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Urology Flashcards

1
Q

BPH

A

benign increase in size of prostate

inner (transitional) zone enlarges

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2
Q

BPH Px

A

LUTS
Storage
- frequency
- urgency, urgency incontinence
- nocturia
SHIPP
- straining
- hesitancy
- incomplete emptying
- poor / intermittent stream
- post-micturition dribbling
- also overflow incontinence

  • enlarged bladder on abdo exam
  • UTI sx, bladder stone
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3
Q

BPH Ix

A
  • urine dip
  • DRE - smooth, enlarged
  • U/E
  • urinary freq/vol chart
  • transrectal US - not routine
  • PSA
  • International Prostate Symptom Score
  • US / CT / cystoscopy
  • post-void bladder scan
  • urodynamic studies if dx unsure
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4
Q

BPH Mx

A
  • avoid caffeine, alcohol

Medical
- tamsulosin
- finasteride
- consider tolterodine / darifenacin

Surgical
- transurethral resection of prostate (TURP)
- transurethral incision of prostate (TUIP)
- Transurethral electrovaporisation of prostate (TEVAP/TUVP)
- Holmium laser enucleation of prostate (HoLEP)
- Open prostatectomy

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5
Q

BPH indications for surgery

A

RUSHES
- Retention
- UTIs
- Stones
- Haematuria
- Elevated creatinine due to bladder outlet obstruction (BOO)
- Sx deterioration

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6
Q

LUTS Ix

A
  • bladder diary
  • post-void bladder scan
  • urinalysis
  • DRE
  • urinary freq/vol chart
  • IPSS
  • bloods
  • urodynamic studies
  • cystoscopy / US / CT
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7
Q

LUTS Mx

A

Voiding sx
- pelvic flood muscle training, bladder training
- tamsulosin / finasteride

Overactive bladder
- bladder retraining
- oxybutynin, tolterodine, darifenacin
- mirabegron

Nocturia
- furosemide in late afternoon
- desmopressin may help

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8
Q

Prostatitis

A

inflammation of prostate

E coli most commonly

RFs
recent UTI, intermittent catheterisation, recent biopsy

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9
Q

Prostatitis Px

A
  • pelvic pain, genital pain
  • LUTS
  • fever, rigors, N+V
  • sexual dysfunction
  • pain with bowel movts
  • inguinal lymphadenopathy
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10
Q

Prostatitis Ix

A
  • DRE - tender, boggy
  • STI screen
  • urine dip, MC+S
  • FBC, blood cultures
  • National Institute of Health Chronic Prostatitis Sx index
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11
Q

Prostatitis Mx

A

Acute
- 14d ciprofloxacin
- admit if unwell

Chronic
- tamsulosin, analgesia

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12
Q

Prostate cancer

A

growth of peripheral zone of prostate - adenocarcinoma

RFs
- older, FHx, black ethnicity, tall, anabolic steroids

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13
Q

Prostate cancer Px

A
  • asym
  • LUTS
  • haematuria
  • erectile dysfunction
  • wt loss, bone pain, cauda equina
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14
Q

Prostrate cancer Ix

A
  • PSA - 50-69yo refer if PSA >3 OR abnormal DRE
  • DRE - firm, craggy, irregular
  • multiparametric MRI
  • Biopsy - transrectal / transperineal - Gleason Grading for severity
  • isotope bone scan
  • CT / MRI for mets
  • TNM staging
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15
Q

Prostate cancer Mx

A
  • surveillance / W+W
  • external beam radiotherapy
  • brachytherapy

Hormone therapy
- androgen-receptor blockers - bicalutamide
- GnRH agonists - goserelin, leuprorelin (Prostap)

  • chemo
  • radical prostatectomy
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16
Q

Bladder cancer - definition and RFx

A

cancer of urothelium of bladder (endothelium) - transitional cell carcinoma

RFs
- smoking
- hydrocarbon exposure - 2-naphthylamine
- Schistosomiasis causing chronic bladder inflammation

