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)
2
Q
What imaging is useful for diagnosing obstructive uropathy?
A
Ultrasound of the kidneys, ureters, and bladder
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
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
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
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.
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.
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
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
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.
11
Q
What tool is used to assess LUTS severity in BPH?
A
International Prostate Symptom Score (IPSS).
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.
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
14
Q
What distinguishes a benign prostate on DRE?
A
Smooth, symmetrical, slightly soft, with a central sulcus.
15
Q
What distinguishes a cancerous prostate on DRE?
A
Firm or hard, asymmetrical, craggy, irregular, with a loss of the central sulcus.
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.
17
Q
How long does it take for 5-alpha reductase inhibitors to improve symptoms?
A
6 months
18
Q
What are common side effects of tamsulosin and finasteride?
A
Tamsulosin: Postural hypotension.
Finasteride: Sexual dysfunction due to reduced testosterone.
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.
20
Q
What are the major complications of TURP?
A
- Bleeding
- Infection
- Urinary incontinence
- Erectile dysfunction
- Retrograde ejaculation
- Urethral strictures
- Failure to resolve symptoms
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).
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
23
Q
What tool is used to assess and track chronic prostatitis symptoms?
A
National Institute of Health Chronic Prostatitis Symptom Index.
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
25
How is acute bacterial prostatitis managed?
- 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.
26
How is chronic prostatitis managed?
- 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.
27
What are the complications of acute bacterial prostatitis?
- Sepsis.
- Prostate abscess: May present as a fluctuant mass and require surgical drainage.
- Acute urinary retention.
- Chronic prostatitis.
28
Where does advanced prostate cancer commonly spread?
Lymph nodes and bones
29
What type of cancer is most prostate cancer?
Adenocarcinoma, typically growing in the peripheral zone of the prostate.
30
What are the key risk factors for prostate cancer?
- Increasing age.
- Family history.
- Black African or Caribbean origin.
- Tall stature.
- Anabolic steroid use.
31
Why is PSA testing controversial?
- High false-positive rate (75%) and false-negative rate (15%).
- Risks of unnecessary biopsies and overdiagnosis.
- May lead to false reassurance.
32
What is the first-line investigation for suspected localised prostate cancer?
Multiparametric MRI.
33
What is the Likert scale for MRI results?
1 – Very low suspicion.
2 – Low suspicion.
3 – Equivocal.
4 – Probable cancer.
5 – Definite cancer.
34
When is a prostate biopsy performed?
Based on MRI findings (Likert 3 or above) and clinical suspicion (PSA and DRE findings).
35
What are the two types of prostate biopsy?
Transrectal ultrasound-guided biopsy (TRUS): Biopsies taken through the rectum.
Transperineal biopsy: Biopsies taken through the perineum under local anaesthetic.
36
What is the Gleason grading system?
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.
37
What are the treatment options for prostate cancer?
- Surveillance or watchful waiting (early cancer).
- External beam radiotherapy.
- Brachytherapy.
- Hormone therapy.
- Surgery (radical prostatectomy).
38
What are the complications of external beam radiotherapy?
Proctitis (pain, altered bowel habits, bleeding, discharge).
39
What are the complications of brachytherapy?
- Cystitis or proctitis.
- Erectile dysfunction.
- Incontinence.
- Increased bladder or rectal cancer risk.
40
What are the side effects of hormone therapy?
Hot flushes, sexual dysfunction, gynaecomastia, fatigue, osteoporosis.
41
What are the complications of radical prostatectomy?
Erectile dysfunction and urinary incontinence.
42
What is the function of the epididymis?
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.
43
What are common infectious causes of epididymo-orchitis?
Bacterial:
- Escherichia coli (E. coli)
- Chlamydia trachomatis
- Neisseria gonorrhoea
Viral: Mumps
44
What are the typical symptoms of epididymo-orchitis?
- 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.
45
What is the key differential diagnosis for epididymo-orchitis?
Testicular torsion
46
What investigations help establish the cause of epididymo-orchitis?
- 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.
47
What antibiotics are recommended for enteric causes of epididymo-orchitis?
