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1. MSRA > Urology > Flashcards

Urology Flashcards

1
Q

What is the cause of most paediatric hydroceles?

A

congenital

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1
Q

What is a hydrocele and what are the 3 types?

A

Fluid collection within tunica vaginalis around the scrotum or spermatic cord
1. communicating (congenital) - patent processus vaginalis
2. non-communicating - patent processus vaginalis but no flow of peritoneal fluid from abdominal cavity occurs; due to excessive production fo fluid within tunica vaginalis
3. hydrocele of the cord - defective closure of tunica of vaginalis

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2
Q

What are 8 causes of hydroceles in adults?

A
  • orchitis
  • epididymitis
  • tuberculosis
  • torsion
  • trauma
  • testicular tumour
  • post renal transplant
  • post radiation treatment
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3
Q

What is the presentation of hydrocele?

A

swelling superior and anterior to testicle; painless; dragging sensation

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4
Q

What is the location of spermatoceles?

A

superior and posterior to testis

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5
Q

Which side is more commonly affected by testicular torsion?

A

Left side

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6
Q

What are the 2 most common causative organisms of epididymo-orchitis in men >35y?

A

E. coli, Pseudomonas (non-sexually transmitted)

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7
Q

What is Prehn’s sign?

A

elevation of testicle relieves pain in epididymo-orchitis (not in torsion)

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8
Q

What are the 3 treatments that may be given in epididymo-orchitis?

A
  • if gonococcal: ciprofloxacin
  • chlamydia, or non-specific genital infection, non-gonococcal urethritis: doxycycline or azithromycin
  • if urine dip +ve and most likely enteric organisms: trimethoprim
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9
Q

What are 2 medical treatments for BPH?

A
  1. alpha-adrenergic antagonists e.g. tamsulosin (relaxation of prostate + bladder neck)
  2. 5-alpha reductase inhibitors e.g. finasteride (reduces production of dihydrotestosterone which enlarges prostate)
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10
Q

What are 2 options for treatment of BPH that are minimally invasive?

A
  1. TUMT - transurethral microwave thermotherapy
  2. TUNA - transurethral needle ablation
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11
Q

What is the gold standard surgical management of BPH?

A

TURP

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12
Q

What may be the signs on examination of urethral injuries?

A

blood at external urethral meatus, perineal bruising, DRE: high riding prostate/inability to palpate prostate

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13
Q

What are 4 conditions that must be met for PSA blood test to be performed?

A
  1. no active urine infection or prostatitis (treatment completed 1 month ago)
  2. not ejaculated last 48h
  3. non vigorous exercise last 48h
  4. no prostate biopsy last 6 weeks
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14
Q

What proportion of children with a UTI have vesicoureteric reflux?

A

30%

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15
Q

What is the pathophysiology of vesicoureteric reflux?

A

Ureters enter the bladder more perpendicular rather than at an angle therefore shorter intramural course of ureters; therefore vesicoureteric junction can’t function properly

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16
Q

What are 5 drugs which may cause urinary retention?

A
  1. Tricyclic antidepressants e.g. amitriptyline
  2. Anticholinergics e.g. antipsychotics, antihistamines
  3. Opioids
  4. NSAIDs
  5. disopyramide (antiarrhythmic)
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17
Q

What are 4 risk factors that define complicated UTI?

A
  1. abnormal urinary tract e.g. calculus, obstruction, indwelling catheter, VUR
  2. virulent organism e.g. Staph aureus
  3. immunosuppression
  4. impaired renal function
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18
Q

What is the definition of recurrent UTI?

A
  • 2 or more UTI in 6 months
  • 3 or more UTIs in 12 months
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19
Q

What are 8 situations to send urine for MCS in suspected UTI?

A
  1. pregnant
  2. > 65 years
  3. persistent symptoms that don’t resolve with abx
  4. recurrent UTI
  5. urinary catheter or recent catheterisation
  6. risk factors for resistance/complicated UTI
  7. atypical symptoms
  8. visible or non-visible haematuria
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20
Q

How should the management approach to UTI be taken in men?

A

confirm diagnosis with urine culture before starting empirical drug treatment (don’t use urine dipstick or microscopy)

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21
Q

What are 2 situations when nitrofurantoin should be avoided?