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17
Q

Bladder cancer Px

A
  • painless, macroscopic haematuria
  • LUTS
  • wt loss, bone pain etc
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18
Q

Bladder cancer Ix

A

2ww if
- >45yo, unexplained visible haematuria
- >60yo, microscopic haematuria + dysuria / raised WCC
- non urgent referral if >60yo, recurrent unexplained UTIs

  • cystoscopy, biopsy (flexible then rigid)
  • CT / MRI / PET
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19
Q

Bladder cancer Mx

A
  • TURBT - transurethral resection of bladder tumour
  • intravesical chemo
  • BCG vaccine
  • radical cystectomy (+ urostomy + ileal conduit)
  • chemo / radio
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20
Q

Renal cell carcinoma (& RFx)

A
  • adenocarcinoma of kidney - from PCT, majority clear cell type
  • Wilms tumour in paeds

Paraneoplastic
- polycythaemia - EPO
- hypercalcaemia - PTH mimic
- HTN - renin
- Stauffers syndrome

RFs
- smoking, obesity, HTN, ESRF, tuberous sclerosis, von Hippel-Lindau, industrial exposure, dialysis

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21
Q

RCC Px

A
  • asym
  • haematuria
  • loin pain
  • wt loss, fatigue, anorexia, night sweats
  • renal mass
  • PUO
  • varicocele
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22
Q

RCC Ix

A
  • FBC, U/E, LFTs, bone profile, PTH
  • urinalysis, cytology
  • US kidney
  • CXR - cannonball mets
  • CT chest, abdo, pelvis
  • ?biopsy
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23
Q

RCC Mx

A
  • nephrectomy - partial / radical
  • arterial embolisation
  • percutaneous cryotherapy
  • radiofrequency ablation
  • chemo / radio
  • biological tx
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24
Q

Testicular cancer (& RFx)

A

commonly germ cells (produce gametes)

Mets to lymphatics, lungs, liver, brain

RFs
- undescended, infertility, FHx, taller

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25
Q

Testicular cancer Px

A
  • lump +/- pain
  • hard, irregular
  • non-fluctuant
  • no transillumination
  • gynaecomastia - Leydig cell tumour
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26
Q

Testicular cancer Ix

A
  • scrotal US
  • Tumour markers - alpha-fetoprotein, bhCG, LDH
  • staging CT
  • Royal Marsden staging
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27
Q

Testicular cancer Mx

A
  • radical orchidectomy
  • chemo / radio
  • sperm banking
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28
Q

Epididymo-orchitis (& causes)

A

infection of epididymis +/- testes

Causes
- genital tract - chlamydia, gonorrhoea
- bladder - E coli
- mumps

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29
Q

Epididymo- orchitis Px

A
  • unilateral testicular pain + swelling
  • dragging
  • tender on palpation
  • urethral discharge
  • fever, LUTS
  • Prehn’s positive - elevation of scrotum eases pain
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30
Q

Epididymo-orchitis Ix

A
  • STI screen - first pass urine, charcoal swab of discharge
  • MSU - dip + MC+S
  • saliva swab / serum ABs - mumps
  • ?US testes
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31
Q

Epididymo-orchitis Mx

A
  • GUM referral

Organism unknown
- ceftriaxone 1g IM + doxycycline 100mg oral BD 10-14d

Enteric organism likely
- ofloxacin / co-amox

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32
Q

Testicular torsion (& RFx)

A

twisting of spermatic cord –> testicular ischaemia / necrosis in 4-6hrs

RFs
- FHx, undescended, age
- often sports related

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33
Q

Testicular torsion Px

A
  • severe, sudden onset pain
  • referred lower abdo pain
  • N+V
  • loss of cremasteric reflex
  • Prehn’s sign negative
  • horizontal testicular lie
  • rotation - epididymis not in normal position
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34
Q

Testicular torsion Ix

A
  • clinical dx
  • USS - whirlpool sign
  • urine dip - r/o infection
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35
Q