- Ofloxacin for 14 days.
- Levofloxacin for 10 days.
- Co-amoxiclav for 10 days (if quinolones are contraindicated)
48
What empirical antibiotics are used for suspected STIs?
- Intramuscular ceftriaxone (single dose).
- Doxycycline.
- Ofloxacin (based on sensitivities).
49
What are the potential complications of epididymo-orchitis?
- Chronic pain.
- Chronic epididymitis.
- Testicular atrophy.
- Sub-fertility or infertility.
- Scrotal abscess.
50
What are two critical side effects of quinolones?
- Tendon damage or rupture, especially the Achilles tendon.
- Lower seizure threshold (caution in epilepsy).
51
What are the examination findings in testicular torsion?
- 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).
52
What is the bell-clapper deformity?
A congenital absence of fixation between the testicle and the tunica vaginalis, allowing the testicle to hang horizontally and rotate freely.
53
What is the initial management for testicular torsion?
- Nil by mouth (in preparation for surgery).
- Analgesia.
- Urgent senior urology assessment.
54
What surgical procedures are performed in testicular torsion?
Orchiopexy: Corrects the testicle's position and fixes it in place.
Orchidectomy: Removes the testicle if necrosis has occurred.
55
What role does scrotal ultrasound play in diagnosis?
It can confirm the diagnosis by showing the **whirlpool sign**, but it should not delay urgent surgery.
56
What are the key causes of scrotal or testicular lumps?
- Hydrocele
- Varicocele
- Epididymal cyst
- Testicular cancer
- Epididymo-orchitis
- Inguinal hernia
- Testicular torsion
57
What are the key examination findings in hydrocele?
- 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
What conditions can secondary hydrocele indicate?
Testicular cancer, testicular torsion, epididymo-orchitis, or trauma.
59
How is hydrocele managed?
- Exclude serious causes.
- Idiopathic cases may be managed conservatively.
- Surgery, aspiration, or sclerotherapy for symptomatic cases.
60
What is a varicocele?
Swollen veins in the pampiniform plexus of the spermatic cord.
61
Why do most varicoceles occur on the left side?
The left testicular vein drains into the left renal vein, which has higher resistance.
62
What are the examination findings in varicocele?
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
What raises suspicion of retroperitoneal tumours in varicocele?
Varicoceles that do not disappear when lying down.
64
What investigations are used for varicocele?
- Ultrasound with Doppler imaging.
- Semen analysis (for fertility concerns).
- Hormonal tests (FSH, testosterone).
65
How is varicocele managed?
- Conservative for uncomplicated cases.
- Surgery or endovascular embolisation for pain, atrophy, or infertility
66
What is an epididymal cyst?
A fluid-filled sac at the head of the epididymis.
67
What is a spermatocele?
An epididymal cyst containing sperm.
68
What are the typical examination findings in an epididymal cyst?
- Soft, round lump at the top of the testicle.
- Associated with the epididymis and separate from the testicle.
- May transilluminate if large.
69
Are epididymal cysts harmful?
Usually harmless, not associated with infertility or cancer.
70
When might epididymal cysts require treatment?
Pain, discomfort, or exceptionally rare torsion of the cyst.
71
What are the two main types of testicular cancer?
Seminomas (better prognosis)
Non-seminomas (mostly teratomas)
72
What age group is most affected by testicular cancer?
Younger men, with the highest incidence between 15 and 35 years.
73
What are the risk factors for testicular cancer?
- Undescended testes
- Male infertility
- Family history
- Increased height
74
What is the typical presentation of testicular cancer?
A painless lump on the testicle.
75
What are the features of a lump in testicular cancer?
- Non-tender or reduced sensation
- Arises from the testicle
- Hard, irregular
- Not fluctuant
- Does not transilluminate
76
What rare symptom may occur in testicular cancer?
Gynaecomastia, particularly with Leydig cell tumours.
77
What is the initial investigation for testicular cancer?
Scrotal ultrasound.
78
What tumour markers are associated with testicular cancer?
**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
What are the stages of testicular cancer?
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
Where does testicular cancer commonly metastasise?
