
What is a common complication of radiotherapy for testicular cancer?
Proctitis
What are patients at increased risk of following radiotherapy for prostate cancer?
Bladder, colon and rectal cancer
What is the management of hard, irregular prostate felt on DRE?
2 week wait referral to urology alongside measuring PSA
What is important to exclude before circumcision can take place?
Hypospadias
What are the side effects of tamsulosin?
- dizziness
- postural hypotension
- dry mouth
- depression
Ongoing loin pain, haematuria, pyrexia of unknown origin suggests what?
Renal cancer
What does circumcision help to reduce?
Rates of HIV transmission
What is the first line investigation for prostate cancer?
Multiparametric MRI
What is the investigation of choice for renal stones?
Non contrast CT KUB
What is the most common form of prostate cancer?
Adenocarcinoma
What is the referral criteria for bladder cancer?
A patient >= 60 years of age with unexplained non-visible haematuria and either dysuria or a raised white cell count on a blood test
What is the analgesia of choice in renal colic?
IM Diclofenac
What is the mode of action of tamsulosin?
Alpha-1 antagonists which promote relaxation of the smooth muscle of the prostate and the bladder
schistosomiasis is a major risk factor for what?
Squamous cell carcinoma of the bladder
What is the treatment of choice for renal stones in pregnant women?
Ureteroscopy
Adult patients with hydroceles should have what?
Ultrasound scan
How are infantile hydroceles managed?
Surgical repair if not resolved spontaneously by ages 1-2
What is the management of epipidimo-orchitis with no known organism?
ceftriaxone 500mg intramuscularly single dose, plus oral doxycycline 100mg twice daily for 10-14 days
What are the investigations of choice for epipdidimo-orchitis?
Younger adults with sexual history - NAAT
Older adults - MSSU
What should be sent for all women with suspected UTI and haematuria?
MSU
Acute vs chronic urinary retention
Chronic will have much larger volumes (1.5L) and be painless
What is a complication of losing too much fluid following catheterisation?
Post-obstructive diuresis: monitor urine output + replace fluids
How do Tamsulosin and finasteride work?
Tamsulosin - alpha blocker - relaxes smooth muscle
Finasteride - 5-alpha reductase inhibitor - inhibits conversion of testosterone to dihydrotestosterone
What are risk factors for bladder cancer?
- Smoking
- Aromatic amines (paint and dye workers)
- Schistosomiasis
What is treatment for TCC of bladder?
TURBT
Where can bladder tumours metastasize to?
- Uterus, rectum, iliac lymph nods, liver, lungs, bone
Management of ureteric stone + signs of infection?
Surgical decompression + IV Abx
What do you call a hernia which cannot be reduced and is painless?
Incarcerated
What can a left sided varicocele be a complication of?
Renal cell carcinoma due to venous congestion of the left testicle
What is the scoring system used to assess prostate cancer severity?
Gleason
What is the management options for prostate cancer?
Low grade - active surveillance
Radical prostatectomy - robotic in younger/fitter patients
Open prostatectomy
What are causes of urinary retention?
- Stones
- BPH, Prostate cancer
- UTIs
- Post surgery
- Constipation in elderly
- Medications such as anticholinergics, benzos
Management of urinary retention
- Bladder scan/renal US
- Post void residual volume
- Catheterisation
- Treat cause
What scoring system can be used to assess prostate symptoms?
International Prostate Symptom Score
How should bladder cancer be investigated?
Flexible cystoscopy with biopsy
CT urogram for staging
What are causes of epididymo-orchitis
STI - Chlamydia/Gonorrhoea
UTI - E coli in older adults
What are signs of epididymo-orchitis?
- Acute scrotal pain/swelling
- Fever
- Dysuria
- Prehn’s positive: lifting up testicle relieves pain
- Present cremasteric reflex
Management of epidiymo-orchitis
- Analgesia
- Scrotal elevation
- Abx to treat underlying cause (Ceftriaxone + Doxy if any STI, Doxy if chlamydia)
What are some causes of erectile dysfunction?
- Vascular disease
- Autonomic neuropathy (diabetes, alcohol excess0
- Drugs
- Psychogenic
- Pelvic surgery
What is the management of erectile dysfunction?
- Psychosexual therapy
- Sildenafil/Tadalafil which increase blood flow to penis (can cause blue vision)
- Injections
What is the referral criteria for haematuria?
Bladder/Renal
- >45 with unexplained haematuria/haematuria which persists after UTI treatment
- >60 with haematuria + dysuria/raised WCC
What causes a hydrocele?
Processes vaginalis does not obliterate complete during foetal development causing abdominal fluid to accumulate in scrotum
Phimosis vs paraphimosis
Phimosis - foreskin too tight to be retracted over the glans of the penis
Paraphimosis - inability to replace foreskin to its original position
What is the management of phimosis vs paraphimosis?
Phimosis - steroid creams/surgery
Paraphimosis - manual pressure/dorsal slits
What is priapism?
Painful erection which continues over 2 hours after sexual activity
What causes priapism?
Ischaemic - lack of venous drainage
Non-ischaemic - often due to trauma
What is management of priapism?
Aspiration of blood within corpus cavernosa and fluid irrigation
Adrenaline injections
What causes prostatitis?