Testicular torsion Mx

A
  • NBM
  • analgesia
  • surgical exploration - for dx
  • orchidopexy
  • orchidectomy - if necrosis
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36
Q

Hydrocele (& causes)

A
  • collection of fluid within tunica vaginalis that surrounds testes
  • communicating - patent processus vaginalis
  • non-communicating - excessive fluid production

Causes
- idiopathic, cancer, torsion, epididymo-orchitis, trauma

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37
Q

Hydrocele Px

A
  • painless
  • soft scrotal swelling
  • fluctuant
  • testicle palpable within hydrocele
  • irreducible, no bowel sounds
  • transilluminates
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38
Q

Hydrocele Ix

A
  • US
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39
Q

Hydrocele Mx

A
  • conservative
  • surgery / aspiration
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40
Q

Varicocele (& causes)

A
  • swelling of veins in pampiniform plexus

Causes
- incompetent valves
- L>R - drains into L renal vein - higher resistance
- RCC - left

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41
Q

Varicocele Px

A
  • throbbing, dull pain, worse standing
  • dragging sensation
  • sub/infertility
  • bag of worms scrotal mass, worse standing
  • red flags - acute onset, R side, remains whilst flat -> urology referral
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42
Q

Varicocele Ix

A
  • US
  • semen analysis - fertility
  • hormone tests - FSH, test - if concern about function
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43
Q

Varicocele Mx

A
  • conservative
  • surgery / endovascular embolisation if painful / testicular atrophy / infertility
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44
Q

Epididymal cyst

A
  • fluid filled cyst at head of epididymis
  • PKD, CF, von Hippel Lindau associations
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45
Q

Epididymal cyst Px

A
  • asym
  • soft, round lump
  • at top of testicle
  • transilluminates
  • can get above lump
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46
Q

Epididymal cyst Ix

A

US

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47
Q

Epididymal cyst Mx

A
  • conservative
  • surgical removal - if pain / discomfort
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48
Q

Scrotal lumps DDx

A

hydrocele
varicocele
epididymal cyst
testicular cancer
epididymo-orchitis
inguinal hernia
testicular torsion

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49
Q

Renal stones: definition and pathophysiology

A

stones form in renal pelvis, get stuck in ureters

obstruction -> AKI
infection -> obstructive pyelonephritis

get stuck at - PUJ, pelvic brim, VUJ

Types
- calcium oxalate
- Uric acid,
- Struvite
- Cystine

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50
Q

Risk factors for renal stones

A
  • dehydration
  • hypercalciuria, hyperparathyroidism, hypercalcaemia
  • cystinuria
  • high dietary oxalate
  • renal tubular acidosis
  • medullary sponge kidney, PKD
  • gout
  • drugs - loop diuretics, steroids, acetazolamide, theophylline
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51
Q

Renal stones Px

A
  • renal colic - loin/groin pain
  • haematuria
  • dysuria
  • N+V
  • reduced UO
  • sepsis sx
52
Q

Renal stones Ix

A
  • urine dip - blood +/- infection
  • Bloods - FBC, U/E, Ca, CRP, coag
  • NCCT KUB
  • AXR
  • US KUB - pregnancy / children
53
Q

Renal stones Mx

A
  • analgesia, antiemetics
  • Abx if infection
  • stones <5mm - W+W
  • tamsulosin

admit if:
- AKI, uncontrollable pain, infected, large >5mm

stones >10mm
- extracorporeal shock wave lithotripsy (ESWL)
- ureteroscopy + laser lithotripsy
- percutaneous nephrolithotomy (PCNL)
- open surgery

infection / AKI
- stent / nephrostomy - decompress - prevent hydronephrosis

54
Q

Tips for prevention of renal stones?

