Urology Flashcards

1
Q

What are the signs of upper urinary tract obstruction?

A
  • Loin to groin or flank pain
  • Reduced or no urine output
  • Non-specific symptoms (e.g., vomiting)
  • Impaired renal function (raised creatinine)
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2
Q

What imaging is useful for diagnosing obstructive uropathy?

A

Ultrasound of the kidneys, ureters, and bladder

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3
Q

What are common causes of upper urinary tract obstruction?

A
  • Kidney stones
  • Tumors pressing on the ureters
  • Ureter strictures
  • Retroperitoneal fibrosis
  • Bladder cancer blocking ureteral openings
  • Ureterocele
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4
Q

What are common causes of lower urinary tract obstruction?

A
  • BPH
  • Prostate cancer
  • Bladder cancer blocking the bladder neck
  • Urethral strictures
  • Neurogenic bladder
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5
Q

What is neurogenic bladder, and what are its causes?

A

Abnormal nerve function of the bladder/urethra leading to overactivity or underactivity. Causes include:
- MS
- Diabetes
- Stroke
- Parkinson’s disease
- Brain/spinal cord injury
- Spina bifida

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6
Q

How is an upper urinary tract obstruction treated?

A

Nephrostomy: A tube inserted through the skin, kidney, and into the ureter to drain urine externally.

Antegrade ureteric stent: A stent placed under radiological guidance through the kidney into the ureter.

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7
Q

How is a lower urinary tract obstruction treated?

A

Urethral catheter: Inserted through the urethra into the bladder.

Suprapubic catheter: Inserted through the skin above the pubic bone directly into the bladder.

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8
Q

What are common complications of obstructive uropathy?

A
  • Pain
  • post-renal AKI
  • CKD
  • Infection (from stagnated urine)
  • Hydronephrosis
  • Urinary retention and bladder distention
  • Overflow incontinence
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9
Q

What are the typical presenting features of hydronephrosis?

A
  • Vague renal angle pain
  • Mass in the kidney area
  • Seen on ultrasound, CT, or intravenous urogram
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10
Q

How is hydronephrosis treated?

A

By treating the underlying cause. If pressure needs relief:
- Percutaneous nephrostomy: Inserting a tube through the skin into the kidney and ureter.
- Antegrade ureteric stent: Placing a stent from the kidney into the ureter.

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11
Q

What tool is used to assess LUTS severity in BPH?

A

International Prostate Symptom Score (IPSS).

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12
Q

What are the components of the initial assessment for BPH?

A
  • Digital rectal examination (DRE): To assess prostate size, shape, and characteristics.
  • Abdominal examination: To check for a palpable bladder or abnormalities.
  • Frequency volume chart: Record of 3 days of fluid intake and urine output.
  • Urine dipstick: To detect infection or haematuria.
  • PSA test: For prostate cancer screening based on patient preference.
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13
Q

What are common causes of a raised PSA?

A

Prostate cancer
BPH
Prostatitis
Urinary tract infections
Vigorous exercise (e.g., cycling)
Recent ejaculation or prostate stimulation

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14
Q

What distinguishes a benign prostate on DRE?

A

Smooth, symmetrical, slightly soft, with a central sulcus.

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15
Q

What distinguishes a cancerous prostate on DRE?

A

Firm or hard, asymmetrical, craggy, irregular, with a loss of the central sulcus.

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16
Q

What medical treatments are used for BPH?

A

Alpha-blockers (e.g., tamsulosin): Relax smooth muscle, providing rapid symptom relief.

5-alpha reductase inhibitors (e.g., finasteride): Gradually reduce prostate size by inhibiting DHT formation.

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17
Q

How long does it take for 5-alpha reductase inhibitors to improve symptoms?

A

6 months

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18
Q

What are common side effects of tamsulosin and finasteride?

A

Tamsulosin: Postural hypotension.

Finasteride: Sexual dysfunction due to reduced testosterone.

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19
Q

What are the surgical options for BPH?

A
  • Transurethral resection of the prostate (TURP): Removing prostate tissue via a diathermy loop.
  • Transurethral electrovaporisation of the prostate (TEVAP/TUVP): Vaporising prostate tissue with a rollerball electrode.
  • Holmium laser enucleation of the prostate (HoLEP): Using a laser to remove prostate tissue.
  • Open prostatectomy: Open surgery to remove the prostate via abdominal or perineal incision.
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20
Q

What are the major complications of TURP?

