Urology Flashcards
How are testicular tumours treated and how do they present?
Always with orchidectomy (inguinal approach) followed by radiotherapy
Painless nodule, sometimes associated with hydrocele
What are the 2 tumour markers of testicular tumours?
AFP and B HCG
How does acute epididymis-orchitis present and which pathogen is the cause in most cases?
Hx of Dysuria and uretheral discharge. Swelling may be tender and eased by elevating the testis
Caused by Chlamydia and Gonorrhoea
What is the difference between orchitis and epididymis-orchitis?
Orchitis is viral
Often caused by underlying viral infections e.g. Mumps
What are the two types of testicular torsion and how are they treated?
Torsion of spermatic code: ABSENT cremasteric reflex
Torsion of testicular appendages: preserved reflex
Both treated by urgent surgical exploration
How do hydroceles present?
- Non-painful
- Soft fluctuant swelling
- Transilluminates
- Can get above it
- Cannot palpate the testes
What is a secondary hydrocele?
Hydrocele not caused by genetic abnormality such as:
- Trauma (e.g. torsion)
- Infection
- Tumour
How can you differentiate between a hydrocele and epididymal cyst?
Epididymal cysts can be palpated separate to the testes
How are hydrocele’s managed?
In children where its due to a patent processus vaginalis, an inguinal approach is used to ligate the processus
In adults, scrotal approach to excise or plicate the sac (Jaboulay’s procedure)
Which condition are varicoceles associated with?
Renal cell carcinoma
This is why US kidneys is required as a follow up in at risk groups
What age group is mainly affected by testicular cancer and what is the most common type?
Affects men 20 - 30 years old
Most common are germ-cell tumours (Seminoma and Non-seminoma germ cell tumours)
What is the most common type of Germ cell tumour and how does it present?
Seminoma tumours (50%)
- Avg age of Dx 40 years
- LDH and HCG can be elevated (10-20%)
- AFP is usually normal
- Pathology shows sheet like cells containing lymphocytic inclusions and granulomas
What are the types of Non-seminomatous germ cell tumours and how do they present?
Types:
- Teratoma
- Yolk sac tumour
- Choriocarcinoma
- Mixed germ cell tumours
- Affects 20-30 yr olds
- AFP and HCG elevated in most cases
- may contain ectopic tissue (i.e. hair)
In a patient 60yrs + with enlarged testes and CD20, what is the likely diagnosis?
Lymphoma
What childhood development issue is associated with testicular tumours?
Undescended testes
How is epididymis-orchitis managed?
Abx
Doxycycline +/- Ciprofloxacin
How are seminomas managed?
Orchidectomy + radiotherapy
How are non-seminomas managed?
Affect pts 20-30years, most commonly teratomas
Managed by Orchidectomy + chemotherapy
What are the 3 classifications of priapism?
Low flow:
- due to vent-occlusion and is MOST COMMON and often PAINFUL. >4hrs presentation requires emergency treatment
High flow:
- Due to unregulated arterial blood flow
Recurrent priapism:
- typically seen in sickle cell disease
What is the management of priapism?
- Ice packs/cold showers
- if due to low flow, blood may be aspirated from corpora
What is the medical management of BPH?
Tamsulosin (alpha blocker): relaxes bladder and prostate muscles. Works fast but NOT BE USED IN HYPOTENSIVE PTs
Finasteride (5-a-reductase inhibitors): causes prostate to shrink but takes time to work
What are the surgical managements of BPH?
- TURP: indicated by renal insufficiency / Failure of medical management / Recurrent cystitis / Urinary retention (intractable)
- Open Prostatectomy: for men with prostates too large for TURP +/- significant bleeding
How can prostate ca and BPH be clinically differentiated?
BPH: smooth enlarged prostate
Prostate ca: irregular and hard enlarged prostate
What can cause a false positive raised PSA?
Prostatitis // UTI // BPH // vigorous exercise or DRE
How is PSA used to Dx prostate ca?
