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Finals > Urology > Flashcards

Urology Flashcards

1
Q

What is obstructive uropathy

A

blockage preventing urine flow through the ureters, bladder and urethra

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2
Q

swelling of the kidney

A

hydronephrosis

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3
Q

presentation of upper urinary tract obstruction

A
  • loin to groin/ flank pain on the affected side
  • Reduced or no urine output
  • vomiting
  • Impaired renal function
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4
Q

presentation of lower urinary tract obstruction

A
  • Difficulty or inability to pass urine (e.g., poor flow, difficulty initiating urination or terminal dribbling)
  • Urinary retention
  • Impaired renal function
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5
Q

how to diagnose obstructive uropathy

A

USS KUB

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6
Q

causes of upper urinary obstruction

A
  • Kidney stones
  • Tumours pressing on the ureters
  • Ureter strictures (due to scar tissue narrowing the tube)
  • Retroperitoneal fibrosis (the development of scar tissue in the retroperitoneal space)
  • Bladder cancer
  • Ureterocele (ballooning of the most distal portion of the ureter – this is usually congenital)
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7
Q

Causes of lower urinary tract obstruction

A
  • BPH
  • Prostate cancer
  • Bladder cancer
  • Urethral strictures (due to scar tissue)
  • Neurogenic bladder
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8
Q

what is neurogenic bladder

A

abnormal function of the nerves innervating the bladder and urethra = overactivity or underactivity in the detrusor muscle of the bladder and the sphincter muscles of the urethra

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9
Q

causes of neurogenic bladder

A
  • MS
  • diabetes
  • stroke
  • parkinson’s
  • brain/spinal chord injury
  • spina bifida
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10
Q

issues related to beurogenic bladder

A
  • urge incontinence
  • increased bladder pressure
  • obstructive uropathy
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11
Q

Mx of obstructive uropathy

A

remove or bypass obstruction
- nephrostomy: drain urine out of body (UUTO)
- urethral/suprapubic catheter (LUTO)

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12
Q

complications of obstructive uropathy

A
  • Pain
  • AKI
  • CKD
  • Infection (from bacteria tracking up urinary tract into areas of stagnated urine)
  • Hydronephrosis
  • Urinary retention and bladder distention
  • Overflow incontinence of urine
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13
Q

Mx of hydronephrosis

A

treat cause
- percutaneous nephrostomy
- antegrade ureteric stent

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14
Q

reasons for a catheter

A
  • Urinary retention
  • Neurogenic bladder
  • Surgery
  • Output monitoring in acutely unwell patients (e.g., sepsis or intensive care)
  • Bladder irrigation (e.g., to wash out blood clots in the bladder)
  • Delivery of medications (chemotherapy to treat bladder cancer)
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15
Q

types of catheter and use

A
  • Intermittent catheters: simple catheters used to drain urine, then immediately removed
  • Foley catheter (two-way catheter): “standard” catheter with an inflatable balloon to hold it in place
  • Coudé tip catheter: has a curved tip to help navigate it past an obstruction during insertion
  • Three-way catheter: has three tubes used for inflating the balloon, injecting irrigation and drainage
  • suprapubic catheter: through abdomen into bladder
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16
Q

define BPH

A
  • enlarged prostate due to hyperplasia of stromal and epithelial cells of the prostate
  • very common in older men
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17
Q

presentation of BPH

A
  • hesitancy
  • weak flow
  • urgency
  • nocturia
  • intermittency
  • straining
  • terminal dribbling
  • incomplete emptying
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18
Q

how to assess BPH

A
  • DRE
  • abdo exam
  • urinary frequency volume chart
  • urine dipstick
  • PSA
    Use international prostate symptom scoring system
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19
Q

Causes of a raised PSA

A
  • Prostate cancer
  • BPH
  • Prostatitis
  • UTI
  • Vigorous exercise (notably cycling)
  • Recent ejaculation or prostate stimulation
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20
Q

Mx of BPH

A

MEDICAL
- alpha blocker (tamsulosin) relax smooth muscle
- 5-alpha reductase inhibitors (finasteride): reduce prostate size
can take up to 6 months to reduce prostate size.

