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Year 6 > Urology > Flashcards

Urology Flashcards

1
Q

Define Balanitis

A

Inflammation of the glans penis and the prepuce

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2
Q

What are the causes of Balanitis?

A

Infective:
- Bacterial = streps and staphs
- Candidiasis
- Viral = HPV, HSV

Non-infective:
- Derm = psoriasis, lichen planus, lichen sclerosis
- Chemical irritants
- Poor hygiene
- Phimosis

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3
Q

Balanitis features

A
  • Redness and discomfort of the plans penis and prepuce
  • Itching
  • Foul-smelling discharge
  • Phimosis
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4
Q

Balanitis investigaion

A

Swab for culture to guide treatment

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5
Q

Balanitis management

A

Abx based on swap

Hygiene advice

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6
Q

Define BPH

A

Non-cancerous enlargement of the prostate, particularly the transitional zone

Leads to compression of the urethra and subsequent LUTS

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7
Q

BPH features

A
  • Hesitancy
  • Weak stream
  • Frequency
  • Urgency
  • Nocturia
  • Incomplete voiding
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8
Q

BPH investigations

A

International Prostate symptoms score (IPSS):
- 20-35 = severely symptomatic
- 8-19 = moderate
- 0-7 = mild

DRE:
- Assess size, consistency and the presence of nodules

PSA:
- To rule out prostate cancer

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9
Q

What are the 2 week wait criteria for prostate cancer?

A

Refer if prostate feels cancerous on DRE or PSA levels are above age range

Consider a PSA or DRE in men with:
- LUTS
- ED
- Visible haematuria

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10
Q

BPH management

A

Conservative:
- Watchful waiting in older pts w/ mild symptoms
- Lifestyle modifications = avoidance of caffeine and alcohol, timed voiding

Medical:
- Alpha blockers (tamsulosin) for dynamic obstruction
- 5-alpha reductase inhibitors (finasteride) to reduce prostate size - this can take up to 6 months to show effects
- IPSS score of 8 or more = give tamsulosin
- If pt has moderate-severe voiding symptoms, then add in finasteride

Minimally invasive:
- Transurethral resection of the prostate (TURP)
- Laser prostatectomy

Surgery:
- For resistant cases

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11
Q

What are the risk factors for bladder cancer?

A

Transitional cell (90%):
- Smoking
- Exposure to aromatic amines (rubber, dyes, chemical industry)
- Use of cyclophosphamide

SCC:
- Schistosomiasis
- Long term catherization (> 10 yrs)

Adenocarcinoma:
- Local bowel cancer

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12
Q

Bladder cancer features

A
  • Painless haematuria
  • Recurrent UTIs
  • Hydronephrosis
  • WL and NS
  • Neuropathic pain on the medial thigh due to compression of the obturator nerve
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13
Q

Bladder cancer investigations

A
  • Urinalysis and MC&S to confirm haematuria
  • CT urogram = identifies filling defects indicating a tumour
  • Flexible cystoscopy = allows for visualisation and biopsy
  • Staging CT/MRI
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14
Q

What are the 2WW criteria for Bladder cancer?

A

Aged 45 and over and have:
- Unexplained visible haematuria w/out an UTI
- Visible haematuria that persists or recurs after successful UTI treatment

Aged 60 and over with unexplained non-visible haematuria and either:
- Dysuria
- Raised WCC

Consider in pts 60 and over w/ recurrent UTIs

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15
Q

How is Bladder cancer staged?

A

TNM system:

  • Tis = non-invasive, in situ
  • Ta = non-invasive
  • T1 = invades inner lining and connective tissue
  • T2 = invades muscle
  • T3 = invades perivesical fat and LN
  • T4 = mets
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16
Q

Bladder cancer management

A

Non-muscle invasive (Tis-T1):
- Transuretheral resection of the bladder tumour (TURBT) is gold standard
- Chemo = fill bladder w/ drugs e.g. Mitomycin C
- Immunotherapy = fill bladder w/ BCG

Muscle invasive (T2+)
- Radical cystectomy w/ urinary diversion (ileal conduit, neo-bladder or Mitrofanoff procedure) = gold standard
- Radio/Chemo

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17
Q

Define Post-obstructive diuresis

A

When urinary obstruction is resolved there is a pathological response to the retained sodium, water and urea = to produce large volumes of urine

Diuresis occurs when there is >200ml/hr for 2 consecutive hours

Need to check the urine osmolarity = if hypo-osmolar, then replace fluids in pt

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18
Q

What are the causes of Epididymo-orchitis?

