urology Flashcards
what tumour markers are raised in seminomas
hCG ( 20%)
what tumour markers are raised in non-seminomas
AFP and/or beta-hVG in 80-85%
prevention of calcium renal stones
high fluid intake
add lemon juice to drinking water
avoid carbonated drinks
limit salt intake
potassium citrate may be beneficial NICE
thiazides diuretics (increase distal tubular calcium resorption)
prevention of oxalate stones
cholestyramine
pyridoxine
prevention of uric acid stones
allopurinol
urinary alkalinization e.g. oral bicarbonate
unilateral hydronephtosis causes
PACT>
Pelvic-ureteric obstruction (congenital or acquired)
Aberrant renal vessels
Calculi
Tumours of renal pelvis
bilateral hydronephrosis causes
SUPER >
Stenosis of the urethra
Urethral valve
Prostatic enlargement
Extensive bladder tumour
Retro-peritoneal fibrosis
acute tubular necrosis findings
bloods > Inc. urea, creatinine ans potassium
muddy brown casts in urine on urinalysis
renal stone management according to size
Renal stones
watchful waiting if < 5mm and asymptomatic. Can also watchful wait if >5mm and patient makes informed decision.
<10mm shockwave lithotripsy. Offer ureteroscopy if this fails, is contraindicasted or anatomical issues) . Consider percutaneous nephrolithotomy if both these fail.
10-20mm. Offer URS or SWL. consider PCLN if both fail.
> 20 mm (including staghorn stones ) percutaneous nephrolithotomy
what is given to combat ‘flare effect’ at beginning of hormonal therapy for prostate cancer
Flutamide (a synthetic antiandrigen)
investigation for Erectile dysfunction
As part of the assessment for erectile dysfunction NICE recommend that all men have their 10-year cardiovascular risk calculated by measuring lipid and fasting glucose serum levels.
Free testosterone should also be measured in the morning between 9 and 11am. If free testosterone is low or borderline, it should be repeated along with follicle-stimulating hormone, luteinizing hormone and prolactin levels. If any of these are abnormal refer to endocrinology for further assessment.
factors favouring organic cause of Erectile dysfunction
Factors favouring an organic cause Factors favouring a psychogenic causes
Gradual onset of symptoms
Lack of tumescence
Normal libido
management of ischaemic priapism
If the priapism has lasted longer than 4 hours, the first-line treatment is aspiration of blood from the cavernosa, this is often combined with injection of a saline flush to help clear viscous blood that has pooled.
If aspiration and injection fails, then intracavernosal injection of a vasoconstrictive agent such as phenylephrine is used and repeated at 5 minute intervals.
If medical therapy fails then surgical options can be considered.
at what size do you do a total nephrectomy instead of partial nephrectomy for RCC
7cm
when to refer people for 2 week bladder cancer pathway
Dysuria with unexplained non-visible haematuria, age 60 years and over
Haematuria (visible and unexplained) either without urinary tract infection or that persists or recurs after successful treatment of urinary tract infection, age 45 years and over
Haematuria (non-visible and unexplained) with dysuria or raised white cell count on a blood test, age 60 years and over
Urinary tract infection (unexplained and recurrent or persistent), age 60 years and over
White cell count raised on a blood test with unexplained non-visible haematuria, age 60 years and over
prostate cancer management according to stage
localised (T1/2)
- conservative (active monitoring)
- radical prostatectomy
- radiotherapy (external beam and brachytherapy)
Localised advanced (T3/4)
- hormonal therapy
- radical prostatectomy
- radiotherapy (external beam and brachytherapy)
Metastatic
- hormonal therapy (GnRH agonists ege Goserelin)
Management of ureteric stones according to size
<10mm. Offer SWL. Consider URS if:
- stone clearance not possible within 4 weeks with SWL or contraindicated or not targetable or previous SWL has failed
10-20mm
Offer SWL if stone clearance possible in 4 weels. Consider PCNL for impacted proximal stones when URS has failed.