A
  1. G6PD deficiency
  2. Acute porphyria
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22
Q

What are 3 situations to avoid / exercise caution with trimethoprim?

A
  1. caution - folate deficiency
  2. renal impairment (use half dose)
  3. blood dyscrasias
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23
Q

What is the antibiotic treatment for UTI in pregnancy?

A

nitrofurantoin (but avoid at term); 2nd choice amoxicillin (only if susceptible) or cefalexin
for 7 days
avoid trimethoprim

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24
Q

What are the 7 commonest organisms that can cause acute UTI?

A
  1. E coli
  2. Proteus
  3. Klebsiella
  4. Eneterobacter
  5. Candida
  6. Enterococci
  7. Staphylococci saprophyticus
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25
Q

In which patient group is Staph saprophyticus a common organism for causing UTI?

A

young, sexually active women

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26
Q

What are 2 organisms causing UTI which may be seen in abnormalities of the urinary tract?

A
  1. Pseudomonas aeruginosa
  2. Staphylococcus epidermidis
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27
Q

What is penile fracture?

A

traumatic rupture of the corpus cavernosum - urologic emergency. 30% occur during sexual intercourse

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28
Q

What is the presentation of penile fracture?

A
  • snapping sound with immediate detumescence; pain varies depending on injury severity. normal external penile appearance obliterated - swelling, eccymosis (eggplant deformity)
  • if urethra injured - blood present at meatus +- haematuria, dysuria, retention
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29
Q

What are 3 investigations that are considered for penile fracture?

A
  1. if urethral injury suspected - retrograde urethrography
  2. carvernosography
  3. MRI
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30
Q

What is the management of penile fracture?

A

mainstay is surgical therapy including evacuating haematoma, correcting defect in tunica albuginea + repairing urethral injury

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31
Q

What is the commonest cause of renal stones (/composition)?

A

calcium oxalate (75%)

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32
Q

What are 4 situations when surgery is indicated for renal tract calculi?

A
  1. persistent / severe pain
  2. renal failure
  3. renal infection
  4. if stone fails to pass/move for 30 days
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33
Q

What are 5 different types of renal stones and their respective incidence?

A
  1. calcium oxalate (75%)
  2. magnesium ammonium phosphate aka struvite (10%)
  3. urate (5%)
  4. hydroxyapatite (5%)
  5. cystine (1%)
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34
Q

What is the gold standard investigation for renal stones?

A

non-contrast CT-KUB

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35
Q

What proportion of renal stones are visible on plain x-rays?

A

80%

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36
Q

What are 4 surgical options for renal tract stones?

A
  1. extracorporeal shock wave lithotripsy - before enters ureter
  2. laser - ureteroscopic fragmentation
  3. pneumatic / shock wave fragmentation of larger stones
  4. percutaneous nephrolithotomy (PCNL) - large/complicated stones
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37
Q

What is advised with regards to dietary calcium in renal tract calculi?

A

normal calcium intake (low calcium diets increase oxalate excretion)

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38
Q

What are 8 foods patients should have less of to reduce oxalate intake if at risk of renal stones?

A
  1. tea
  2. chocolate
  3. nuts
  4. strawberries
  5. rhubarb
  6. spinach
  7. beans
  8. beetroot
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39
Q

What is the normal value for urine output?

A

0.5ml / kg / hour (35ml / hr in 70kg patient)

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40
Q

What is the failure rate of male sterilisation (vasectomy)?

A

1 in 2000

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41
Q

When can men have unprotected intercourse after a vasectomy?

A

semen analysis needs to be performed twice afterwards before can have UPSI - usually at 12 weeks

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42
Q

What are 5 complications of vasectomy?

A
  1. bruising
  2. haematoma
  3. infection
  4. sperm granuloma
  5. chronic testicular pain (5-30%)
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43
Q

What is the success rate of vasectomy REVERSAL?

A

up to 55% if done within 10 years (25% after 10)

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44
Q
A
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45
Q

What is the management of bilateral hydroceles in the newborn?

A

Reassure - most are communicating (patent processus vaginalis) and self resolve within a few months

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46
Q

What should be done if a hydrocele in an infant persists beyond 1 year of age?