A
  • Bleeding
  • Infection
  • Urinary incontinence
  • Erectile dysfunction
  • Retrograde ejaculation
  • Urethral strictures
  • Failure to resolve symptoms
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21
Q

What are the symptoms of chronic prostatitis?

A
  • Pelvic pain (e.g., in the perineum, testicles, scrotum, penis, rectum, groin, lower back, or suprapubic area).
  • Lower urinary tract symptoms (e.g., dysuria, hesitancy, frequency, retention).
  • Sexual dysfunction (e.g., erectile dysfunction, pain on ejaculation, haematospermia).
  • Pain during bowel movements.
  • Tender and enlarged prostate on examination (though it may be normal).
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22
Q

How does acute bacterial prostatitis differ in presentation from chronic prostatitis?

A

Acute onset of symptoms similar to chronic prostatitis.
Systemic symptoms of infection, such as:
- Fever
- Myalgia
- Nausea
- Fatigue
- Sepsis

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23
Q

What tool is used to assess and track chronic prostatitis symptoms?

A

National Institute of Health Chronic Prostatitis Symptom Index.

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24
Q

What investigations are performed for prostatitis?

A
  • Urine dipstick: To confirm infection.
  • Urine microscopy, culture, and sensitivities (MC&S): To identify causative organisms and antibiotic sensitivities.
  • Chlamydia and gonorrhoea NAAT testing: For suspected STIs
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25
Q

How is acute bacterial prostatitis managed?

A
  • Hospital admission: For systemically unwell or septic patients (to conduct blood tests, cultures, and administer IV antibiotics).
  • Oral antibiotics: 2-4 weeks (e.g., ciprofloxacin, ofloxacin, or trimethoprim).
  • Analgesia: Paracetamol or NSAIDs.
  • Laxatives: For pain during bowel movements.
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26
Q

How is chronic prostatitis managed?

A
  • Alpha-blockers (e.g., tamsulosin): Relax smooth muscle for symptom relief.
  • Analgesia: Paracetamol or NSAIDs.
  • Psychological treatment: Cognitive behavioural therapy or antidepressants if indicated.
  • Antibiotics: For <6 months of symptoms or a history of infection (e.g., trimethoprim or doxycycline for 4-6 weeks).
  • Laxatives: For bowel movement-related pain.
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27
Q

What are the complications of acute bacterial prostatitis?

A
  • Sepsis.
  • Prostate abscess: May present as a fluctuant mass and require surgical drainage.
  • Acute urinary retention.
  • Chronic prostatitis.
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28
Q

Where does advanced prostate cancer commonly spread?

A

Lymph nodes and bones

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29
Q

What type of cancer is most prostate cancer?

A

Adenocarcinoma, typically growing in the peripheral zone of the prostate.

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30
Q

What are the key risk factors for prostate cancer?

A
  • Increasing age.
  • Family history.
  • Black African or Caribbean origin.
  • Tall stature.
  • Anabolic steroid use.
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31
Q

Why is PSA testing controversial?

A
  • High false-positive rate (75%) and false-negative rate (15%).
  • Risks of unnecessary biopsies and overdiagnosis.
  • May lead to false reassurance.
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32
Q

What is the first-line investigation for suspected localised prostate cancer?

A

Multiparametric MRI.

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33
Q

What is the Likert scale for MRI results?

A

1 – Very low suspicion.
2 – Low suspicion.
3 – Equivocal.
4 – Probable cancer.
5 – Definite cancer.

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34
Q

When is a prostate biopsy performed?

A

Based on MRI findings (Likert 3 or above) and clinical suspicion (PSA and DRE findings).

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35
Q

What are the two types of prostate biopsy?

A

Transrectal ultrasound-guided biopsy (TRUS): Biopsies taken through the rectum.

Transperineal biopsy: Biopsies taken through the perineum under local anaesthetic.

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36
Q

What is the Gleason grading system?

A

Grades (prostate biopsy) tissue samples from 1 (normal) to 5 (abnormal).

Score = most prevalent pattern + second most prevalent pattern.

Scores:
6: Low risk.
7: Intermediate risk (3+4 is lower risk than 4+3).
8+: High risk.

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37
Q

What are the treatment options for prostate cancer?

