Urology Flashcards
Background facts about stone disease
10% incidence
50% recur in 10 years
Can occur anywhere in the renal tract
What is the presentation of patients with renal stones
Renal colic
Loin to groin pain
Haematuria
Look for changes to GFR, creatinine and WCC
Low urine pH suggests Uris acid component
What is the gold standard. Investigations for renal stones
CT KUB
X-ray and ultrasound are also useful
What are the risk factors for developing renal stones
High protein intake
High salt intake
White ethnicity
Dehydration
Obesity
Hypercalcemia secondary to hypepraarhyroidism and sarcoidosis
Fhx
What is the conservative management of renal stones
Hydration
NSAIDs for pain relief
Anti-emetics
What other management options are available for stones
- medical expulsion therapy via tamsulosin which is an alpha blocker.
- shockwave lithotripsy - uses focused sound waves to break stone into smaller pieces which makes it easier to pass through
- ureteroscopy + can be used in combination with laser lithotripsy
- percutaneous neprholithotomy
What are the different types of renal stone compositions
Calcium oxalate
Calcium phosphate
Uric acid (only one that is radiolucent)
Struvite
Cysteine
What are the risk factors for UTIs in women
Sexually active
Post menopause
History of recurrent UTis
Diabetes
Increasing age
Investigations for UTI
Urine dipstick - nitrites and leukocyte esterase
Urine microscopy
Urine cultures
Ultrasound and CT KUB
Treatments for UTIs
Nitrofurantoin
Trimethoprim + sulfamethoxazole
Co-amoxiclav
What are the risk factors for UTIs in men
BPH
Urinary tract stones
Urethral strictures
Increasing age
Catheterisation
Treatment for UTI in men
Ciprofloxacin or levofloxacin
What are the risk factors for prostate cancer
Age
Black ethnic background
Family history
Investigations for prostate cancer
PSA testing
Prostate biopsy
Bone scan -
X-rays - lytic lesions
What zone do most prostate cancers occur in
Peripheral zone 75%
Transitional zone 20%
Central 5%
What treatment options are available for prostate cancer
Watchful waiting and active surveillance
Brachytherapy - low dose radiation close to source
External beam radiotherapy daily for 6- 8 weeks
Radical prostatectomy
Androgen deprivation therapy - bicalutamide
What drug is used as androgen deprivation therapy in prostate cancer
Bicalutamide - blocks the action of androgens on its receptor preventing growth. Does not alter amount of androgens produced
What scoring scale is used for prostate cancer
Gleasons
What types of histological types are there in bladder cancer
Transitional cell
Squamous cell
Adenocarcinoma
What are the risk factors for bladder cancer
Smoking
Azo dyes
Age
Pelvic radiation
Schistosoma infection
Chemo drugs - cyclophosphamide
Family history
What investigations to consider for bladder cancer
Urinalysis for haematuria
Urine Cytology - looks for any abnormalities under microscope
Cystoscopy - allows to see tumours
CT urogram - images any tumours
What treatment options are available for bladder cancer
For non invasive cancer - transurethral resection of the cancer is done but this has a high recurrence rate
Chemotherapy - mitomycin C
Immunotherapy
Radical cystectomy
Radiotherapy
What immunotherapy is used in bladder cancer:
BCG bacillus calmette guerin
What chemo is used n bladder cancer
Mitomycin C
Alkylating agent which inhibits DNA replication and synthesis
Types of kidney cancer
Renal cell: (affects the PCT )
- clear cell
- papillary
- chromophobe
-collecting duct
- unclassified
Sarcoma
Transitional cell - upper urothelial cancer (affects the renal pelvis and ureter)
Wilm’s tumour in children
Risk factors for renal cancer
Male
Smoking
Increasing age
Obesity
Hypertension
Cystic disease
+ve FHx
Symptoms of renal cancer:
Asymptomatic
Flank pain
Palpable mass
Hameutria
Red flag symtoms
Fever
What imaging is done for renal cancer
Ultrasound
CT with contrast
MRI
CT chest - mets possible
Bone scan - bone mets possible
Biopsy
Treatment for renal cancer
Surgery to remove tumour
Immunotherapy
Presentation of wilms tumour
Age less than 5 usually
Abdominal pain
Hypotension or hypertension
Haematuria
Palpable mass
Varicoele
Anaemia
Lack of appetite
Treatment of wilms tumour
Surgical removal -
Systemic chemo and radiotherapy
Investigations for testicular cancer
Ultrasound Doppler
CT of abdomen and pelvis
MRI for staging
Treatments for testicular cancer
Radical orchiectomy
External beam RT and chemo post surgery
Risk factors for testicular cancer:
White background
Undescened testes
Previous history
Family history
HIV
What can cause ED
Diabetes
Atherosclerosis
Obesity
Smoking
Pelvic radiotherapy and prostate surgery
Low testeosteorne
MS
Peyronies disease
Meds:
Alpha blockers
Anti-hypertensives
Examples of storage symptoms
Urgency
Frequency
Nocturia
Incontinence
Examples of voiding symptoms
Slow stream
Straining
Intermittency
Hesitancy
Terminal dribbling
Inconticne symptoms can be measured using which symptom index
IPSS
International prostate symptom score
1-7 mild
8-19 moderate
20-35 severe
LUTS can be caused by pathology in which dimensions
Prostate
Urethra
Bladder
Pelvic organs
Neurological disease (cauda equina or pelvic/sacral tumours)
Symptoms that indicate that LUTS might be because of something neuro
Back pain
Sciatica
Ejeaculatiry disturbance
Sensory changes in perineum, legs or feet
Acute loin pain but no stone. Differentials…
1) clot or tumour colic
2) PUJO
3) pyelonephritis
Acute loin pain - non uro causes
AAA
MI or pneumonia
Ectopic or ovarian cyst rupture
Appendicitis, IBD flare
Intestinal obstruction
Testicular torsion
Prolapsed intervertebral disc
Chronic loin pain causes
Cancer
Renal stones
Renal infection
PUJO
Ureteric reflux or stone
Types of incontinence
Stress
Urge
Mixed
Overflow
Maybe be caused by internal sphincter weakness (neuromuscular defect)
Or bladder overactivity (infection, tumour or stone may also irritate bladder
Causes of an enlarged liver
Infection
Congestion
Amyloid
Cancer + mets
Hydatid cysts
Cirrhosis
Abscess
Causes of abdominal distension 5Fs
- foetus
- flatus
- faeces
- fat
- fluid as it’s
Treatments for incontinence
Lifestyle changes
Pelvic floor exercises
Sling
Collagen injections
Weight loss and smoking cessation
Oxybutynin
Alpha agonists
Botulinum injections into wall of detrusor
