Urology Flashcards
risk factors for testicular cancer
cryptorchidism
fhx
mumps orchitis
infertility
klinefelters syndrome
What are they types of testicular cancer
Which are most common and at what age
95% are Germ cell - seminomas (35yrs) and non-seminomas (25yrs) (teratomas, yolk sac etc)
Non germ cell - Leydig, Sarcoma
presentation of testicular cancer
young
painless lump
may have gynaecomastia
hydrocele
tumour markers for testicular cancer
bHCG - seminomas
bHCG and AFP - non seminomas
gold standard ix for urethritis
NAAT - gonorrhoea or chlamydia
rx of urethritis
one dose IM ceftriaxones + azithromycin if gonnococcal
no sex for 7 days
contact tracing
common organism causing Fournier gangrene
e coli
rx of fournier
surgical debridement, abx
renal stones types
calcium oxalate
uric acid
struvite
what foods are high in oxalate
chocolate and crisps
gold standard ix or renal stones
CT KUB non contrast
RF for stones
dehydration, high oxalate diet. high calcium eg hyperparathyroidism, loop diuretics, infection, sarcoidosis, diabetes, PCKD
3 locations of stone lodging
uretopelvic junction
vesicoureteric
mid way where iliac vessels cross
rx of stones
jj stent
nephrostomy
lithotripsy - <2cm but CI if on anti coags
if stone <10mm and distal what drug do you give to help smooth muscle relaxation
alpha blocker
pain med of choice for stones
NSAIDs
rx of renal stones if:
- <5mm and asymptomatic
- 5-10mm
-10-20mm
->20mm
Renal stones
watchful waiting if < 5mm and asymptomatic
5-10mm shockwave lithotripsy
10-20 mm shockwave lithotripsy OR ureteroscopy
> 20 mm percutaneous nephrolithotomy
rx of ureteric stones
shockwave lithotripsy +/- alpha blockers>
< 10mm shockwave lithotripsy +/- alpha blockers
10-20 mm ureteroscopy
which stone type is radio lucent
uric acid
renal stone prevention
avoid dehydration
low oxalate diet
allopurinol
thiazides - calcium oxalate
low salt diet
acute vs chronic urinary retention
chronic drains > 1.5L and is painlesss
acute is painful and drains less
how does tamsulosin work
how does finasteride work
Tamsulosin - alpha blocker that relaxes smooth muscle in the prostate
Finasteride - 5alpha reductase. Inhibits conversion of testosterone into dihydrotestosterone which is more potent.
causes of acute urinary retention
BPH
constipation
drug induced
UTI
CES
post anaesthesia
ix o acute urinary retention
bladder scan - confirm retention
Real USS - hydronephrosis
U&Es - renal impairement
Urine MCS once catheterised - infection
FBC, CRP - infection
If signs of CES - MRI wholes spine
how may acute urinary retention present in a pt with chronic retention
painless overflow incontinence
voiding sx of BPH
storage sx of BPH
voiding - hesitancy, poor flow, strain, post micturition dribble
storage - frequency, incontinence, nocturne
initial ix for BPH
post voiding scan
urine MC&S and urine dip
DRE
PSA
ddx of BPH
prostate cancer
prostatitis
UTI
rx of BPH
tamsulosin, finasteride + lifestyle mods (as seen in nitty gritty)
TURP
side effects of tamsulosin and finasteride
TURP complications
Tamsulosin - postural hypotension, dizines
finasteride - reduced libido and impotence
TURP - impotence, incontinence