A
  • Surveillance or watchful waiting (early cancer).
  • External beam radiotherapy.
  • Brachytherapy.
  • Hormone therapy.
  • Surgery (radical prostatectomy).
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38
Q

What are the complications of external beam radiotherapy?

A

Proctitis (pain, altered bowel habits, bleeding, discharge).

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39
Q

What are the complications of brachytherapy?

A
  • Cystitis or proctitis.
  • Erectile dysfunction.
  • Incontinence.
  • Increased bladder or rectal cancer risk.
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40
Q

What are the side effects of hormone therapy?

A

Hot flushes, sexual dysfunction, gynaecomastia, fatigue, osteoporosis.

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41
Q

What are the complications of radical prostatectomy?

A

Erectile dysfunction and urinary incontinence.

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42
Q

What is the function of the epididymis?

A

It stores and matures sperm, which travel from the testicle through the head, body, and tail of the epididymis before draining into the vas deferens.

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43
Q

What are common infectious causes of epididymo-orchitis?

A

Bacterial:
- Escherichia coli (E. coli)
- Chlamydia trachomatis
- Neisseria gonorrhoea
Viral: Mumps

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44
Q

What are the typical symptoms of epididymo-orchitis?

A
  • Gradual onset of unilateral testicular pain.
  • Dragging or heavy sensation.
  • Swelling of the testicle and epididymis.
  • Tenderness over the epididymis.
  • Urethral discharge (suggests STI).
  • Systemic symptoms: fever and possibly sepsis.
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45
Q

What is the key differential diagnosis for epididymo-orchitis?

A

Testicular torsion

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46
Q

What investigations help establish the cause of epididymo-orchitis?

A
  • Urine MC&S.
  • Chlamydia and gonorrhoea NAAT testing on first-pass urine.
  • Charcoal swab of urethral discharge for gonorrhoea culture and sensitivities.
  • PCR testing for mumps (saliva swab).
  • Serum antibodies for mumps (IgM for acute, IgG for past infection or vaccination).
  • Ultrasound for torsion or tumours.
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47
Q

What antibiotics are recommended for enteric causes of epididymo-orchitis?

A
  • Ofloxacin for 14 days.
  • Levofloxacin for 10 days.
  • Co-amoxiclav for 10 days (if quinolones are contraindicated)
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48
Q

What empirical antibiotics are used for suspected STIs?

A
  • Intramuscular ceftriaxone (single dose).
  • Doxycycline.
  • Ofloxacin (based on sensitivities).
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49
Q

What are the potential complications of epididymo-orchitis?

A
  • Chronic pain.
  • Chronic epididymitis.
  • Testicular atrophy.
  • Sub-fertility or infertility.
  • Scrotal abscess.
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50
Q

What are two critical side effects of quinolones?

A
  • Tendon damage or rupture, especially the Achilles tendon.
  • Lower seizure threshold (caution in epilepsy).
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51
Q

What are the examination findings in testicular torsion?

A
  • Firm, swollen testicle.
  • Elevated (retracted) testicle.
  • Absent cremasteric reflex.
  • Abnormal testicular lie (often horizontal).
  • Rotation of the testicle (epididymis not in the normal posterior position).
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52
Q

What is the bell-clapper deformity?

A

A congenital absence of fixation between the testicle and the tunica vaginalis, allowing the testicle to hang horizontally and rotate freely.

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53
Q

What is the initial management for testicular torsion?

A
  • Nil by mouth (in preparation for surgery).
  • Analgesia.
  • Urgent senior urology assessment.
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54
Q

What surgical procedures are performed in testicular torsion?

A

Orchiopexy: Corrects the testicle’s position and fixes it in place.
Orchidectomy: Removes the testicle if necrosis has occurred.

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55
Q

What role does scrotal ultrasound play in diagnosis?

A

It can confirm the diagnosis by showing the whirlpool sign, but it should not delay urgent surgery.

56
Q

What are the key causes of scrotal or testicular lumps?

A
  • Hydrocele
  • Varicocele
  • Epididymal cyst
  • Testicular cancer
  • Epididymo-orchitis
  • Inguinal hernia
  • Testicular torsion
57
Q

What are the key examination findings in hydrocele?

A
  • Testicle is palpable within the hydrocele.
  • Soft and fluctuant, may be large.
  • Irreducible, with no bowel sounds (distinguishes it from a hernia).
  • Transilluminates when a torch is shone through.
58
Q

What conditions can secondary hydrocele indicate?