SURGICAL
- TURP
- transurethral electrovaporisation of the prostate (TEVAP/TUVP)
- holium laser enucleation of the prostate (HoLEP)
- open prostatectomy

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21
Q

side effect of tamsulosin

A

postural hypotension

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22
Q

side effect of finasteride

A

sexual dysfunction due to reduced testosterone

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23
Q

complication of TURP

A
  • bleeding
  • infection
  • Urinary incontinence
  • Erectile dysfunction
  • Retrograde ejaculation
  • Urethral strictures
  • Failure to resolve symptoms
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24
Q

define prostatitis

A

inflammation of the prostate
- acute bacterial: rapid
- chronic: >3months sx

chronic can be subdivided into chronic or chronic bacterial

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25
Q

presentation of chronic prostatitis

A

> 3months:
- pelvic pain
- Lower urinary tract sx
- sexual dysfunction
- pain with bowel movements
- tender/enlarged prostate

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26
Q

presentation of acute prostatitis

A

chronic sx +
- fever
- myalgia
- nausea
- fatigue
- sepsis

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27
Q

Ix for prostatitis

A
  • urine dipstick
  • Urine MC&S
  • chlamydia and gonorrhoea NAAT test
  • DRE
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28
Q

Mx of prostatitis

A

acute
- admission if unwell
- oral abx (cipro or trimethoprim for 2-4 weeks)
- analgesia
- laxatives

chronic
- Alpha-blockers relax smooth muscle
- Analgesia
- Psychological treatment, where indicated
- Abx if < 6 months of sx or hx of infection (e.g., trimethoprim or doxycycline for 4-6 weeks)
- Laxatives

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29
Q

complications of acute prostatitis

A
  • sepsis
  • prostate abscess
  • acute urinary retention
  • chronic prostatitis
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30
Q

most common cancer in men

A

prostate

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31
Q

where does advanced prostate cancer spread to

A

lymph nodes and bones

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32
Q

what is prostate cancer dependent on

A

androgens (testosterone)

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33
Q

most common type of prostate cancer

A

adenocarcinoma in the peripheral zone

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34
Q

RFs for prostate cancer

A
  • Increasing age
  • Family history
  • Black African or Caribbean origin
  • Tall stature
  • Anabolic steroids
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35
Q

presentation of prostate cancer

A

asymptomatic or lower urinary tract sx
- hesitancy
- frequency
- weak flow
- terminal dribbling
- nocturia
- haematuria
- erectile dysfunction
- FLAWS for advanced

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36
Q

what is the function of PSA

A

secreted in semen to stop ejaculate from clotting

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37
Q

Ix for prostate cancer

A
  • PSA
  • DRE
  • multiparametric MRI (1st line)
  • prostate biopsy (if MRI says could be cancer) TRUS or trasnperineal
  • isotope bone scan for mets
  • Gleason Grading based on histology from biopsy
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38
Q

what is gleason grading

A

grade tissues 1-5
add 2 scores:
- most prevalent histology pattern and second most

6= low risk
7= intermediate
8= high risk

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39
Q

staging for Prostate cancer

A

TNM

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40
Q

Mx of prostate cancer

A

MDT
- Surveillance or watchful waiting in early prostate cancer
- External beam radiotherapy directed at the prostate
- Brachytherapy
- Hormone therapy
- Surgery

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41
Q

side effect of external beam radiotherapy

A

proctitis (inflammation of the rectum)

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42
Q

what is epididymo-orchitis

A

inflammation of the epididymis and testicle usually on one side

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43
Q

function of the epididymis

A

store sperm whilst they mature

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44
Q

causes of epididymo-orchitis

A
  • E coli
  • chlamydia trachomatis
  • neisseria gonorrhoea
  • mumps
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45
Q

presentation of epididymo-orchitis

A

gradual onset, over minutes to hours, with unilateral:

  • Testicular pain
  • Dragging or heavy sensation
  • Swelling of testicle and epididymis
  • Tenderness on palpation, particularly over epididymis
  • Urethral discharge (should make you think of chlamydia or gonorrhoea)
  • Systemic symptoms
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46
Q

key differential for epididymo-orchitis

A

testicular torsion

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47
Q

Ix for epididymo-orchitis

A
  • urine MC&S
  • Chlamydia and gonorrhoea NAAT testing
  • Charcoal swab of purulent urethral discharge for gonorrhoea culture and sensitivities
  • Saliva swab for mumps
  • Serum antibodies for mumps (IgM – acute infection, IgG – previous infection or vaccination)
  • Ultrasound may be used to assess for torsion or tumours

need to distinguish whether E coli or STI cause

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48
Q

Mx of epididymo-orchitis

A

very unwell = IV abx

E-coli:
- ofloxacin 14 days
- Levofloxacin 10 days
- Co-amoxiclav 10 days

STI
- IM ceftriaxone
- doxycycline
- ofloxacin

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49
Q

complications of epidiymo-orchitis

A

chronic pain
chronic epididmitis
testicular atrophy
sub-fertility/infertility
scrotal abscess