A
  • increase fluids
  • lemon juice, avoid carbonated drinks, reduce salt, normal Ca intake, reduce oxalate/purine rich foods, limit dietary protein
  • potassium citrate / thiazide diuretics
55
Q

Bladder stones (Px, Ix and Mx)

A
  • from stasis of urine in bladder
  • chronic urinary retention / schistosomiasis

Px
- LUTS

Ix
- as for renal stones

Mx
- cystoscopy, fragment with lithotripsy

56
Q

Acute urinary retention

A
  • acute inability to pass urine
57
Q

Causes of acute urinary retention

A
  • BPH
  • urethral strictures, calculi, cystocele, constipation, masses
  • meds - anticholinergics, TCAs, antihistamines, opioids, benzos
  • neuro cause
  • post-op, post-partum
58
Q

Acute urinary retention Px

A
  • no UO
  • lower abdo discomfort, distension
  • acutely confused
  • pain, distress
59
Q

Acute urinary retention Ix

A
  • MSU for MC+S
  • bloods - U/E, FBC, CRP
  • DRE
  • bladder scan - >300mls, also check post-void residual volume
60
Q

Acute urinary retention Mx

A
  • catheter
  • if >1000mls - US kidneys to r/o high-pressure chronic retention / hydronephrosis
  • Ix / Tx cause
  • TWOC after tx cause
  • IV fluids for post-obstructive diuresis
61
Q

Chronic urinary retention

A
  • chronic inability to pass urine
  • bladder desensitised
  • high-pressure - impaired renal function, bl hydronephrosis, bladder outflow obstruction
  • low-pressure - normal renal function, no hydronephrosis
62
Q

Causes of chronic urinary retention

A
  • BPH
  • pelvic prolapse
  • pelvic masses - fibroids
  • neuro - peripheral neuropathies, MS, Parkinson’s
63
Q

Chronic urinary retention Px

A
  • painless urinary retention
  • LUTS - weak stream, hesitancy
  • overflow incontinence
  • palpable distended bladder
64
Q

Chronic urinary retention Ix

A
  • post-void bladder scan
  • bloods - FBC, CRP, U/E
  • USS urinary tract
65
Q

Chronic urinary retention Mx

A
  • catheter - long-term / intermittent self-catheterisation
66
Q

Neurogenic bladder

A

Abnormal function of nerves innervating bladder / urethra

Causes
- MS, DM, stroke, Parkinson’s, brain / spinal cord injury, spina bifida

Results in
- urge incontinence
- increased bladder pressure
- obstructive uropathy

67
Q

Hydronephrosis

A

Swelling of renal pelvis + calyces in kidney

68
Q

Causes of hydronephrosis

A

Unilateral - PACT
- Pelvic-ureteric obstruction (congenital or acquired)
- Aberrant renal vessels
- Calculi
- Tumours of renal pelvis

Bilateral - SUPER
- Stenosis of the urethra
- Urethral valve
- Prostatic enlargement
- Extensive bladder tumour
- Retro-peritoneal fibrosis

69
Q

Hydronephrosis Px

A
  • vague renal angle tenderness
  • mass
70
Q

Hydronephrosis Ix

A
  • USS
  • CT
  • IV urogram - XR with IV contrast in urinary tract
71
Q

Hydronephrosis Mx

A
  • tx cause
  • nephrostomy
  • antegrade ureteric stent
72
Q

Lower UTI: uncomplicated?

A

infection of bladder (can spread to kidneys = pyelonephritis)

Uncomplicated
- normal renal tract structure / function

73
Q

what is a complicated UTI?

A

increased likelihood of complications due to anatomical, functional or pharmacological factors predisposing to recurrence
e.g. stones, obstruction, DM, male

74
Q

Causative organisms of lower UTI

A

KEEPS
- klebsiella
- e coli - most common
- enterococcus
- pseudomonas
- staph (coagulase negative

  • candida
  • catheters
75
Q

what 4 things might make you suspect pyelonephritis?