A

Testicular cancer, testicular torsion, epididymo-orchitis, or trauma.

59
Q

How is hydrocele managed?

A
  • Exclude serious causes.
  • Idiopathic cases may be managed conservatively.
  • Surgery, aspiration, or sclerotherapy for symptomatic cases.
60
Q

What is a varicocele?

A

Swollen veins in the pampiniform plexus of the spermatic cord.

61
Q

Why do most varicoceles occur on the left side?

A

The left testicular vein drains into the left renal vein, which has higher resistance.

62
Q

What are the examination findings in varicocele?

A

Scrotal mass resembling a “bag of worms.”
More prominent on standing, disappears when lying down.
Asymmetry in testicular size if the varicocele has caused atrophy.

63
Q

What raises suspicion of retroperitoneal tumours in varicocele?

A

Varicoceles that do not disappear when lying down.

64
Q

What investigations are used for varicocele?

A
  • Ultrasound with Doppler imaging.
  • Semen analysis (for fertility concerns).
  • Hormonal tests (FSH, testosterone).
65
Q

How is varicocele managed?

A
  • Conservative for uncomplicated cases.
  • Surgery or endovascular embolisation for pain, atrophy, or infertility
66
Q

What is an epididymal cyst?

A

A fluid-filled sac at the head of the epididymis.

67
Q

What is a spermatocele?

A

An epididymal cyst containing sperm.

68
Q

What are the typical examination findings in an epididymal cyst?

A
  • Soft, round lump at the top of the testicle.
  • Associated with the epididymis and separate from the testicle.
  • May transilluminate if large.
69
Q

Are epididymal cysts harmful?

A

Usually harmless, not associated with infertility or cancer.

70
Q

When might epididymal cysts require treatment?

A

Pain, discomfort, or exceptionally rare torsion of the cyst.

71
Q

What are the two main types of testicular cancer?

A

Seminomas (better prognosis)
Non-seminomas (mostly teratomas)

72
Q

What age group is most affected by testicular cancer?

A

Younger men, with the highest incidence between 15 and 35 years.

73
Q

What are the risk factors for testicular cancer?

A
  • Undescended testes
  • Male infertility
  • Family history
  • Increased height
74
Q

What is the typical presentation of testicular cancer?

A

A painless lump on the testicle.

75
Q

What are the features of a lump in testicular cancer?

A
  • Non-tender or reduced sensation
  • Arises from the testicle
  • Hard, irregular
  • Not fluctuant
  • Does not transilluminate
76
Q

What rare symptom may occur in testicular cancer?

A

Gynaecomastia, particularly with Leydig cell tumours.

77
Q

What is the initial investigation for testicular cancer?

A

Scrotal ultrasound.

78
Q

What tumour markers are associated with testicular cancer?

A

Alpha-fetoprotein (AFP): Raised in teratomas, not in pure seminomas.

Beta-hCG: May be raised in both teratomas and seminomas.

Lactate dehydrogenase (LDH): Non-specific marker.

79
Q

What are the stages of testicular cancer?

A

Royal Marsden Staging System

Stage 1: Isolated to the testicle.
Stage 2: Spread to retroperitoneal lymph nodes.
Stage 3: Spread to lymph nodes above the diaphragm.
Stage 4: Metastasised to other organs.

80
Q

Where does testicular cancer commonly metastasise?

A

Lymphatics
Lungs
Liver
Brain

81
Q

What treatments are used for testicular cancer?

A
  • Surgery: Radical orchidectomy (testicle removal), prosthesis optional.
  • Chemotherapy
  • Radiotherapy
  • Sperm banking: Preserving sperm before treatment to prevent infertility.
82
Q

What is the prognosis for early testicular cancer?

A

Greater than 90% cure rate.

83
Q

What symptoms suggest pyelonephritis rather than a lower UTI?

A
  • Fever
  • Loin/back pain
  • Nausea or vomiting
  • Renal angle tenderness
84
Q

What does a positive nitrite test on a urine dipstick indicate?

A

Presence of gram-negative bacteria (e.g., E. coli) converting nitrates to nitrites.

85
Q

What is the most common cause of UTIs?

Name other common causes of UTIs.