Acute - often due to bacterial infection
Chronic - recurrent/persistent prostatitis usually caused by E coli
How will prostatitis present on DRE?
Tender, warm, swollen prostate
How is prostatitis managed?
2 weeks of ciprofloxacin
What are the 2 types of renal cancer?
- Clear cell carcinoma
- TCC
What the 2 most common types of testicular cancer?
- Seminoma
- Teratoma
What are risk factors for testicular cancer?
- Younger age
- HIV
- Undescended testes
What is the management of testicular cancer?
- Scrotal US
- Tumour markers: hCG, AFP, LDH
- Radical orchidectomy (+ radio/chemo)
What is testicular torsion?
Twisting of the testicle around the spermatic cord -> obstruction of blood flow to testicle
How does testicular torsion present?
- Sudden onset severe pain
- Absent cremasteric
- Negative Prehns
- Following trauma
What is the management of torsion?
- Surgical exploration
- Bilateral orchidopexy: fix both testicles
What is the management of undescended testes?
Bilateral: refer to paeds to rule out genetic causes then surgery at 6 months
Unilateral: review at 6-8 weeks with referal at 3 months
What are causes of raised PSA?
- UTI
- BPH
- Prostate cancer
- Retention
- Catheterisation
Why are Abx given following prostate biopsy?
Minimise risk of infection where bowel flora can move into the prostate
Indications that a mass is renal
Moves up and down with respiration, mass palpable on bimanual
palpation, able to get above mass
Why does ureteric obstruction cause pain?
Ureteric spasm arises from peristalsis attempting to push the stone and relieve obstruction. This causes local ischaemia and hence pain
What are common sites for ureteric stones?
- Renal pelvis
- Pelvic-ureteric junction
- Vesico-ureteric junction
What immediate test should be done with painless scrotal swellings?
Trans-illumination: illumination suggests hydrocele
Where are prostate cancers likely to originate?
Peripheral zone
Which drugs can cause priapism?
Trazadone
What are the most common causes of pyelonephritis?
- E coli: gram negative pink rod shaped bacteria
- Klebsiella
- Proteus
- Enterococcus
What are the common components of renal stones?
- Calcium oxalate (most common)
- Calcium phosphate
Patients with signs of chronic retention should not have what?
TWOC - this can exacerbate renal impairment so they need a long term catheter
Lifestyle interventions for stress incontinence
- Stop smoking
- Lose weight
- Avoid alcohol/caffeine
- Avoid drinking at nightime
Causes of recurrent UTI in men
- Bladder outflow obstruction
- Urinary tract surgery
- Immunosuppression
Common organisms which cause UTI
- Escherichia coli
- Klebsiella
- Enterococcus
- Proteus sp
What are causes of urethral strictures?
- Pelvic trauma
- Perineal trauma
- Urethral instrumentation
- Long term catheter
Investigations for urethral strictures
- Cystoscopy
- U+E
- Urinalysis
- Urodynamic testing
What are complications of urethral strictures?
- Calculus formation in the urinary tract
- Chronic infection
- Bladder diverticula
What causes bladder diverticula?
- Chronic increase in intravesical pressure causing mucousa to push through the muscle layer -> risk of chronic infection
What is the management of urethral strictures?
- Internal urethrotomy
- Urethroplasty
- Graft reconstruction
Men with erectile dysfunction should have what tests
Glucose, lipid profile, testosterone
What is the most common testicular tumour in younger men?
Non-seminomatous germ cell tumours
What is a Wilms tumour?
Nephroblastoma
What is the most common organic cause of erectile dysfunction?
DM
Where are staghorn calculi found?
Renal pelvis
What are the 2 broad classes of testicular cancers?
Seminomas and non-seminomatous germ cell tumours
How do testicular cancers metastasize?
Para aortic lymph nodes
How to classify LUTS?
Storage: frequency, urgency, nocturia, dysuria
Voiding: hesitancy, poor stream, dribbling
What is a common complication of radical prostatectomy?
Erectile dysfunction
How long can finasteride treatment take?
6 months
Risk factors for testicular cancer?
- Infertility
- FH
- Cryptorchidism
What usually precedes development of a urethral stricture?
Urethral inflammation often due to infection
Tumour containing different types of tissue e.g. cartilage?
Teratoma
What is the management of neuropathic bladder?
Intermittent self catheterisation
Management of mixed colonisation of urinary catheters?
No changes needed - mixed growth bacteria is very common and does not cause symptoms usually
Cystocele vs Rectocele
Cystocele - prolapse of anterior vaginal wall containing bladder
Rectocele - Prolapse of posterior vaginal wall containing rectum
What are lifestyle modifications for urge incontinence?
Avoid caffeine
Pelvic floor excercises
Bladder retraining
Avoid alcohol/smoking
Weight loss
Abx of choice for prostatitis?
Ciprofloxacin
What is sometimes on present on standing?
Varicocele
What is an epidydimal cyst?
Painless nodule at the head of the epididymis adjacent to inferior pole of testis
Gynaecomastia can be a presenting feature of what?
Testicular cancer
terminal, painful haematuria
Think bladder calculi
What can present with recurrent balanitis and ballooning around the penis?
Phimosis
Bell clapper deformity (testis is not fixed) increases the risk of what?
Testicular torsion
What is an electrolyte complication of TURP?
Hyponatraemia