A
  • Young and sexually active w/ multiple partners = chlamydia the gonorrhoea
  • Older or w/ single sexual partner = E.coli UTI

Less common:
- Mumps
- TB

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19
Q

Epididymo-orchitis features

A
  • Acute scrotal pain and swelling
  • Fever
  • Dysuria
  • Urethral discharge
  • Prehn’s positive = lifting the testicle relives the pain
  • Cremasteric reflex intact
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20
Q

Epididymo-orchitis management

A
  • Analgesia, scrotal elevation and rest
  • If due to STI = single dose IM ceftriaxone (cover gonorrhoea) plus 10-14 days of oral doxycycline (cover chlamydia)
  • If E.coli related = treat w/ levofloxacin 10 days or ofloxacin 14 days
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21
Q

What are the causes of ED?

A
  • Vascular = atherosclerosis can lead to impaired blood flow to the penis
  • Autonomic neuropathy = in DM or excessive alcohol intake
  • Medications = anti-HTNs
  • Psychological = anxiety, depression, other factors
  • Endocrine = prolactinoma, hypogonadism
  • Pelvic surgery = can damage the nerves and blood vessels
  • Anatomical abnormalities = Peyronie’s disease (fibrous scar tissue inside the penis)
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22
Q

What signs point to organic vs psychological causes of ED?

A

Organic:
- Lack of tumescence (swelling with blood)
- Slow-onset
- Normal libido

Psychological:
- Situational
- High levels of stress
- Still having morning erections

23
Q

ED management

A
  • Psychosexual therapy
  • Oral phosphodiesterase inhibitors (e.g. Sildenafil) enhance the effects of nitric oxide to increase blood flow to the penis - can cause flushing, headaches and blue tinge to vision
  • Vacuum erection devices to draw blood into the penis by applying negative pressure
  • Intra-cavernosal injections to directly increase blood flow
  • Penile prostheses for resistant cases
24
Q

What are the causes of a Hydrocele?

A

Primary (congenital):
- Incomplete obliteration of the processus vaginalis
- This allows fluid from the abdomen to gradually accumulate in the scrotum

Secondary:
- Occurs when there is excessive fluid production w/in the tunica vaginalis
- Due to malignancy trauma or infection

25
Q

Hydrocele investigations

A
  • Testicular exam = transilluminates and you can get above the swelling to feel the cord
  • Can do an USS (usually just a clinical diagnosis)
26
Q

Hydrocele management

A

Primary:
- Observe as most will spontaneously resolve by 12 months of age
- If it persists past 12 months, or its causing discomfort then refer to surgery

Secondary:
- Conservatively - most self resolve
- If not, then can refer to surgery

27
Q

What are the Lower urinary tract symptoms (LUTS)?

A

Voiding:
- Weak stream
- Straining
- Hesitancy
- Terminal dribbling
- Incomplete emptying

Storage:
- Urgency
- Frequency
- Urgency incontinence
- Nocturia

28
Q

Define Phimosis

A

When the foreskin is too tight to be retracted over the glans of the penis

Is considered normal in infants and young children, but should resolve with time

Phimosis in adults may be indicative of an underlying pathology

29
Q

Define Paraphimosis

A

Inability/forgetting to replace the foreskin to its original position after it has been retracted, leading to venous congestion and potentially causing ischaemia and oedema of the glans penis

Usually due to iatrogenic mistakes when catheterising pts

30
Q

What are the causes of Phimosis in adults?

A
  • STIs
  • Eczema
  • Psoriasis
  • Lichen planus/sclerosis
  • Balanitis
31
Q

Phimosis management

A

Topical steroid creams to reduce inflammation and encourage stretching of the foreskin

Circumcision can be used in refractory cases

32
Q

Paraphimosis management

A

Reducing the oedema of the glans by applying manual pressure over a period of time

If that fails, a dorsal slit procedure is done where by the foreskin is cut to relieve the constriction

33
Q

Define Priapism

A

A prolonged, typically painful erection lasting more than 2 hours, beyond sexual activity or unrelated to sexual stimulation

This is a urological emergency due to the risk of irreversible damage to the penis (ischaemia leading to ED)

34
Q

What are the causes of Priapism?

A

Ischaemic (low flow):
- Most common type
- Caused by a lack of venous drainage from the corpora cavernosa
- Is related to haematological disorders (SCA), malignancies and certain drugs

Non-ischaemic (high flow):
- Due to unregulated cavernous arterial flow
- Often a result of trauma

35
Q

Priapism management

A
  • 1st line = aspiration of the blood w/in the corpus cavernosa and irrigation w/ normal saline - always do a blood gas of the aspirted blood
  • 2nd line = intracavernosal injections of alpha agonists e.g. adrenaline
  • 3rd line = surgical shunt
36
Q

What type of cancer is Prostate cancer?