A

Escherichia coli (E. coli) – gram-negative anaerobic rod.

  • Klebsiella pneumoniae
  • Enterococcus
  • Pseudomonas aeruginosa
  • Staphylococcus saprophyticus
  • Candida albicans (fungal)
86
Q

What antibiotics are commonly used for uncomplicated UTIs?

What are alternative antibiotics for UTIs?

A

Trimethoprim (resistance is common)
Nitrofurantoin (avoid if eGFR <45)

Pivmecillinam, Amoxicillin, Cefalexin

87
Q

How long should antibiotics be given for a simple lower UTI in women?
How long should antibiotics be given for special cases (e.g., pregnancy, catheter-related UTIs)?

A

Women: 3 days
Men: 7 days
Special cases: 7 days

Immunosuppressed women, abnormal anatomy, impaired kidney function: 5-10 days

88
Q

Why are UTIs in pregnancy concerning?

A

They increase the risk of:
- Pyelonephritis
- Premature rupture of membranes
- Preterm labour

89
Q

What antibiotics are safe during pregnancy?

A
  • Nitrofurantoin (avoid in the third trimester, may cause neonatal haemolysis)
  • Amoxicillin (only after sensitivities are known)
  • Cefalexin
90
Q

Why is trimethoprim avoided in the first trimester?

A

It is a folate antagonist, increasing the risk of congenital malformations like neural tube defects.

91
Q

When is an MSU sample needed for microscopy, culture, and sensitivity testing?

A
  • Pregnant patients
  • Recurrent UTIs
  • Atypical symptoms
  • Symptoms not improving with antibiotics
92
Q

What are the risk factors for pyelonephritis?

A

Female sex
Structural urological abnormalities
Vesico-ureteric reflux (VUR)
Diabetes

93
Q

What is the most common causative organism for pyelonephritis?

A

Escherichia coli (E. coli) – a gram-negative, anaerobic, rod-shaped bacterium

94
Q

What is the classic triad of symptoms in pyelonephritis?

A
  • Fever
  • Loin or back pain
  • Nausea/vomiting
95
Q

What are the first-line antibiotics for community management of pyelonephritis according to NICE (2018)?

A
  • Cefalexin
  • Co-amoxiclav (if culture results are available)
  • Trimethoprim (if culture results are available)
  • Ciprofloxacin
96
Q

What complications (of pyelonephritis) should be considered in patients with severe symptoms or poor response to treatment?

A

Renal abscess
Kidney stone obstructing the ureter

97
Q

What imaging is used to assess renal damage in chronic pyelonephritis?

A

Dimercaptosuccinic acid (DMSA) scans, which use radiolabeled DMSA to highlight healthy kidney tissue and detect scarring.

98
Q

What are the typical symptoms of interstitial cystitis?

A
  • Suprapubic pain (worse with a full bladder, often relieved by urination)
  • Frequency of urination
  • Urgency of urination
  • Symptoms lasting for more than 6 weeks
  • Symptoms may worsen during menstruation
99
Q

What findings may be seen during cystoscopy in interstitial cystitis?

A
  • Hunner lesions: Red, inflamed patches with small blood vessels (found in 5-20% of patients).
  • Granulations: Tiny haemorrhages on the bladder wall
100
Q

How is interstitial cystitis initially managed?

A

Supportive management including:
- Diet changes (avoiding alcohol, caffeine, tomatoes)
- Smoking cessation
- Pelvic floor exercises
- Bladder retraining
- Cognitive behavioural therapy
- Transcutaneous electrical nerve stimulation (TENS)

101
Q

What oral medications may help manage interstitial cystitis symptoms?

What intravesical medications may be helpful in interstitial cystitis?

A
  • Analgesia
  • Antihistamines
  • Anticholinergic medications (e.g., solifenacin, oxybutynin)
  • Mirebegron (beta-3-adrenergic-receptor agonist)
  • Cimetidine (histamine-2-receptor antagonist)
  • Pentosan polysulfate sodium
  • Ciclosporin (immunosuppressant)
  • Lidocaine
  • Pentosan polysulfate sodium
  • Hyaluronic acid
  • Chondroitin sulphate
102
Q

What is hydrodistention, and how does it help with interstitial cystitis?

A

Hydrodistention involves filling the bladder with water to high pressure during a cystoscopy, often leading to temporary (3-6 months) symptom improvement.