A

Fever
Loin/back pain
Nausea/vomiting
Renal angle tenderness on examination

76
Q

Lower UTI Px

A
  • dysuria
  • suprapubic pain / discomfort
  • frequency, urgency, incontinence
  • haematuria
  • cloudy / foul-smelling urine
  • confusion
77
Q

Lower UTI Ix

A

Urine dip
- Nitrites / leucocytes, blood
- NB if only leukocytes then don’t treat as UTI unless other clinical reasons

MSU to MC+S
- if pregnant, recurrent, atypical sx, no resolution with abx, men, haematuria

78
Q

Lower UTI Mx for males and non pregnant females? how longer would you treat for?

A

Non pregnant women - nitrofurantoin or trimethoprim for 3 days

Men - nitro or trimethoprim for 7 days

NB avoid nitro if eGFRv <45

79
Q

lower UTI treatment for pregnant women? how long?

A

7 days of ABx

Nitrofurantoin (avoid in the third trimester)
Amoxicillin (only after sensitivities are known)
Cefalexin

80
Q

Lower UTI: which ABx need to be avoided in which trimester?

A

nitro - avoid in 3rd trimester (risk of haemolysis)
trimethoprim - avoid in 1st trimester (folate antagonist - can cause congenital malformations)

81
Q

What is pyelonephritis?

A

inflammation of the kidney resulting from bacterial infection - affects renal pelvis and parenchyma

Causes: same as lower UTI, typically e coli

82
Q

risk factors for pyelonephritis?

A

Female sex
Structural urological abnormalities
Vesico-ureteric reflux (urine refluxing from the bladder to the ureters – usually in children)
Diabetes

83
Q

Pyelonephritis Px

A

key triad:
- fever
- loin/back pain
- n+v

other:
Lower UTI sx e.g. dysuria
Systemic illness
Loss of appetite
Haematuria
Renal angle tenderness

84
Q

Pyelonephritis Ix

A
  • Urine dip
  • MSU for MC+S
  • bloods - raised WCC and CRP
  • USS / CT to exclude other pathology e.g. stones
85
Q

Pyelonephritis Mx

A
  1. Cefalexin
  2. Co-amoxiclav (if culture results are available)
  3. Trimethoprim (if culture results are available)
  4. Ciprofloxacin (keep tendon damage and lower seizure threshold in mind)
86
Q

patient is admitted with sepsis following pyelonephritis: what is the sepsis 6?

A

Three tests:
Blood lactate level
Blood cultures
Urine output

Three treatments:
Oxygen to maintain oxygen saturations of 94-98% (or 88-92% in COPD)
Empirical broad-spectrum IV antibiotics (according to local guidelines)
IV fluids

87
Q

what is chronic pyelonephritis?

A
  • recurrent infections leading to scarring of parenchyma and CKD (possible ESRF)
  • DMSA scan to assess damage
88
Q

Interstitial cystitis

A

chronic inflammation of bladder

complex causes, various dysfunction

89
Q

Interstitial cystitis Px

A
  • LUTS
  • suprapubic pain, worse with full bladder, relieved on emptying
  • > 6wks
90
Q

Interstitial cystitis Ix

A
  • urinalysis - ?UTIs
  • swabs - ?STIs
  • cystoscopy - ?bladder Ca - may see Hunner lesions, granulations
  • DRE - prostate
91
Q

Interstitial cystitis Mx

A
  • supportive
  • meds
  • surgery
92
Q

Circumcision

A
  • in Jewish and Islamic faiths
  • reduces risk of penile cancer, UTI, HIV

Medical indications
- phimosis
- recurrent balanitis
- BXO
- paraphimosis

  • exclude hypospadias first
93
Q

Balanitis

A
  • inflammation of glans penis
  • various causes

Ix
- clinical dx
- swab if needed
- biopsy if doubt on cause / extensive skin change

Mx
- gentle saline washes
- 1% hydrocortisone - irritation / dermatitis
- topical clotrimazole - candida
- oral fluclox / clari - staph / strep infection
- metronidazole - anaerobic balanitis
- clobetasol / circumcision - lichen sclerosus