Lymphatics
Lungs
Liver
Brain
81
What treatments are used for testicular cancer?
- Surgery: Radical orchidectomy (testicle removal), prosthesis optional.
- Chemotherapy
- Radiotherapy
- Sperm banking: Preserving sperm before treatment to prevent infertility.
82
What is the prognosis for early testicular cancer?
Greater than 90% cure rate.
83
What symptoms suggest pyelonephritis rather than a lower UTI?
- Fever
- Loin/back pain
- Nausea or vomiting
- Renal angle tenderness
84
What does a positive nitrite test on a urine dipstick indicate?
Presence of gram-negative bacteria (e.g., E. coli) converting nitrates to nitrites.
85
What is the most common cause of UTIs?
Name other common causes of UTIs.
Escherichia coli (E. coli) – gram-negative anaerobic rod.
- Klebsiella pneumoniae
- Enterococcus
- Pseudomonas aeruginosa
- Staphylococcus saprophyticus
- Candida albicans (fungal)
86
What antibiotics are commonly used for uncomplicated UTIs?
What are alternative antibiotics for UTIs?
Trimethoprim (resistance is common)
Nitrofurantoin (avoid if eGFR <45)
Pivmecillinam, Amoxicillin, Cefalexin
87
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)?
Women: 3 days
Men: 7 days
Special cases: 7 days
Immunosuppressed women, abnormal anatomy, impaired kidney function: 5-10 days
88
Why are UTIs in pregnancy concerning?
They increase the risk of:
- Pyelonephritis
- Premature rupture of membranes
- Preterm labour
89
What antibiotics are safe during pregnancy?
- Nitrofurantoin (avoid in the third trimester, may cause neonatal haemolysis)
- Amoxicillin (only after sensitivities are known)
- Cefalexin
90
Why is trimethoprim avoided in the first trimester?
It is a folate antagonist, increasing the risk of congenital malformations like neural tube defects.
91
When is an MSU sample needed for microscopy, culture, and sensitivity testing?
- Pregnant patients
- Recurrent UTIs
- Atypical symptoms
- Symptoms not improving with antibiotics
92
What are the risk factors for pyelonephritis?
Female sex
Structural urological abnormalities
Vesico-ureteric reflux (VUR)
Diabetes
93
What is the most common causative organism for pyelonephritis?
Escherichia coli (E. coli) – a gram-negative, anaerobic, rod-shaped bacterium
94
What is the classic triad of symptoms in pyelonephritis?
- Fever
- Loin or back pain
- Nausea/vomiting
95
What are the first-line antibiotics for community management of pyelonephritis according to NICE (2018)?
- Cefalexin
- Co-amoxiclav (if culture results are available)
- Trimethoprim (if culture results are available)
- Ciprofloxacin
96
What complications (of pyelonephritis) should be considered in patients with severe symptoms or poor response to treatment?
Renal abscess
Kidney stone obstructing the ureter
97
What imaging is used to assess renal damage in chronic pyelonephritis?
Dimercaptosuccinic acid **(DMSA)** scans, which use radiolabeled DMSA to highlight healthy kidney tissue and detect scarring.
98
What are the typical symptoms of interstitial cystitis?
- 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
What findings may be seen during cystoscopy in interstitial cystitis?
- **Hunner lesions**: Red, inflamed patches with small blood vessels (found in 5-20% of patients).
- **Granulations**: Tiny haemorrhages on the bladder wall
100
How is interstitial cystitis initially managed?
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
What oral medications may help manage interstitial cystitis symptoms?
What intravesical medications may be helpful in interstitial cystitis?
- 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
What is hydrodistention, and how does it help with interstitial cystitis?
Hydrodistention involves filling the bladder with water to high pressure during a cystoscopy, often leading to temporary (3-6 months) symptom improvement.
103
What surgical options may be considered for severe interstitial cystitis?
- 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
Which carcinogen found in cigarette smoke is associated with bladder cancer?
Aromatic amines, which are also found in dye and rubber industries (historically), are key carcinogens.
105
Which infection is a risk factor for squamous cell carcinoma of the bladder in certain regions?
