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Surgery > Urology > Flashcards

Urology Flashcards

1
Q

What are Lower Urinary Tract Symptoms?

A

Storage (irritative):
frequency
urgency
nocturia
incontinence

Voiding (obstructive):
hesitancy
poor stream
straining
terminal dribbling
incomplete emptying

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2
Q

Investigations for LUTS?

A

International Prostate Symptom Scale
Bladder diary
Uroflowmetry

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3
Q

Causes of polyuria?

A

primary polydipsia
cranial diabetes insipidus
nephrogenic diabetes insipidus
T1DM
T2DM

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4
Q

What does uroflowmetry measure?

A

the volume of urine released
the speed at which it is released
how long the release takes
the post-residual volume

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5
Q

What is a normal post-residual volume?

A

<50ml is normal
<100ml usually acceptable in patients >65

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6
Q

What is urinary incontinence?

A

the involuntary leakage of urine

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7
Q

Types of urinary incontinence?

A

stress incontinence
urge incontinence
mixed incontinence
overflow incontinence
functional incontinence
anatomical (fistula, ectopic ureter)

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8
Q

Investigations for urinary incontinence?

A

U&Es
MSSU -> culture & sensitivity
urinalysis
flow studies
bladder diary
US bladder
cystoscopy
urodynamic studies

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9
Q

What is stress incontinence?

A

involuntary leakage of urine in the presence of raised intra-abdominal pressure and in the absence of detrusor activity

caused by intrinsic sphincter deficiency

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10
Q

Mx of stress incontinence?

A

conservative:
weight loss, caffeine reduction, pelvic floor exercises, medication review
medical:
duloxetine, topical oestrogen can help in post-menopausal women
surgical:
urethral bulking agents, no sling/suspension

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11
Q

What is urge incontinence?

A

involuntary loss of urine associated with urgency due to overactivity of the detrusor muscle, aka overactive bladder

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12
Q

Mx of urge incontinence?

A

conservative:
lifestyle, red. caffeine, alcohol, bladder retraining
medical:
anticholinergics, beta-3 adrenergic agonist (mirabegron)
surgical:
intra-vesical Botox, neuromodulation, CLAM ileocystoplasty, diversion procedures

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13
Q

Mx of mixed incontinence?

A

discover which form of incontinence is affecting the patient more and treat this

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14
Q

Mx of overflow incontinence?

A

usually due to urinary retention
catherisation

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15
Q

Causes of temporary incontinence?

A

DIAPPERS
Delirium
Infection
Atrophic Vaginitis
Pharmaceuticals (diuretics, opiates, anticholinergics)
psychological issues
excess fluid
reduced mobility
stool (constipation)

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16
Q

Risk Factors for urinary incontinence?

A

female
Caucasian
childbirth
vaginal birth
multiparity
multiple pregnancy
traumatic or prolonged delivery
pelvic surgery
radiotherapy
neurological diseases
incr. age

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17
Q

Morbidity associated with urinary incontinence?

A

decreased QOL
sexual dysfunction
perineal infections
incr. risk of falls
psychological
incr. caregiver burden

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18
Q

What is benign prostatic hyperplasia?

A

a benign proliferation of the smooth muscles and the epithelial cells within the transition zone of the prostate

cause unknown but testosterone believed to play a role

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19
Q

Epidemiology of BPH?

A

extremely common
50% in 50yrs
80% in 80yrs
25% require treatment

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20
Q

Presentation of BPH?

A

asymptomatic (incidental finding)
voiding symptoms (obstructive LUTS)
decreased urine flow rate
outflow obstruction
acute urinary retention
haematuria
hydronephrosis and renal compromise
UTIs

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21
Q

Investigations for BPH?

A

Hx
DRE
urinalysis + U&Es
PSA
renal US (hydronephrosis)
cystoscopy (bladder disease)
uroflowmetry

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22
Q

Mx of BPH?

A

conservative:
watchful waiting
lifestyle changes (caffeine, evening fluids)
medical:
alpha antagonists (tamsulosin)
5 alpha reductase inhibitors (finasteride)
+ anticholinergics
surgical:
TURP
laser prostatectomy
simple prostatectomy

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23
Q

What is haematuria?

A

the presence of blood in the urine
can be microscopic or macroscopic

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24
Q

Causes of transient haematuria?

A

vigorous exercise
sexual intercourse
menstruation

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25
Q

DDx for haematuria?

A

kidney:
trauma
pyelonephritis/renal TB
RCC
renal calculi
infarction
glomerulonephritis/ IgA nephropathy
HSP

ureter:
calculus
tumour

bladder:
trauma
cystitis
calculus
tumour
schistosomiasis

urethra:
trauma
calculus
carcinoma
stricture
urethritis

prostate:
ca
prostatitis
BPH

bleeding disorders
anticoagulation
transient
haemolysis
rhabdomyolysis

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26
Q

Investigations for haematuria?