94
Q

Erectile dysfunction ( + causes and RFx)

A
  • inability to maintain erection sufficient for satisfactory sexual performance

Causes
Organic - gradual sx onset, normal libido
Psychogenic - sudden onset, decreased libido, good quality spontaneous erections, major life events, psych problems
Mixed

RFs
- older age, CVD (obesity, DM, lipids, HTN, smoking), alcohol, SSRIs, BBs

95
Q

Erectile dysfunction Ix

A
  • QRISK
  • free testosterone level (9-11am) - if low, rpt with FSH, LH, prolactin
96
Q

Erectile dysfunction Mx

A
  • PDE-5 inhibitors - sildenafil
  • if young and always had problem - refer to urology
  • if pt cycles >3hrs/wk - stop
97
Q

Urethral injury

A
  • blood in meatus
  • bulbar rupture - straddle injury, urinary retention, perineal haematoma
  • membranous rupture - penile/perineal haematoma, prostate displaced upwards

Ix
- ascending urethrogram

Mx
- suprapubic catheter

98
Q

Bladder injury

A
  • haematuria, suprapubic pain, inability to void

Ix
- IVU / cystogram

Mx
- laparotomy / conservative

99
Q

Penile fracture

A
  • traumatic rupture of corpus cavernosa and tunica albuginea in erect penis

Px
- snap / popping
- immediate pain / swelling
- Aubergine sign
- firm immobile haematoma

Ix
- clinical dx
- US
- retrograde urethrography if ?urethral injury

Mx
- surgical repair
- no sex for 6-8wks

100
Q

Urethral stricture

A
  • narrowing of urethra

Causes
- iatrogenic (catheter)
- STIs - gonorrhoea
- penile fracture
- hypospadias
- lichen sclerosus

Px
- decreased stream, incomplete bladder emptying, spraying of stream, dysuria

Ix
- uroflowmetry
- US postvoid residual (PVR) measurement

Mx
- dilatation
- endoscopic urethrotomy

101
Q

Vasectomy

A
  • under LA
  • semen analysis 2x post-op before sex

Cx
bruising, haematoma, infection, sperm granuloma, chronic testicular pain

102
Q

Priapism

A
  • persistent penile erection >4hrs, not associated with sexual stimulation

Patho
- ischaemic - due to impaired vasorelaxation, reduced outflow
- non-ischaemic - high arterial inflow - eg fistula formation

Causes
- sickle cell, sildenafil, drugs (anti-HTN, anticoagulants, antidepressants…), trauma

103
Q

Priapism Px

A
  • erection >4hrs
  • pain in penis
  • if not painful / fully rigid - more so non-ischaemic
104
Q

Priapism Ix

A
  • cavernosal blood gas - ischaemic pO2 / pH reduced, pCO2 increased
  • doppler / duplex US
  • FBC, tox screen
105
Q

Priapism Ix

A
  • cavernosal blood gas - ischaemic pO2 / pH reduced, pCO2 increased
  • doppler / duplex US
  • FBC, tox screen
106
Q

Priapism Mx

A
  • ischaemic - emergency
  • aspirate blood
  • inject phenylephrine, rpt 5 mins
  • consider surgery - shunt
107
Q

Haematuria

A
  • blood in urine
  • non/visible, a/symptomatic

Causes
- UTI, renal cancer, bladder cancer, renal calculi, prostate cancer, BPH, trauma, schistosomiasis, glomerulonephritis, HSP
- pseudo - eg rifampicin, beetroot, methyldopa

108
Q

Haematuria Hx

A
  • ask about urine colour, clots, timing in stream
  • LUTS, fever, rigors, flank pain etc
  • recent trauma
  • smoking, occupational exposures
109
Q

Haematuria Ix

A
  • DRE, examine external genitalia
  • urinalysis
  • FBC, U/E, clotting, PSA
  • flexible cystoscopy
  • USS / CT urogram
110
Q