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50
Q

define testicular torsion

A

twisting of the spermatic cord with rotation of the testicle
EMERGENCY

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51
Q

Presentation of testicular torsion

A
  • acute rapid onset of unilateral testicular pain
  • abdo pain
  • vomiting
  • firm swollen testicle
  • elevated testicle
  • absent cremasteric reflex
  • horizontal testicle
  • rotation of testicle
52
Q

A cause of testicular torsion

A

Bell Clapper deformity

53
Q

Mx of testicular torsion

A

NBM
analgesia
surgical exploration
orchioplexy or orchidectomy

54
Q

USS sign in testicular torsion

A

whirlpool sign

55
Q

causes of scrotal or testicular lumps

A
  • testicular cancer
  • hydrocele
  • varicocele
  • epididymal cyst
  • Epididymo-orchitis
  • Inguinal hernia
  • Testicular torsion
56
Q

what is a hydrocele

A

collection of fluid within the tunica vaginalis that surrounds the testes

57
Q

presentation of hydrocele

A
  • painless
  • soft scrotal swelling
  • TRANSILLUMINATES
  • testicle palpable
  • irreducible and no bowel sounds
58
Q

causes of hydrocele

A
  • idiopathic
  • Testicular cancer
  • Testicular torsion
  • Epididymo-orchitis
  • Trauma
59
Q

Mx of hydrocele

A

conservative
surgery/aspiration in large cases

60
Q

define varicocele

A

Veins in the pampiniform plexus become swollen.
most commonly left side

61
Q

Side effect of varicocele

A
  • infertility
  • testicular atrophy
62
Q

presentation of varicocele

A
  • Throbbing/dull pain or discomfort, worse on standing
  • A dragging sensation
  • Sub-fertility or infertility
  • “bag of worms” scrotum
  • prominent on standing, disappears lying down
  • asymmetry in testicular size
63
Q

concerning signs of varicocele

A

do not disappear on lying down
suggests retroperitoneal tumours
urgent referral

64
Q

Mx of varicocele

A

conservative
surgery if painful, testicular atrophy or infertile

65
Q

what is an epididymal cyst

A

fluid filled sac at the head of the epididymis
if it contains sperm = spermatocele

66
Q

presentation of epididymal cyst

A
  • Soft, round lump
  • Typically at the top of the testicle
  • Associated with the epididymis
  • Separate from the testicle
  • May be able to transilluminate large cysts
67
Q

Mx of epididymal cyst

A

harmless- conservative
removed if painful

68
Q

what is testicular cancer

A

arises from the germ cells in the testes (produce sperm)
incidence 15-35yrs

69
Q

types of testicular cancer

A

seminomas
non-seminomas (mostly teratomas)

70
Q

RFs for testicular cancer

A
  • undescended testes
  • male infertility
  • FH
  • tall
71
Q

presentation of testicular cancer

A
  • painless lump on testicle
  • hard
  • irregular
  • non fluctuant
  • no transillumination
  • rarely gynaecomastia (leydig cell tumour)
72
Q

Ix for testicular cancer

A

Scrotal USS
AFP
B-hCG
LDH
Staging CT

73
Q

What staging criteria is used for testicular cancer

A

Royal Marsden staging system

74
Q

common sites of testicular cancer metastasis

A
  • lungs
  • lymphatics
  • liver
  • brain
75
Q

Mx of testicular cancer

A

MDT
- surgery
- chemo
- radiotherapy
- sperm banking

76
Q

long term side effects of treatment for testicular cancer

A
  • Infertility
  • Hypogonadism (testosterone replacement may be required)
  • Peripheral neuropathy
  • Hearing loss
  • Lasting kidney, liver or heart damage
  • Increased risk of cancer in the future
77
Q

prognosis of testicular cancer

A
  • early- 90% cure rate
  • metastatic often curable
  • seminomas better prognosis than non-seminomas
78
Q

what is a LUTI

A

infection in the bladder

79
Q

causes of UTI

A

E coli
klebsiella pneumoniae
enterococcus
pseudomons aeruginosa
staph saprophyticus
candida albicans