A

urinalysis (normal + early morning MSU for renal TB and Schistosoma eggs)
bloods (FBC, coag, ESR, blood film)
biochemistry (U&Es, serum Ca, LFTs, CPK, PSA)
imaging (CXR, CT KUB, renal US, CT scan, cystoscopy, ureteroscopy, renal biopsy)

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27
Q

When to refer to urology in cases of haemturia?

A

all macroscopic
all symptomatic microscopic
all microscopic in patients > 40, <40 refer to renal
all persistent asymptomatic

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28
Q

Reasons to admit to hospital in haematuria?

A

clot retention
anaemia
shock

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29
Q

What is visible haematuria until proven otherwise?

A

bladder cancer

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30
Q

Types of bladder cancer?

A

transitional cell cancer 90%
SCC 4%
adenocarcinomas 2%

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31
Q

RFs for bladder cancer?

A

male
incr. age
Caucasians
smoking (TCC)
aromatic hydrocarbons (TCC)
chronic inflammation (SCC)
schistosomiasis EGYPT (SCC)
cyclophosphamide
exposure to other carcinogens
Hx of pelvic radiotherapy

32
Q

Presentation of bladder cancer?

A

visible painless haematuria (bladder ca until proven otherwise)

storage-related LUTS
anaemia

33
Q

Staging of bladder cancer?

A

TNM
non-muscle invading (CIS, Ta, T1)
muscle-invasive (T2-T4)

34
Q

Mx of bladder cancer?

A

Non-muscle invasive:
TURBT
single dose intravesical chemo
follow-up TURBT after 6wks
long-term cystoscopy follow up
intravesical BCG to reduce recurrence risk

Muscle-invasive:
radical cystectomy
urinary diversion
metastatic disease -> radical radiotherapy
chemotherapy with platinum-based

35
Q

Prognosis of bladder cancer?

A

low-grade superficial lesions - 90% 5yr SR
invasive/high-grade lesions - 50% 5yr SR

36
Q

Risk Factors for prostate cancer?

A

age
African ethnicity
more common in Scandinavian
diet (animal fat)
obesity
genetic
endocrine (testosterone)
nationality (less common in Japan)

37
Q

Staging and grading of prostate cancer?

A

Staging - TNM
grading - Gleason score

38
Q

Presentation of prostate ca?

A

most asymptomatic (incidental finding)
LUTS due to outflow obstruction
acute urinary retention

more advanced disease -> ureteric obstruction or bony mets

39
Q

Investigations for prostate ca?

A

Bloods (FBC, coag, U&E, LFTs)
PSA
DRE (firm irregular prostate)
MRI
TRUS
isotope bone scan for bony mets (sclerotic lesions)
CXR and CT TAP for mets

40
Q

Causes of raised PSA?

A

UTIs
ejaculation
cycling
recent urology procedures including DRE
BPH
prostate ca

41
Q

Mx of prostate cancer?

A

local stage T1 and T2:
radical prostatectomy
radical radiotherapy
brachytherapy
active surveillance
watchful waiting if life expectancy <10yrs

locally advance (T3 and T4):
radical prostatectomy
radical radiotherapy
androgen deprivation therapy

metastatic disease:
androgen deprivation therapy

42
Q

Prognosis of prostate cancer?

A

localised tumour 80% 5yr SR
local spread 40% 5yr SR
mets 20% 5yr SR

43
Q

What is RCC?

A

renal cell carcinoma is a kidney cancer that originates in the lining of the proximal convoluted tubule
clear cell most common type

most lethal urological cancer

44
Q

RFs for RCC?

A

smoking
obesity
radiation
cadmium exposure
leather industry
FHx in von-Hippel-Lindau syndrome

45
Q

Presentation of RCC?

A

most commonly asymptomatic

classic triad:
macroscopic haematuria
flank pain
palpable mass

paraneoplastic syndromes (haem, endo, hepatic cell dysfunction)

mets (B, B, L, L)

46
Q

Investigations for RCC?

A

Bloods (FBC, ESR, U&Es, LFTs, coag, LDH, Ca)
renal US
CT (staging and planning sz)

47
Q

Staging of RCC?

A

Stage 1 - cancer <7cm
stage 2 - cancer >7cm
Stage 3 - cancer expanded into veins or adrenal gland
Stage 4 - ca cells in more than one LN

48
Q

Mx of RCC?

