Urology Flashcards
What is Cystinurua?
Autosomal recessive condition where someone is predisposed to renal stones composed of cystine. Features include recurrent kidney stones throughout childhood
What is the treatment that helps with cystine kidney stones?
Penicillamine
What is Priapism?
Persistent painful erections lasting longer than 4 hours.
Sickle cell disease is a risk factor
What can falsely raise a PSA test?
An active UTI of previous in last 6 weeks
Ejaculation in last 48 hours
Vigorously exercise
Urological intervention in last 6 weeks
What could a left sided varicocele indicate?
Renal cáncer
What is the first line treatment for urge incontinence?
Bladder training
What is a key investigation for diagnosis of bladder cancer?
Flexible cystoscopy
Can visualise bladder lining
Can take biopsies for histological diagnosis
What is the first line analgesic in renal colic?
IM/PR Diclofenac
Which infection predisposes to staghorn calculi?
Proteus Mirabilis
Which antibiotic is recommended for pregnant women with UTIs who are close to term?
Cefalexin
Who should Nitrofurantoin be avoided in?
Those with a renal function eGFR below 45
Decreased efficacy
Where does prostate cancer usually occur?
Peripheral zone
Where does BPH usually occur?
Transitional zone
How does Goserelin work?
Gonodotrophin releasing hormone agonist
GnRH is secreted intermittently.
What this drug does is increase GnRH secretion leading to continual secretion and subsequently disrupts the hormonal axis.
The end result is reduced secretion of testosterone which reduces growth of the prostate tumour
Which tumour marker is normally raised in non-seminoma germ cell tumours.
AFP
What is the bell clapper deformity?
Bell clapper deformity occurs when the testes is not fixed to the tunica vaginalis and hangs freely leaving it free to rotate
What is a Wilm’s Tumour?
Most common renal malignancy in children
What are risk factors for TCC of bladder?
Smoking
Exposure to aromatic amines (employed in rubber, dyes, and chemical industry)
Use of Cyclophosphamide
What are risk factors for SCC of Bladder?
Schistosomiasis infection
Long-term catheterisation (10+ years)
What is Phimosis?
Phimosis is characterised by an inability to retract the foreskin over the glans, commonly seen in infants and young children, which often resolves over time, but can also occur in adults due to various pathological conditions
What does a Clear Cell Renal Cell Carcinoma look like under the microscope?
Well circumscribed lesion, mostly golden with interspersed areas of hemorrhagic and fibrotic tissue. Microscopically: Well defined cell membranes with mostly transparent cytoplasm, interspersed with highly vascularised stroma
WHAT ARE THE FIRST LINE INVESTIGATIONS IN A PATIENT WITH PAINLESS HAEMATURIA?
CT urogram and cystoscopy
What is a CT Urogram?
A CT of the urinary system using contrast
What is Detrusor overactivity?
A common cause of urge incontinence
Symptoms are often precipitated by a certain ‘trigger’, for e.g. sound of running water, coffee, tea, arriving home (‘latchkey incontinence’ - a conditioned reflex), leaving home
What is the first line imaging investigation for Prostate Cancer?
Multi-Parametric MRI
What can be used to prevent the formation of calcium renal stones?
Thiazide Diuretic
This is because thiazide diuretics inhibit the sodium-chloride cotransporter in the distal convoluted tubule, which leads to increased calcium reabsorption into the blood via the calcium-sodium exchange, therefore lowering urinary calcium levels.
What is the most common complication of a TURP?
Retrograde Ejacula tion
How does the size of the kidney stone affect the treatment?
<5mm = Watch and wait , review in 4 weeks
<20mm = Shockwave Lithotripsy
>20mm = Percutaneous Nephrolithotomy
Hydronephrosis = Urgent nephrotic decompression
What is percutaneous nephrolithotomy?
Passing a nephroscope percutaneously into the renal system, fragmenting the stone then extracting it.
Why must you prescribe an anti-androgen with a GnRH agonist in prostate cancer?
Prevent paradoxical increase in symptoms with GnRH agonists is correct. Initially, treatment of prostate cancer with GnRH agonists can cause a paradoxical increase in symptoms such as bone pain, bladder obstruction and other symptoms, this is referred to as a ‘tumour flare’. This occurs because GnRH temporarily causes the pituitary to increase luteinizing hormone (LH) secretion before it begins to inhibit LH release. The increase in LH causes increased stimulation of Leydig cells in the testicles which in turn produce more testosterone. Testosterone stimulates the survival and growth of prostate cancer. Therefore the initial increase in production of testosterone caused by GnRH agonists can cause paradoxical survival, growth and resultant symptoms of prostate cancer. Anti-androgens act by blocking androgen receptors which prevent androgens such as testosterone from binding their receptors and suppressing luteinizing hormone, which in turn reduces testosterone levels.
What is decompression haematuria?
Occurs commonly after catheterisation of a patient with long term urinary retention, due to rapid decrease in pressure
What are the differentials of frank haematuria?
LUTI
Urolithiasis
BPH
Bladder Cancer
Prostate Cancer
Renal Cell Carcinoma
What is a good way to remember the who is more likely to get which type of testicular cancers?
Teratomas - troops (age 20-30)
Teratomas have a worse prognosis -TERRORtoma
Seminomas - sergeants (age 30-40)
Which bacteria commonly causes epididymi-orchitis in younger males?
Chlamydia Trachomatis
Which medication is first line following failure of conservative measures in stress incontinence?
Duloxetine
Which medication is first line following failure of conservative measures in urge incontinence?
Oxybutynin