80
Q

presentation of LUTI

A
  • Dysuria
  • Suprapubic pain/discomfort
  • Frequency
  • Urgency
  • Incontinence
  • Haematuria
  • Cloudy or foul smelling urine
  • Confusion is common in older and frail patients
81
Q

Mx of LUTI

A

trimethoprim
nitrofurantoin (not in GFR <45)

3 days simple
5-10 days immunosuppressed
7 days- men, pregnant, catheter

82
Q

Mx of LUTI in pregnancy

A
  • nitrofurantoin (avoid in third trimester neonatal haemolysis)
  • cefalexin
  • trimethoprim avoidede generally due to risk of neural tube defects in first trimester
83
Q

what is pyelonephritis

A

inflammation of the kidney resulting from bacterial infection

84
Q

RFs for pyelonephritis

A
  • female
  • structural urological abnormalities
  • Vesico-ureteric reflux
  • Diabetes
85
Q

causes of pyelonephritis

A
  • e coli
  • Klebsiella pneumoniae
  • Enterococcus
  • Pseudomonas aeruginosa
  • Staphy saprophyticus
  • Candida albicans
86
Q

presentation of pyelonephritis

A

LUTI sx +
- fever
- loin/back pain
- N&V
- renal angle tenderness

87
Q

Ix for pyelonephritis

A
  • urine dipstick
  • MSU
  • Bloods (WCC, CRP)
  • USS or CT
88
Q

Mx of pyelonephritis

A

7-10 days of cefalexin

89
Q

what is chronic pyelonephritis

A

recurrent episodes of infection in the kidneys
lead to CKD and ESRF
Can do DMSA scan

90
Q

what is interstitial cystitis

A

chronic condition causing inflammation in the bladder, resulting in lower urinary tract symptoms and suprapubic pain

91
Q

Presentation of interstitial cystitis

A

similar to LUTI. At least 6 weeks of:
- Suprapubic pain, worse with a full bladder and often relieved by emptying the bladder
- Frequency
- Urgency
- Symptoms may be worse during menstruation

92
Q

Ix of cystitis

A

Need to exclude other causes:
- urinalysis
- swabs
- cystoscopy: see Hunner lesions and granulations
- prostate exam

93
Q

Mx of interstitial cystitis

A

supportive
oral:
- analgesia, antihistamine, contraceptive
intravesical medication:
- lidocaine,hyaluronic acid
surgery: cauterise hunner lesions, botox

94
Q

what is bladder cancer

A

cancer in the bladder arises from the endothelial lining
majority are superficial at presentation

95
Q

RFs for bladder cancer

A
  • smoking
  • increased age
    aromatic amines (dye/rubber industries) (transitional cell)
    schistosomiasis (SCC)
96
Q

types of bladder cancer

A
  • transitional cell carcinoma (90%)
  • squamous cell carcinoma (5%)
  • adenocarcinoma (2%)
  • sarcoma
  • small cell carcinoma
97
Q

presentation of bladder cancer

A

painless haematuria

98
Q

Ix bladder cancer

A

cystoscopy

99
Q

staging for bladder cancer

A

TNM
- non-muscle invading BC (Tis-T1)
- muscle invasive BC (T2-T4)

100
Q

Mx of bladder cancer

A
  • transurethral resection of bladder tumour (early stage)
  • intravesical chemo
  • intravesical BCG
  • radical cystectomy (need a urostomy after)
  • chemo and radiotherapy
101
Q

what are renal stones

A

renal calculi, urolithiasis and nephrolithiasis
hard stones that form in the renal pelvis, where the urine collects before travelling down the ureters

102
Q

where to stones commonly get stuck

A

vesico-ureteric junction

103
Q

complications of kidney stones

A
  • obstruction –>AKI
  • infection with obstructive pyelonephritis
104
Q

types of kidney stones

A

Calcium
- calcium oxalate (MC)
- calcium phosphate

Other
- uric acid
- struvite (staghorn)
- cystine (inherited)