A

Sx management primarily, RCC usually resistant to chemorads

Sx:
radical nephrectomy
partial nephrectomy

minimally invasive:
radiofrequency ablation
microwave
cryoablation

observation may be suitable for small asymptomatic in patients with limited life expectancy

mets -> tyrosine kinase inhibitors +/- cytoreductive nephrectomy if good response

49
Q

Prognosis of RCC?

A

T1 - 70-94%
T2 - 50-75%
T3 - 22-70%
T4 - 5%

50
Q

First-line investigation in suspected prostate ca?

A

multiparametric MRI had replaced TURS

51
Q

Times to wait before checking PSA?

A

prostate biopsy - 2 months
prostatitis - 1 month
ejaculation or vigorous exercise - 48hrs

52
Q

Types of testicular cancer?

A

90% GCT
seminomas:
classical
anaplastic
spermatocytic
non-seminomas:
teratoma
embryonal
yolk sac
choriocarcinoma

53
Q

Presentation of testicular cancer?

A

painless lump
pain in 5%
features of mets (weight loss, lymphadenopathy, abdo pain)

54
Q

DDx for testicular lump?

A

testicular cancer
hydrocele
epididymal cyst
indirect inguinal hernia

55
Q

Investigations for testicular ca?

A

scrotal US
serum tumour markers (LDH, AFP, bhCG)
CT TAP

56
Q

Mx of testicular ca?

A

Sx is the mainstay -> radical inguinal orchidectomy
+
Stage 1 -> adjuvant platinum chemo
Stage 2 -> adjuvant chemo + retroperitoneal LN dissection

57
Q

Prognosis for testicular ca?

A

generally v good
>90% SR for stage 1
>60% for stage 4

58
Q

Which testicular cancers are particularly sensitive to chemorads?

A

chemotherapy -> teratomas
radiotherapy -> seminomas

59
Q

Tumour markers in testicular cancer?

A

LDH - raised in both
HCG - raised in non-seminomas, sometimes in seminomas
AFP - raised in non-seminomas only

60
Q

Types of penile cancer?

A

SCC 95%
Kaposi’s sarcoma
BCC
melanoma

61
Q

RFs for penile cancer?

A

pre-malignant lesion
foreskin
smoking
HPV

62
Q

Presentation of penile cancer?

A

painless lump or ulcer on the distal aspect of penis/glans

inguinal mass (nodal disease)

63
Q

Investigations for penile cancer?

A

bloods
biopsy
CT TAP
MRI penis with artificial erection

64
Q

Mx of penile cancer?

A

topical treatments (imiquimod, 5-FU) for small and superficial
sx -> circumcision to partial penectomy to total penile amputation
sentinel lymph node biopsy +/- dissection

chemorads in advanced disease

65
Q

What is a hydronephrosis?

A

dilation of the renal pelvis and calyces, can occur with or without an obstruction

66
Q

Presentation of hydronephrosis?

A

incidental
flank pain
anuria
renal failure
sepsis
HTN
palpable bladder
palpable mass

67
Q

Investigations for hydronephrosis?

A

U&Es
Renal US
CT urogram
excretory renogram

68
Q

Causes of unilateral hydronephrosis?

A

obstructing stone
blood clot
pelviurerteric junction obstruction
ureteric TCC
bladder TCC
extrinsic mass (pregnancy, tumour)

69
Q

Causes of bilateral hydronephrosis?

A

bladder outlet obstruction
BPH
urethral stricture
posterior urethral valve
bilateral ureteric obstruction at bladder level
cancer (cervical, prostate, rectal, bladder)
adjacent IBD
retroperitoneal fibrosis
hydronephrosis of pregnancy
bilateral PUJO

70
Q

What is acute urinary retention?

A

inability to pass urine when bladder is full
commonly accompanied by suprapubic discomfort/pain, tenderness on palpation and dullness to percussion

71
Q

Predisposing factors to urinary retention?

A

obstruction
post-op
post-partum
meds (opioids, antimuscarinics)
insufficient detrusor muscles
trauma
neurological impairment

72
Q

Symptoms of urinary retention?

A

inability to pass urine
suprapubic discomfort
abdo pain
distress, delirium, restlessness
overflow incontinence

73
Q

Investigations for urinary retention?

A

bladder US
urinary catherisation (diagnostic + therapeutic)
urinalysis
bloods
urodynamics

74
Q

Mx of urinary retention?

A

decompression of bladder (needle in emergency, catherisation)

75
Q

Treatment of renal stones?

A

stone <5mm - expectant
stone <2cm - lithotripsy
stone <2cm + pregnant - ureteroscopy
complex stone - nephrolithotomy
hydronephrosis - nephrostomy

Surgery (10 decks)

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