Urology Flashcards
Causes of acute urinary retention?
mechanical obstruction (BPH most common)
constipation
clot retention from haematuria
cancer
urethral stricture
urolithiasis
infection
post-operative
meds (antimuscarinics, opioids)
neurologic impairment
inefficient detrusor muscle
trauma to pelvis, urethra, penis
Presentation of acute urinary retention?
suprapubic tenderness
enlarged palpable bladder
dull to percussion
inability to pass urine despite urge
restlessness/distress/delirium
Mx of acute urinary retention?
urethral catherisation
self-intermittent catherisation
suprapubic catherisation
Contraindications to urethral catherisation?
recent urological surgery i.e., radical prostatectomy
pelvic fracture
Complications of urethral catheterisation?
urge sensation from irritation
leakage
blockage
urethral trauma / stricture formation
infection
abscess, fistula formation
bladder perforation
Complications from relief of urinary retention?
transient hypotension
post-obstructive diuresis
haematuria (transient)
What is BPH?
benign prostatic hyperplasia
benign enlargement of the transition zone of the prostate gland
Presentation of BPH?
LUTS voiding symptoms
poor flow
hesitancy
intermittent stream
dribbling
sensation of incomplete bladder emptying
nocturia
BPH on exam?
homogenous smooth enlargement of the prostate with preservation of the central sulcus
Mx of BPH?
conservative -> ‘watchful waiting’
medical ->
alpha-adrenergic antagonists (tamsulosin, silodosin)
5-alpha reductase inhibitors (finasteride)
surgical ->
minimally invasive procedures (transurethral needle ablation, thermotherapy)
Transurethral resection of the prostate (TURP)
open, laparoscopic or robotic radical prostatectomy
Complications of TURP?
post-operative haemorrhage
failure to resolve symptoms
sepsis
urinary incontinence
retrograde ejaculation and/or erectile dysfunction
urethral strictures
TURP syndrome
What is TURP syndrome?
caused by excessive hypotonic (glycine) irrigation solution absorption during surgery
hyponatraemia, hypervolaemia, hypertension and confusion
Mx of TURP syndrome?
treatment -> diuresis and fluid restriction
prevention -> sx < 1hr, decreased fluid pressure/hanging height, use of bipolar diathermy with saline as irrigation fluid
RFs for urolithiasis?
dehydration/ poor fluid intake
hypercalciuria
recurrent UTIs
diseases (gout, T2DM, PKD)
Presentation of urolithiasis?
severe ‘loin to groin’ pain
rigors/chills
nausea/vomiting
Types of kidney stones?
calcium oxalate (80%)
calcium phosphate
uric acid
struvite (staghorn)
cysteine
Investigations for urolithiasis?
non-contrast CT KUB is gold-standard
renal US for hydronephrosis
urinalysis
check for infection
calcium, phosphate and uric acid levels
Complications of urolithiasis?
AKI
obstruction
hydronephrosis
urinary infection or sepsis
severe pain
Mx of urolithiasis?
analgesia (IM diclofenac)
conservative (if no complications and stone <10mm)
surgical:
ureteroscopy lithotripsy (pregnant women)
extracorporeal shock wave lithotripsy (ESWL)
percutaneous nephrolithotomy (large stones, proximal stones, staghorn calculi)
open/laparoscopic stone retrieval
if infection or obstruction:
nephrostomy
RFs for renal cell carcinoma?
smoking
obesity
HTN
horseshoe kidney
CKD
VHL
ADPKD
tuberous sclerosis
Presentation of RCC?
mostly asymptomatic
classic triad -> haematuria, flank pain, abdo mass
paraneoplastic syndromes
Paraneoplastic syndromes associated with RCC?
polycythaemia (erythropoietin)
hypercalcaemia
HTN
Stauffer’s syndrome (elevated LFTs without liver mets)
Mx of RCC?
radical or partial nephrectomy
poor response to chemorads in general
arterial embolisation
percutaneous cryotherapy
radiofrequency ablation
chemorads for mets
Staging of RCC?
TNM
Stage 1 - <7cm
Stage 2 - >7cm
Stage 3 - local spread but not beyond Gerota’s fascia
Stage 4 - beyond Gerota’s fascia
Types of bladder cancer?
Transitional cell carcinoma (90%)
SCC
adenocarcinoma
RFs for bladder cancer?
smoking
incr. age
aromatic hydrocarbons (TCC)
(dye and rubber)
schistosomiasis (SCC)
chronic cystitis (SCC)
Painless haematuria is _____________?
bladder cancer until proven otherwise
Presentation of bladder cancer?
haematuria (painless)
irritative LUTS (dysuria, frequency, urgency)
Investigations for bladder cancer?
flexible cystoscopy
TURBT (diagnostic and therapeutic)
Staging of bladder cancer?
TNM
clear distinction between non-muscle-invasive (Ta - T1) and muscle-invasive (T2-T4)
Mx of bladder cancer?
non-muscle invasive:
TURBT
(repeat TURBT)
intravesical BCG
intravesical chemo
muscle-invasive:
radical cystectomy (+urostomy)
neoadjuvant chemo
regular surveillance with cystoscopy required as high rates of recurrence
Types of prostate cancer?
adenocarcinoma
peripheral zone of prostate
Presentation of prostate cancer?
LUTS
bone pain
firm, irregular ‘craggy’ prostate with loss of central sulcus
Investigations for prostate cancer?
PSA
multi-parametric MRI
TRUS biopsy
isotope bone scan
CT TAP
Gleason scoring?
done to determine prognosis of prostate ca
2 most abundant grades detected are ranked out of 5 and added together
higher score = worse prognosis
Mx of prostate cancer?
‘watchful waiting’
radical prostatectomy (open/laparoscopic/robotic)
+ radiation (external beam or brachytherapy)
androgen deprivation therapy
radiation for bone mets
Types of androgen deprivation therapy?
medical:
GnRH agonist
GnRH antagonist
anti-androgens
surgical:
bilateral orchidectomy
Indications for renal transplant?
end-stage renal disease:
DM
HTN
PKD
chronic glomerulonephritis
Contraindications to renal transplant?
active infection
active malignancy
active substance abuse
reversible renal failure
uncontrollable psychiatric illness
non-adherence with treatment
Scar associated with renal transplant?
hockey-stick scar
Process of renal trasplant?
donor kidney usually placed in iliac fossa
renal artery and vein are anastomosed to external iliac artery and vein
ureter is implanted to the bladder
existing kidney not usually removed
Donor matching for kidney transplant?
HLA type A, B and C on chromosome 6
Immunosuppression post-renal transplant?
basiliximab 2 doses post-sx
life-long:
tacrolimus
ciclosporin
mycophenolate
azathioprine
prednisolone
Complications of renal transplant?
transplant rejection (hyperacute, acute, chronic)
transplant failure
electrolyte imbalance
immunosuppressants:
IHD
T2DM
infections (PCP, TB, CMV)
Non-Hodgkin lymphoma
skin cancer (SCC)
