Urology Flashcards
What is 1st line to manage lower UTIs in Men?
7 days of nitro or trimethoprim
What is Fournier’s Gangrene? Sx? RF?
Necrotising fasciitis of Scrotum.
Sx: extreme pain, fever, oedematous testicle(s), erythema, necrotising lesion.
RF: T2DM
How can you classify Priapism?
> 2 hours since sexual stimulation:
- Ischaemic: obstruction means lack of venous drainage, usually due to haematological conditions such as sickle cell
- Non-ischaemic: unregulated cavernous arterial flow, often due to trauma
How d you manage priaprism?
manual drainage of blood, saline drainage, and intracavernosal alpha antagonists (adrenaline/phenylephrine).
What is Balanoposthitis? What are the synptoms?
Inflammation of glans penis and foreskin (just balanitis is foreskin is not involved).
Redness, swelling, foul-smelling discharge.
How does prostatitis present? How is it managed?
Inflammation of the prostate gland: perineal/prostatic pain, LUTS, systemic features (fever).
Mx: oral quinolones (ciprofloxacin) 500mg BD 2/52
By what route do you perform a prostatic biopsy?
Trans-peroneal.
What is the most common type of tumour found in the prostate gland?
Adenocarcinoma
How do we score prostate cancer?
Gleason scoring:
2 biopsies of tissue (the first is the most common type of tissue found).
These are graded /5 and added together.
Grades 3-5 are cancerous.
Added together, <7 is low risk, 7 is moderate, 8-10 is high risk.
What are the management options for prostate cancer?
- Prostatectomy: for anyone without metastatic disease.
- Radiotherapy: adjuvant or radical
- Hormonal therapies: androgen analogues, GnRH analogues, GnRH antagonists
How do the hormonal therapies used in prostate cancer work?
- Androgen analogues: downregulate testosterone
- GnRH analogues: decrease LH/FSH via -ve feedback
- GnRH antagonists: reducing GnRH means LH/FSH produced less
What is the most common complication of a TURP procedure? Mx? How do you avoid this?
Clot retention: pt presents with urinary retention and frank haematuria. Clot needs evacuation with diathermy to bleeding points.
Tell pts to avoid heavy lifting and walking for 1 week after the procedure.
What is a Bell Clapper deformity? What does it make you more at risk for?
Testes not fixed to the tunica vaginalis - more at risk for torsion as they can rotate more easily.
What is a varicocele? How do you know what caused it?
Enlargement of the scrotal veins, causing an aching or heaviness and ‘bag of worms’ texture upon palpation.
Can be caused by different reasons, to find this out you do an USS abdo.
Why may someone with a left sided renal cancer present with aching testes and a ‘bag of worms’ texture?
Venous congestion due to left sided renal cancer leads to varicocele.
Why may a varicocele lead to cause infertility?
Increase in temperature due to pooling of blood makes it too hot for sperm production.
What is a hydrocele?
Collection of fluid within the tunica vaginalis (surrounds testes and spermatic cord).
How would you manage a 6 month old with a hydrocele?
Watch and wait- may resolve by 1-2 years.
If they don’t after this point, they must be surgically drained as it increases the risk of indirect inguinal hernias.
What is the sensitivity of USS for detecting testicular torsions?
almost 100%
How do you manage Epididymo-orchitis?
14 days ofloxacin or 10 days levofloxacin in low risk of sexual hx.
If it is in a higher risk man (<39 years) refer to sexual health for testing and manage based on result.
What is high pressure chronic retention?
Residual volume >1L, abnormal renal profile, post-obstructive diuresis >200ml/hr.
At what point can you TWOC a high pressure chronic retention pt?
After specialist input.
How would manage anyone >45 with painless, visible haematuria?
2WW bladder cancer
What are the signs of TCC/Urotheliomas?
Visible, painless haematuria, hydronephrosis, bladder outflow obstruction.
Where do TCCs/Urotheliomas spread first?
Local lymph nodes
What is gold standard for investigating TCC/Urotheliomas?
Cystoscopy.
What is gold standard for diagnosis of renal stones?
CTKUB
Are calcium stones radio opaque or radio lucent?
Radio-opaque
Are Uric acid stones radio opaque or radio lucent? What pH of urine do they favour?
Radio lucent.
Low urinary pH (acidic) - and lower urine volumes.
Are Struvite stones radio opaque or radio lucent? What pH do they favour? What is their classic shape?
Relatively radiolucent.
More common in higher pH urine, therefore are associated with proteus bacteria as these alkaline the urine.
Staghorn.
Are Cystine stones radio opaque or radio lucent?
Relatively radiolucent.
Which renal injury are Calcium-oxylate/phosphate stones associated with?
Renal tubular acidosis.
How do you manage and obstructed kidney with hydronephrosis?
Stent or nephrostomy.
Commence sepsis 6 as these easily become infected.
What is first line for ureteric colic pain?
PR diclofenac
What is sued for medical expulsion of renal stones?
Tamsulosin (alpha blocker)
How can we surgically manage renal stones >5mm but < 2cm?
Extracorporeal shock wave lithotripsy or ureteroscopy (pregnant women who cannot have ESWL).
How do you manage renal stones which are >2cm or complicated (e.g., staghorn)?
Percutaneous nephrolithotomy.
What IPSS indicates the need for an alpha blocker?
> 7.
</=7 then lifestyle modifications are 1st line.