103
Q

What surgical options may be considered for severe interstitial cystitis?

A
  • Cauterization of Hunner lesions during cystoscopy
  • Botulinum toxin injections during cystoscopy
  • Neuromodulation (implanted electrical nerve stimulator)
  • Augmentation cystoplasty (using a section of ileum to increase bladder capacity)
  • Cystectomy (bladder removal)
104
Q

Which carcinogen found in cigarette smoke is associated with bladder cancer?

A

Aromatic amines, which are also found in dye and rubber industries (historically), are key carcinogens.

105
Q

Which infection is a risk factor for squamous cell carcinoma of the bladder in certain regions?

A

Schistosomiasis, particularly in areas with a high prevalence of the infection

106
Q

What occupational exposure is associated with bladder cancer?

A

Retired dye factory workers are at higher risk for transitional cell carcinoma of the bladder.

107
Q

What are the main types of bladder cancer?

A
  • Transitional cell carcinoma (90%)
  • Squamous cell carcinoma (5%) – more common in areas of schistosomiasis
  • Adenocarcinoma (2%)
  • Rare: Sarcoma and Small-cell carcinoma
108
Q

What is the hallmark symptom of bladder cancer?

A

Painless haematuria

109
Q

What are the NICE guidelines for referral in cases of unexplained haematuria?

A
  • Aged over 45 with visible haematuria (without a UTI or persisting after UTI treatment)
  • Aged over 60 with microscopic haematuria (positive on urine dipstick) plus:
    Dysuria
    Raised white blood cells on a full blood count
110
Q

When should non-urgent referrals be considered in patients over 60?

A

recurrent unexplained UTIs

111
Q

What are the stages of non-muscle-invasive bladder cancer?

A
  • Tis (carcinoma in situ): Cancer cells only affect the urothelium (flat).
  • Ta: Cancer only affects the urothelium, projecting into the bladder.
  • T1: Cancer invades the connective tissue beyond the urothelium but not the muscle.
112
Q

How is non-muscle-invasive bladder cancer treated?

A
  • Transurethral resection of bladder tumour (TURBT): Removal of the bladder tumour during cystoscopy.
  • Intravesical chemotherapy: Chemotherapy given directly into the bladder.
  • Intravesical Bacillus Calmette-Guérin (BCG): Immunotherapy to stimulate the immune system to attack the tumour.
113
Q

What are the options for urine diversion after radical cystectomy?

A
  • Urostomy with ileal conduit (most common)
  • Continent urinary diversion
  • Neobladder reconstruction
  • Ureterosigmoidostomy (rarely used now)
114
Q

Where do renal stones typically form?
What is the most common type of kidney stone?

What are other types of kidney stones?

A

Renal pelvis

Calcium-based stones (about 80% of cases). They can be:
- Calcium oxalate (more common)
- Calcium phosphate

Other types:
- Uric acid stones (radiolucent, not visible on x-ray)
- Struvite stones (associated with infection)
- Cystine stones (associated with cystinuria, an autosomal recessive disorder)

115
Q

How do renal stones present?

A
  • Renal colic: Unilateral, severe loin-to-groin pain that fluctuates in intensity.
  • Haematuria (blood in the urine)
  • Nausea/vomiting
  • Reduced urine output
  • Signs of infection if obstruction occurs, like fever or sepsis
116
Q

What is the initial investigation of choice for diagnosing kidney stones?

A

Non-contrast CT scan (CT KUB) is the preferred method for diagnosing kidney stones. It is recommended within 24 hours of presentation.

117
Q

What is the role of ultrasound in diagnosing kidney stones?

A

Ultrasound is a less preferred alternative to CT but is useful in pregnant women and children. A negative result does not exclude kidney stones.

118
Q

What is the first-line treatment for pain in kidney stones?

A

NSAIDs, such as IM diclofenac. IV paracetamol is an alternative if NSAIDs are not suitable. Opiates are less effective and not routinely used.

119
Q

How should small stones (less than 5mm) be managed?

A

Watchful waiting is recommended, as there is a 50-80% chance that stones will pass without intervention. Tamsulosin, an alpha-blocker, can aid in the passage of stones.

120
Q

What are key recommendations to prevent recurrent kidney stones?