A

Routine referral to urology for consideration of repair

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47
Q

What is the clinical importance of varicoceles?

A

Associated with infertility

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48
Q

What is the investigation to diagnose varicocele?

A

US with Doppler studies

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49
Q

What is the management of varicocele?

A

Conservative usually - surgery if troubled by pain

50
Q

What is the commonest type of penile cancer?

A

Squamous cell cancer

51
Q

What are 8 risk factors for penile cancer?

A
  1. HIV
  2. HPV
  3. Genital warts
  4. Phimosis
  5. Paraphimosis
  6. Balanitis
  7. Poor hygiene
  8. Age >50y
52
Q

What are 4 risk factors for prostate cancer?

A
  1. Increasing age
  2. Obesity
  3. Afro-Caribbean ethnicity
  4. Family history
53
Q

What is the management of testicular torsion?

A

urgent surgical exploration - if torted testis identified, both testes should be fixed (As bell clapper testis is often bilateral)

note likely to be non viable after 6h of symptoms - orchiectomy

54
Q

What is the first line treatment of lower UTI in pregnancy not at term (including duration)?

A

nitrofurantoin PO 7 days

55
Q

What type of cancer causes the majority of testicular cancers?

A

95% are germ cell tumours

56
Q

What are 2 types of germ cells tumours?

A
  1. seminomas
  2. non-seminomas (embryonal, yolk sac, teratoma and choriocarcinoma)
57
Q

What are 2 types of non-germ cell testicular tumours?

A
  1. Leydig cell tumours
  2. sarcomas
58
Q

What are 5 risk factors for testicular cancer?

A
  1. infertility
  2. cryptorchidism (undescended testicle)
  3. family history
  4. Klinefelter’s syndrome
  5. mumps orchitis
59
Q

What is the commonest presenting symptom of testicular cancer?

A

painless lump

60
Q

What are 4 possible presenting features of testicular cancer?

A
  1. painless lump
  2. pain in a minority
  3. hydrocele
  4. gynaecomastia
61
Q

Why does gynaecomastia sometimes occur in testicular cancer?

A
  • increased oestrogen: androgren ratio
  • germ-cell tumours - hCG - Leydig cell dysfunction - increase in both oestradiol and testosterone production, rise in oestradiol relatively greater than testosterone
62
Q

Which tumour marker may be elevated in testicular seminomas?

A

hCG

in 20%

63
Q

Which 2 tumour markers may be elevated in non-seminoma testicular cancer?

A

AFP and/or beta-hCG in 85% (LDH in 40%)

64
Q

What is the first line investigation for suspected testicular cancer?

A

ultrasound testes

65
Q

What is the management of testicular cancer?

A
  • depends on whether tumour is seminoma or non-seminoma
  • orchidectomy
  • chemotherapy and radiotherapy - depending on staging and tumour type
66
Q

What is the recommended antibiotic therapy for acute prostatitis?

A

quinolone (e.g. cipro) or trimethoprim

67
Q

What is the first line treatment abx for acute pyelonephritis?

A

broad-spectrum cephalosporin or quinolone

68
Q

What are 5 risk factors for urinary incontinence?

A
  1. advancing age
  2. previous pregnancy and childbirth
  3. high BMI
  4. hysterectomy
  5. family history
69
Q

What investigations should be performed for all causes of urinary incontinence? Give 4

A
  1. bladder diary - minimum 3 days
  2. vaginal exam - exclude pelvic organ prolapse + ability to voluntarily contract pelvic floor muscles
  3. urine dipstick + culture
  4. urodynamic studies
70
Q

What is the first line management of stress urinary incontinence?

A

bladder retraining - minimum 6 weeks

71
Q

What drugs may be offered second line in urge urinary incontinence?

A
  • antimuscarinics first line: oxybutynin, tolterodine, darifenacin
  • mirabegron (beta-3 agonist) if elderly
72
Q

What is the first line maangement of stress incontinence?

A

pelvic floor muscle training - 8 contractions TDS minimum 3 months

73
Q

In addition to PFME what are 2 other options for the management of stress incontinence?