A

Usually adenocarcinomas - typically affect the peripheral prostate

37
Q

Prostate cancer features

A
  • LUTS
  • Haematospermia (blood in semen)
  • Pelvic discomfort
  • Bone pain = mets
  • ED
38
Q

Prostate cancer investigations

A
  • DRE = asymmetrical, hard/craggy/nodular prostate w/ loss of median sulcus
  • PSA
  • Multiparametric MRI = gold standard imaging
39
Q

Prostate cancer management

A
  • Cancer not visible/palpable = watchful waiting/active surveillance
  • Cancer confined to the prostate = radical prostatectomy =/- external beam therapy (EBT)
  • Cancer beyond the prostate but not invasive = hormonal therapy (GnRH analogues, androgen antagonists, GnRH antagonists), EBT
  • Metastatic = Hormonal, chemo (docetacel, cabazitaxel), immunotherapy
40
Q

What are the risk factors for Prostatitis?

A

Usually due to bacterial infection and can be acute or chronic:

  • Pre-existing UTI
  • Epididymitis
  • Catheter use
  • Previous urethral surgery
  • Presence of prostate stones
  • Radiotherapy
41
Q

Prostatitis features

A
  • Perineal or prostatic pain
  • LUTS
  • Systemic symptoms = fever, myalgia
  • Boggy prostate on PR exam
42
Q

Prostatitis management

A
  • Abx tailored to cause = usually fluoroquinolones for 2 wks
  • Analgesia
  • Management of urinary retention if present
43
Q

What are the types of Testicular cancer?

A

Germ cell (95%):
- Seminoma = 55%
- Teratoma = 33%
- Mixed = 12%

Non-germ cell:
- Leydig tumour
- Sarcomas

44
Q

Testicular cancer features

A
  • Painless lump in the scrotum
  • Germ cell tumours may be hormone producing and can increase the oestrogen:androgen ratio resulting in gynecomastia
  • Spread via paraaortic lymph nodes, then chest and neck lymph nodes
45
Q

Testicular cancer investigations

A
  • Scrotal USS
  • Tumour markers = AFP, hCG and LDH
46
Q

Testicular cancer management

A
  • Radical orchidectomy
  • Radiotherapy = esp good for seminomas which are highly sensitive to radiation
  • Chemo = adjuvant in advanced disease (cisplatin)
47
Q

What are the risk factors for Testicular torsion?

A
  • Bell-Clapper deformity = an anomaly where the testis is inadequately fixed allowing it to rotate freely
  • Undescended testes
  • Trauma
  • Prior intermittent torsion
  • Testicular tumour
48
Q

What are the risk factors for Testicular cancer?

A
  • Age < 45
  • Caucasian
  • Previous Hx
  • Cryptorchidism
  • HIV
  • Previous mumps orchitis
  • Klinefelter’s
49
Q

Stress incontinence management

A

Conservative:
- Avoid caffeine, fizzy drinks, limit fluid intake
- Pelvic floor exercises

Medical:
- Duloxetine

Surgical:
- Incontinence pessaries
- Bulking agents injected into bladder neck
- Fascial slings
- Mid-urrtheral slings = gold standard

50
Q

Urge incontinence management

A

Conservative:
- Avoid caffeine, fizzy drinks and limit fluid intake
- Bladder training

Medical:
- Anticholinergics = oxybutynin, solifenacin
- Mirabegron (beta 3 receptor agonist)

Surgical:
- Injection of botox into detrusor muscle to paralyse it
- Sacral nerve stimulation (only in tertiary centres)

51
Q

Define Overflow incontinence

A

When a small amount of urine leaks with no warning

This occurs when the pressures within the bladder overcome the pressures of the outlet structures due to:
- Detrusor muscle damage
- Constipation= increases pressure in the bladder by extrinsic pressure

52
Q

Cryptorchidism management

A

Treatment is surgical = orchidopexy, done around 12 months of age

For bilateral undescended testes at birth:
- Urgent referral to senior paediatrician w/in 24hrs to rule out congenital adrenal hyperplasia
- If ruled out, and the testes haven’t descended by 3 month then refer to the surgeons by 6 months

For unilateral undescended testes at birth:
- Review at 6-8 weeks, if still undescended then review at 4-5 months
- If still undescended then refer to surgeons by 6 months of age

53
Q

UTI management

A

Women = nitrofurantoin or trimethoprim for 3 days

Men = nitrofurantoin or trimethoprim for 7 days

Pregnancy = nitrofurantoin for 7 days till3rd trimester, then give trimethoprim instead

Year 6 (12 decks)

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