Haematuria 2 WW

A

> 45yo with
- unexplained visible haematuria w/o UTI
- visible haematuria after UTI Ix

> 60yo
- unexplained non-visible haematuria + dysuria / raised WCC

111
Q

Haematuria Mx

A
  • Tx cause
  • if clot retention - 3 way catheter - washout / irrigation
  • to control bleed - rigid cystoscopy
112
Q

Stress incontinence

A
  • urine leakage with increased intra-abdo pressure - coughing / straining
  • weakness of pelvic floor muscle
  • post-partum, constipation, obesity, post-menopausal, pelvic surgery
113
Q

Urge incontinence

A
  • overactive bladder - detrusor hyperactivity
  • eg stroke, infection, malignancy, cholinesterase inhibitors
114
Q

Overflow incontinence

A
  • from chronic urinary retention - stretching of bladder -> loss of bladder sensation, urine overflows
  • BPH, spinal cord injury, congenital defects
115
Q

Continuous incontinence

A
  • constant leakage of urine
  • anatomical abnormality - ectopic ureter, bladder fistulae
116
Q

Urinary incontinence Px

A
  • involuntary leakage of urine
  • ask about other urinary sx
117
Q

Urinary incontinence Ix

A
  • bladder diaries
  • QoL questionnaire
  • examine prostate, prolapse, ?fistula
  • urine dip
  • post-void bladder scan
  • urodynamic studies
  • cystoscopy, IV urogram, MRI
118
Q

Urinary incontinence Mx

A
  • wt loss, reduce caffeine, stop smoking

Stress
- pelvic floor muscle training
- duloxetine
- surgery - tension-free vaginal tape….

Urge
- bladder retraining
- oxybutynin, tolterodine
- mirabegron
- botox injections, ….

119
Q

Urethritis (& RFx)

A
  • inflammation / infection of urethra
  • gonococcal - N gonorrhoeae
  • Non-gonococcal - chlamydia, mycoplasma genitalium…

RFs
- MSM
- <25yo
- previous STIs
- new sexual partner
- >1 partner in last yr

120
Q

Urethritis Px

A
  • dysuria
  • penile irritation
  • discharge
  • sx of epididymitis / ReA
121
Q

Urethritis Ix

A
  • urethral swab / STI screen / first-void urine / MSU
122
Q

Urethritis Mx

A

gonococcal
- ceftriaxone 1g IM + azithromycin 1g oral

Non-gonococcal
- oral doxy 7d / single dose oral azithromycin

contact tracing etc

123
Q

Fourniers gangrene

A
  • nec fasc that affects perineum
  • eg GAS, e coli…

RFs
- DM, alcohol, poor nutrition, steroids, trauma…

Px
- severe pain, fever, unwel
- crepitus, skin necrosis, haemorrhagic bullae

Ix
- clinical dx
- FBC, U/E, CRP, LFT, coag, cultures
- CT
- tissue / pus to MC+S

Mx
- broad spec abx
- surgical debridement
- skin grafts

124
Q

Paraphimosis

A
  • inability to replace retracted foreskin -> glans swells, reduced venous return -> penile ischaemia, infection

RFs
- phimosis, catheter, poor hygiene, prior occurrence

Px
- pain, swelling

Mx
- analgesia
- manual pressure
- dextrose soaked gauze
- needle punctures into glans penis, drain swelling - Dundee technique
- dorsal slit / emergency circumcision

125
Q

Penile cancer

A
  • rare urological cancer - mostly SCC
  • HPV 6,16,18 association

RFs
- HPV, phimosis, smoking, lichen sclerosis, untreated HIV
- circumcision protective

Px
- ulcerating lesion on glans
- +/- pain,
- discharge / bleeding
- inguinal lymphadenopathy

Ix
- penile biopsy
- CT TAP, PET
- TNM staging

Mx
- surgical removal
- radio / chemo

finals (21 decks)

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