A
  • surgical: retropubic mid-urethral tape
  • medical: duloxetine if decline surgical
74
Q

What is the mechanism of action of duloxetine to treat stress urinary incontinence?

A
  • a combined noradrenaline and serotonin reuptake inhibitor
  • increased synaptic concentration of noradrenaline and serotonin within the pudendal nerve → increased stimulation of urethral striated muscles within the sphincter → enhanced contraction
75
Q

How may hypospadias present if missed during newborn baby check?

A

abnormal urine stream

76
Q

What are 4 characteristics of hypospadias?

A
  1. ventral urethral meatus
  2. hooded prepuce
  3. chordee (ventral curvature of penis) if severe
  4. urethral meatus open more proximally in severe variants; 75% distally located
77
Q

What are 2 conditions that rarely accompany hypospadias?

A
  1. cryptorchidism
  2. inguinal hernia
78
Q

What is the management of hypospadias?

A
  • referral to specialist services
  • corrective surgery age 12 months
  • must NOT be circumcised prior - may be used in corrective procedure
  • if very distal - may not require treatment
79
Q

At what age does corrective surgery for hypospadias usually occur?

A

12 months

80
Q

What is the most important counselling to give to parents of children with hypospadias?

A

must not be circumcised prior to surgery - foreskin may be used in corrective procedure

81
Q

What is the classic presentation of bladder cancer?

A

painless, visible haematuria (e.g. transitinoal cell carcinoma)

82
Q

What is the triad of renal cell carcinoma presentation?

A
  1. haematuria
  2. loin pain
  3. abdominal mass
83
Q

What are 2 drugs that can cause red/orange urine?

A
  1. rifampicin
  2. doxorubicin
84
Q

What are the NICE guidelines for 2ww referral for haematuria?

A
  • age 45 years and over AND unexplained visible haematuria without UTI
  • age 45 years and over AND visible haematuria that persists or recurs after successful UTI treatment
  • age 60 years and older AND non-visible haematuria AND dysuria OR raised WCC
85
Q

What are NICE guideslines for non-urgent referral for haematuria?

A

Aged 60 years and over with recurrent or persistent unexplained UTI

86
Q

What do NICE advise for the management of non-visible haematuria in someone <40 years?

A

if normal renal function, no proteinuria and normotensive do not need referral

87
Q

When do NICE recommend alpha blockers (E.g. tamsulosin) are used for renal stones?

A

distal ureteric stones <10mm in size

88
Q

How quickly should non-contrast CT KUB be performed for suspected renal stones?

A
  • within 24h of admission for all patients
  • immediately if fever, solitary kidney or diagnosis uncertain (exclude ruptured AAA)
89
Q

What diagnostic imaging should be used in pregnant women and children for suspected renal stones?

A

US

90
Q

What are the NICE first-line guidance for renal stones?

A
  • <5mm and asymptomatic: watchful waiting
  • 5-10mm: shockwave lithotripsy
  • 10-20mm shockwave lithotripsy or ureteroscopy
  • > 20mm percutaneous nephrolithotomy
91
Q

What are the options for managing ureteric stones?

A
  • <10mm: shockwave lithotripsy +- alpha blockers
  • 10-20mm ureteroscopy
92
Q

What are the options for treating ureteric calculi causing obstruction and infection?

A
  • nephrostomy tube placement
  • insertion of ureteric catheters
  • ureteric stent placement
93
Q

When is ureteroscopy indicated over shockwave lithotripsy for renal calculi?

A
  • pregnant females / other CIs for lithotripsy
  • complex stone diesase
94
Q

What is usually done after ureteroscopy for renal calculi?

A

stent left in situ for 4 weeks afterwards

95
Q

What are 6 ways of prevention calcium renal stones?

A
  1. high fluid intake
  2. add lemon juice to drinking water
  3. avoid carbonated drinks
  4. limit salt intake
  5. potassium citrate
  6. thiazide diuretics (increase distal tubular calcium resorption)
96
Q

What are 2 ways of avoiding oxalate renal stones?

A
  1. cholestyramine - reduces urinary oxalate secretion
  2. pyridoxine - reduces urinary oxalate section
97
Q

What are 2 ways to prevent uric acid stones?