105
Q

what is a staghorn calculus

A

stone forms in the shape of the renal pelvis

106
Q

presentation of renal stones

A
  • renal colic: unilateral loin to groin pain, colicky
  • haematuria
  • N&V
  • reduced urine output
  • sx of sepsis if infection
107
Q

Ix of kidney stones

A
  • urine dipstick
  • blood tests
  • Xray
  • Non contrast CT KUB
  • USS KUB
108
Q

Mx of kidney stones

A
  • Analgesia (NSAID IM diclofenac)
  • antiemetic
  • Abx if infection
  • watchful waiting <5mm
  • tamsulosin (muscle relax to help passage)
  • surgery >10mm, or if infection
109
Q

surgical mx for kidney stones

A
  • Extracorporeal shock wave lithotripsy (ESWL): shock externally
  • Ureteroscopy and laser lithotripsy: camera inserted and then use laser
  • percutaneous nephrolithotomy (PCNL): camera through pt back and break stones up
  • open surgery
110
Q

How to prevent future stones

A
  • increase fluids
  • add lemon juice to water
  • avoid fizzy drinks
  • reduce salt
  • normal calcium intake
111
Q

medications to prevent recurrence of kidney stones

A
  • potassium citrate: calcium oxalate stones
  • thiazide diuretics: calcium oxalate stones
112
Q

what is renal cell carcinoma

A

most common type of kidney tumour
adenocarcinoma from renal tubules

113
Q

triad presentation of RCC

A
  • haematuria
  • flank pain
  • palpable mass
    (FLAWS)
114
Q

types of RCC

A
  • clear cell (80%)
  • papillary (15%)
  • chromophobe (5%)
  • Wilm’s tumour in children <5yrs
115
Q

RFs for RCC

A
  • smoking
  • obesity
  • hypertension
  • ESRF
  • Von Hippel-Lindau Disease
  • Tuberous sclerosis
116
Q

where does RCC spread to?

A
  • tissues around the kidney within the Gerota’s fascia
  • cannonball metastasis
117
Q

which paraneoplastic syndromes is RCC associated with?

A
  • polycythaemia
  • hypercalcaemia
  • hypertension
  • Stauffer’s syndrome
118
Q

Staging of RCC

A

CT thorax, abdo, pelvis
- Stage 1: < 7cm + confined to the kidney
- Stage 2: > 7cm + confined to the kidney
- Stage 3: Local spread to nearby tissues or veins, but not beyond Gerota’s fascia
- Stage 4: Spread beyond Gerota’s fascia, including metastasis

119
Q

Mx of RCC

A

Surgery
- partial nephrectomy
- radical nephrectomy

Non-surgical
- arterial embolisation
- percutaneous cryotherapy
- radiofrequency. ablation

120
Q

what is a renal transplant

A

a kidney is transplanted into a patient with end-stage renal failure
adds 10 yrs to life compared to dialysis

121
Q

how is the donor kidney transplanted

A
  • donor kidney blood vessels are connected (anastomosed) with the pelvic vessels, usually the external iliac vessels
  • ureter of the donor kidney is anastomosed directly with the bladder.
  • placed anteriorly in the abdomen, “hockey stick” incision
122
Q

immunosuppressants needed after renal transplant

A

Tacrolimus
Mycophenolate
Ciclosporin
Azathioprine
Prednisolone

123
Q

side effects of immunosuppressants

A
  • Immunosuppressants cause seborrhoeic warts and skin cancers (look for scars from skin cancer removal)
  • Tacrolimus causes a tremor
  • Cyclosporine causes gum hypertrophy
  • Steroids cause features of Cushing’s syndrome
124
Q

Complications of renal transplant

A
  • Transplant rejection (hyperacute, acute or chronic)
  • Transplant failure
  • Electrolyte imbalances
125
Q

complications related to immunosuppressants

A
  • Ischaemic heart disease
  • Type 2 diabetes (steroids)
  • Infections are more likely, more severe and may involve unusual pathogens
  • Non-Hodgkin lymphoma
  • Skin cancer (particularly squamous cell carcinoma)
126
Q

Infections secondary to immunosuppressant meds

A
  • Pneumocystis jiroveci pneumonia (PCP/PJP)
  • Cytomegalovirus (CMV)
  • Tuberculosis (TB)
127
Q

Cause of phimosis

A
  • Balanitis Xerotica Obliterans (lichen sclerosis

Finals (10 decks)

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