A
  • Increase oral fluid intake (2.5 – 3 liters per day)
  • Add fresh lemon juice to water to reduce stone formation
  • Avoid carbonated drinks (cola drinks)
  • Limit dietary salt intake (less than 6g/day)
  • Maintain a normal calcium intake (too little calcium can increase risk)

For specific stones:
- Calcium oxalate stones: Reduce intake of oxalate-rich foods (e.g., spinach, beetroot, nuts)
- Uric acid stones: Reduce intake of purine-rich foods (e.g., liver, kidney, anchovies)
- Limit dietary protein

121
Q

Which medications can reduce the risk of recurrent calcium oxalate stones?

A
  • Potassium citrate (helps raise urine pH)
  • Thiazide diuretics (e.g., indapamide) for patients with raised urinary calcium
122
Q

What is the classic triad of symptoms for RCC?

A
  • Haematuria (blood in the urine)
  • Flank pain
  • Palpable renal mass
123
Q

What are the three most common subtypes of renal cell carcinoma?

A
  • Clear cell (around 80%)
  • Papillary (around 15%)
  • Chromophobe (around 5%)
124
Q

What is Wilms’ tumor?

A

A type of kidney cancer that affects children under 5 years old.

125
Q

What are some key risk factors for renal cell carcinoma?

A
  • Smoking
  • Obesity
  • Hypertension
  • End-stage renal failure
  • Von Hippel-Lindau Disease
  • Tuberous sclerosis
126
Q

How does renal cell carcinoma typically present?

A
  • Haematuria
  • Vague loin pain
  • Non-specific cancer symptoms (e.g., weight loss, fatigue, anorexia, night sweats)
  • Palpable renal mass
127
Q

According to NICE guidelines, when should a two-week wait referral be made for suspected RCC?

A

For patients over 45 years old with unexplained visible haematuria, either without a UTI or persisting after treatment for a UTI.

128
Q

How does renal cell carcinoma typically spread?

A

It often spreads locally within Gerota’s fascia and may extend to the renal vein and then the inferior vena cava.

129
Q

What are “cannonball metastases”?

A

Cannonball metastases are well-defined, circular opacities seen on CXR and are characteristic of metastatic renal cell carcinoma. They can also appear with choriocarcinoma, and less commonly with prostate, bladder, and endometrial cancers.

130
Q

What are the common paraneoplastic features of renal cell carcinoma?

A
  • Polycythaemia (due to erythropoietin secretion)
  • Hypercalcaemia (due to a hormone mimicking parathyroid hormone)
  • Hypertension (due to factors like increased renin secretion)
  • Stauffer’s syndrome (abnormal liver function tests without liver metastasis)
131
Q

What is the staging for RCC based on size and spread?

A

Stage 1: Tumor <7cm, confined to the kidney
Stage 2: Tumor >7cm, confined to the kidney
Stage 3: Local spread to nearby tissues or veins, but confined within Gerota’s fascia
Stage 4: Spread beyond Gerota’s fascia, including metastasis

132
Q

How are patient and donor kidneys matched in a renal transplant?

A

Matching is based on the human leukocyte antigen (HLA) type A, B, and C on chromosome 6. The closer the match, the less likely there is organ rejection and the better the transplant outcomes.

recipients can undergo desensitisation therapy before a transplant from a living donor to improve compatibility and reduce the likelihood of rejection.

133
Q

What medication is used to prevent transplant rejection?
What kind of medications do transplant recipients need to take long-term?

A

Basiliximab, a monoclonal antibody targeting the interleukin-2 receptor on T-cells, is given in two doses after surgery to prevent acute rejection.

Life-long immunosuppression is required to reduce the risk of transplant rejection, including medications such as:
- Tacrolimus
- Mycophenolate
- Ciclosporin
- Azathioprine
- Prednisolone

134
Q

What are common side effects of specific immunosuppressants after a renal transplant?

A
  • Seborrhoeic warts and skin cancers (due to immunosuppressants)
  • Tacrolimus: causes tremors
  • Ciclosporin: causes gum hypertrophy
  • Steroids: causes features of Cushing’s syndrome
135
Q

What are general complications associated with immunosuppressants after renal transplantation?

A
  • IHD
  • T2DM (due to steroids)
  • Increased risk of infections, including unusual pathogens
  • Non-Hodgkin lymphoma
  • Skin cancer, particularly squamous cell carcinoma
136
Q

What unusual infections can occur due to immunosuppressants?

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