A
  1. allopurinol
  2. urinary alkalinisation e.g. oral bicarbonate
98
Q

What are 4 key parts of the assessment of suspected BPH?

A
  1. dipstick urine
  2. U+Es, PSA
  3. urinary frequency-volume chart - at least 3 days
  4. IPSS
99
Q

What are the 3 categories for IPSS?

A
  • 20-35: severely symptomatic
  • 8-19: moderately symptomatic
  • 0-7: mildly symptomatic
100
Q

What is first line for moderate-severe voiding symptoms in BPH?

A

alpha-1 antagonists (tamsulosin, alfuzosin)

101
Q

What is the mechanism of action of alpha-1 antagonists for BPH?

A

decrease smooth muscle tone of prostate and bladder

102
Q

What is the mechanism of action of 5-alpha reductase inhibitors for BPH?

A

block conversion of testosterone to dihydrotestosterone (DHT) - reduces prostate volume and may slow disease progression (can take 6 months)

103
Q

When are 5-alpha reductase inhibitors indicated in BPH?

A

significantly enlarged prostate considered at high risk of progression

104
Q

What are 4 adverse effects of 5 alpha reductase inhibitors?

A
  1. erectile dysfunction
  2. reduced libido
  3. ejaculation problems
  4. gynaecomastia
105
Q

When is combined treatment for BPH with alpha-1 antagonists and 5 alpha-reductase inhibitor recommended?

A

if man has bothersome moderate-to-severe voiding symptoms and prostatic enlargement

106
Q

What drug can be tried for BPH with mixture of storage and voiding symptoms that persistent after alpha-blocker alone?

A

antimuscarinic e.g. tolterodine or darifenacin

107
Q

What is the most significant risk factor for transitional cell carcinoma of the bladder?

A

smoking

108
Q

What are 4 risk factors for transitional cell carcinoma of the bladder?

A
  1. smoking
  2. exposure to aniline dyes - 2-naphthylamine, benzidine (printing/textiles)
  3. rubber manufacture
  4. cyclophosphamide
109
Q

What are 2 risk factors for squamous cell carcinoma of the bladder?

A
  1. schistosomiasis
  2. smoking
110
Q

What are 3 associations with epididymal cysts?

A
  1. polycystic kidney disease
  2. cystic fibrosis
  3. von Hippel-Lindau syndrome
111
Q

What is the management of epididymal cysts?

A

usually supportive; surgical removal or sclerotherapy may be attempted for large / symptomatic cysts

112
Q

How long should you wait to perform PSA in someone who has had a UTI or prostatitis?

A

1 month

113
Q

What is the first-line investigation for priapism?

A

Cavernosal blood gas analysis (identify whether ischaemic or non-ischaemic priapism)

114
Q

What is a second-line investigation for priapism if cavernosal blood gas analysis is not possible?

A

doppler or duplex ultrasonography

115
Q

What is the management of ischaemic priapism?

A
  • if >4 hours: aspiration of blood from cavernosa + saline flush
  • 2nd line: intracavernosal injection of vasoconstrictive agent e.g. phenylephrine, repeated every 5 minutes
  • if fails - surgery
116
Q

What is the management of non-ischaemic priapism?

A

usually suitable for observation first-line

117
Q

What is phimosis?

A

inability ot retract the foreskin because of a narrow preputial ring

118
Q

What complication can develop from phimosis?

A

inability to clean under foreskin associated with stones in the preputial sac + Development of cancer of the penis

119
Q

What problems with intercourse can phimosis cause?

A

pain during intercourse

120
Q

What are the 2 types of phimosis?

A
  • primary: without scarring (rarely congenital)
  • secondary: scarring from conditions such as recurrent balanitis, traumatic retraction of foreskin, balanitis xerotica et obliterans
121
Q

What is the management pf physiological vs pathological phimosis?

A
  • physiological: conservative (becomes retractable with time), topical steriods can help
  • pathological: circumcision, short course of topical steroids
122
Q

What is meant by asthenozoospermia?

A

reduced sperm motility

123
Q

What is the term used to refer to poor sperm morphology?

A

teratospermia

1. MSRA (27 decks)

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