urology Flashcards
erectle dysfunction
inabililty to achieave and maintain an errection to permit satisfactory performance.
can be organic or psychogenic- or mixed
Organic- vascular(e.g DM, hyerlipidaemia), neuronal (PD, CE), anatomical (peryones disease, prostate ca)
very common disorder.
Ix: detailed history taking including past relationship history.
gradual onset- more liekly organic
sudden onset with good morning and self stimmed errections- psychogenic.
if after assessment there is concern about endocrine, cardiac etc then investigate these.
for everyone- cateogrise cvs risk.
management of Errectile dysfunction
if priaprism- emergency admission
refer to urology if they are espechially young, history of trauma
refer to endo if hypogonadism
Rx: wt loss if indicated.
smoking cessation
stop cycling.
if NOT at high risk of cardiac - phosphodiestarase-5 inhibitor— sildenafil, tadalafil, ec. 50mg available over the counter.
low test may reduce response to PDE-5
penile cancer
95% is squamous cell cancer of the glans or foreskin.
Tis- Ca in situ
T1- grown below the skin (1a- not in blood or lymph, 1b is in)
T2- into spongy tissue, may or may not be in urethrea
T3- same as T2
T4- spread to bone/ prostate etc.
Rx: chaemotherapy cream if it has not grown into the tissue
surgery if gone deeper.
discuss bladder trauma
2 types- extraperitoneal- occur with pelvic fractures- rupture occurs in the ant or lateral aspects of the bladder.
intraperitoneal- high energy impacts to distended bladder.- generally in the dome of the bladder.— urea is absorbed by the cavity- elevating blood nitrate and urea.
bladder trauma commonly picked up on 2nd survery signs include- unstable pelvis, blood at meatus, pain, high riding prostate.
but if you see gross haematuria- pretty convincing.
Ix: if haemodynamically stable- retrograde cystography.
CT cystography can also be used.
Rx: IP rupture- repair surgically + catheter for 10 days.
EP rupture- catheter and let it heal itself.
discuss kidney trauma
most common injury of the urinary tract
blunt trauma most common cause.
haematuria is a good indicator.
contrast enhanced CT is imaging of choice.
injuries are then graded from 1-5.
Rx: if haemostable- go for non op management. consider angioembolisation to help control.
surgery if unstable- control bleeding +/_ salvage kidney.
discuss urethral and uteric injuries
most commonly caused by medical interventions e.g catheterisation
bleeding from tip of urethra is commonest cause.
strictures or anastomoses can form if not careful
catheterisation or surgery is the commonest treatments
treatment for overactive bladder acctivity
bladder retraining minimm 6 weks, with supervision.
reduce caffeine, loose weight.
vaginal oestrogen if atrophic.
antimuscarinics- tolterodine, oxybutanin.