Schistosomiasis, particularly in areas with a high prevalence of the infection
106
What occupational exposure is associated with bladder cancer?
Retired dye factory workers are at higher risk for transitional cell carcinoma of the bladder.
107
What are the main types of bladder cancer?
- Transitional cell carcinoma (90%)
- Squamous cell carcinoma (5%) – more common in areas of schistosomiasis
- Adenocarcinoma (2%)
- Rare: Sarcoma and Small-cell carcinoma
108
What is the hallmark symptom of bladder cancer?
Painless haematuria
109
What are the NICE guidelines for referral in cases of unexplained haematuria?
- 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
When should non-urgent referrals be considered in patients over 60?
recurrent unexplained UTIs
111
What are the stages of non-muscle-invasive bladder cancer?
- 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
How is non-muscle-invasive bladder cancer treated?
- 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
What are the options for urine diversion after radical cystectomy?
- Urostomy with ileal conduit (most common)
- Continent urinary diversion
- Neobladder reconstruction
- Ureterosigmoidostomy (rarely used now)
114
Where do renal stones typically form?
What is the most common type of kidney stone?
What are other types of kidney stones?
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
How do renal stones present?
- 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
What is the initial investigation of choice for diagnosing kidney stones?
Non-contrast CT scan (CT KUB) is the preferred method for diagnosing kidney stones. It is recommended within 24 hours of presentation.
117
What is the role of ultrasound in diagnosing kidney stones?
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
What is the first-line treatment for pain in kidney stones?
NSAIDs, such as IM diclofenac. IV paracetamol is an alternative if NSAIDs are not suitable. Opiates are less effective and not routinely used.
119
How should small stones (less than 5mm) be managed?
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
What are key recommendations to prevent recurrent kidney stones?
- 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
Which medications can reduce the risk of recurrent calcium oxalate stones?
- Potassium citrate (helps raise urine pH)
- Thiazide diuretics (e.g., indapamide) for patients with raised urinary calcium
122
What is the classic triad of symptoms for RCC?
- Haematuria (blood in the urine)
- Flank pain
- Palpable renal mass
123
What are the three most common subtypes of renal cell carcinoma?
- Clear cell (around 80%)
- Papillary (around 15%)
- Chromophobe (around 5%)
124
What is Wilms' tumor?
A type of kidney cancer that affects children under 5 years old.
125
What are some key risk factors for renal cell carcinoma?
- Smoking
- Obesity
- Hypertension
- End-stage renal failure
- Von Hippel-Lindau Disease
- Tuberous sclerosis
126
How does renal cell carcinoma typically present?
- Haematuria
- Vague loin pain
- Non-specific cancer symptoms (e.g., weight loss, fatigue, anorexia, night sweats)
- Palpable renal mass
127
According to NICE guidelines, when should a two-week wait referral be made for suspected RCC?
For patients over 45 years old with unexplained visible haematuria, either without a UTI or persisting after treatment for a UTI.
128
How does renal cell carcinoma typically spread?
It often spreads locally within Gerota’s fascia and may extend to the renal vein and then the inferior vena cava.
129
What are “cannonball metastases”?
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
What are the common paraneoplastic features of renal cell carcinoma?
- 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
What is the staging for RCC based on size and spread?
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
How are patient and donor kidneys matched in a renal transplant?
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
What medication is used to prevent transplant rejection?
What kind of medications do transplant recipients need to take long-term?
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
What are common side effects of specific immunosuppressants after a renal transplant?
- Seborrhoeic warts and skin cancers (due to immunosuppressants)
- Tacrolimus: causes tremors
- Ciclosporin: causes gum hypertrophy
- Steroids: causes features of Cushing’s syndrome
135
What are general complications associated with immunosuppressants after renal transplantation?
- IHD
- T2DM (due to steroids)
- Increased risk of infections, including unusual pathogens
- Non-Hodgkin lymphoma
- Skin cancer, particularly squamous cell carcinoma
136
What unusual infections can occur due to immunosuppressants?
- Pneumocystis jiroveci pneumonia (PCP/PJP)
- Cytomegalovirus (CMV)
- Tuberculosis (TB)