Measure PSA, if it is high, measure FREE PSA.
If FREE PSA <20%, high suspicion of ca over BPH. Go for BIOPSY
Which part of the prostate is most often affected by cancer?
Peripheral zone (70%)
How is prostate ca graded?
Using GLEASON grading system
Where 2 is best prognosis and 10 is the worst. The scoring is based on a scoring of 1-5 of the most dominant grade (differentiation of cells) and second most dominant grade added together for a score out of 10.
What are the 4 stages of prostate ca and how are they managed?
Stage 1: only seen on intracapsular microscopy (from biopsy).
- Rx: Prostatectomy OR radiotherapy
Stage 2: Confined but deforming gland
- Rx: Prostatectomy OR radiotherapy
Stage 3: ca extends beyond the capsule and seminal vesicle.
- Rx: Radiotherapy +/- Hormonal or both
Stage 4: metastasis (LNG, Bone, Liver, Lung)
- Rx: mets without bone = hormonal (e.g. Goserelin)
- Rx: mets with bone = Radiotherapy
What is a DTPA scan?
Used to assess glomerular filtration rate and renal function.
NOT TO BE USED IN RENAL IMPAIRMENT
What condition is a renogram MAG3 scan indicated in?
PUJ obstruction (once dx on CT or DMSA scan)
What is the gold standard imaging for haematuria?
CT followed by cystoscopy (if needed)
How is vesicle-ureteric reflux investigated?
Micturating cysto-uretoscopy
What is the most common type of renal stone and what is its opacity?
Calcium oxalate
It is radio-opaque
What is the most radio-opaque type of kidney stone?
Calcium phosphate
RTA Types 1 and 3 increase risk of this stone formation
Which type of kidney stone is radiolucent and what is it associated with?
Uric acid
Associated with stag horn calculi and malignancy
What type of kidney stone does an infection with Proteus mirabilis (UTI) precipitate?
Struvite stones
How would you manage a stone measuring 0.5cm without signs of obstruction?
Conservative Mx
When is ESWL indicated and when is it contraindicated?
Stones measuring 0.5cm - 2cm in kidney or ureter
CONTRAINDICATED IN PREGNANCY + AAA
How are kidney stones >2cm managed?
PCNL
How does management differ for renal stones located at the lower pole of the kidney?
> 1cm = PCNL
<1cm = ureteroscopy
What is the most cause of bladder injury and how does it present?
Pelvic fracture displaced anteriorly
PC: suprapubic pain followed by anuria
What are the 2 types of urethral injury?
Bulbar rupture (most common): occurs in saddle type injuries (bikes)
Membranous injury: prostate will be displaced upwards by DRE
What is the most common type of urethral injury?
Bulbar rupture
What are the indications of renal replacement therapy (dialysis)?
- Persistent hyperkalaemia
- Metabolic acidosis (pH <7.2)
- Fluid overload
- Urea >30
What is an allograft?
from a donor of same species but different genetics
What is the most common type of bladder cancer in western people and what are its risk factors?
TCC
RF: Smokers, dye, rubber and leather factory work
What is the most common type of bladder cancer in Africa and what are its risk factors?
SCC
RF: Schistosomaisis, LTC, Bladder stones
How is a T1 Renal cell carcinoma managed?
Partial nephrectomy
How is a T2 or above renal cell carcinoma managed?
Radical nephrectomy with venous control
What is the common triad of symptoms in pts with RCC?
Mass, pain and haematuria
Associated symptoms may include left sided varicocele, high Hb
What is the most common genitourinary malignancy in under 15 year olds and how is it managed?
Nephroblastoma
Rx: surgical resection + chemo
What is PCKD associated with?
Liver cysts (70%), Berry aneurysms (25%), Pancreatic cysts (10%)
They present with malignant hypertension
What colour does a TCC appear on dissection?
Pink
Most renal cancers appear yellow or brown except TCC
