Urology Flashcards
List 4 causes of acute urinary retention
Men: most commonly BPH
UTI
Constipation
Medications (anticholinergics, opiates, antidepressants)
In acute urinary retention, other than abdo exam, name the other examination which should be performed and why?
peripheral nervous system (assess lower limbs for cauda equina compression)
list two important things to undertake with regards to post-catheterisation care
document residual volume
take specimen for CSU
retract foreskin over glans penis
list 3 investigations to perform in acute urinary retention
U&E and creatinine for AKI
renal USS (if U&E elevated)
FBC, CRP, MSU for infection
(note: PSA will be elevated in urinary retention anyway)
List 4 treatments for hyperkalaemia
Calcium gluconate
Insulin and dextrose
Salbutamol nebulisers
Calcium resonium
painful retention + 700ml from urinary catheter. Acute or chronic retention?
acute
chronic will hold higher volumes e.g. 1.5L and be PAINLESS
condition at risk of after urinary retention and precautions
post-obstructive diuresis
hourly urine output monitoring with replacement of losses with IV fluids
name 2 medications that a pt with acute urinary retention may have been started on after treatment, and how they exert their effects
tamsulosin (alpha-1 receptor adrenergic antagonist) - relaxes prostatic smooth muscle
finasteride (anti-androgen 5-alpha-reducatase inhibitor) - inhibits conversion of testosterone to dihydrotestosterone (more potent androgen in prostatic tissue)
List 4 causes of macroscopic haematuria
IgA nephropathy
renal tract tumour
renal tract stone
renal tract trauma
schistosomiasis
nephritic syndrome
2 investigations to establish cause of haematuria
renal tract USS
KUB-x ray
flexible cystoscopy
urinary cytology
list 3 factors a/w bladder tumours
smoking
aromatic amines (paint and dye workers)
chronic cystitis
shistosomiasis
most likely malignant cell in bladder cancer
transitional cell carcinoma
bladder cancer T1 TCC - 2 treatments indicated?
TURBT
intravesicle agents (BCG)
list 3 places a bladder tumour may metastasise
liver, lungs, bone
pelvic structures: uterus, rectum
lymph nodes e.g. iliac
list 4 non-malignant causes of raised PSA
UTI
BPH
prostatitis
prostate biopsy
DRE
urinary retention
catheterisation
explain the following terms: sensitivity, PPV
sensitivity: number of people who are positive who test positive (pick up rate)
true positives/(true positives + false negatives)
PPV: number of positive tests which are positive people
true positives/(true positives + false positives)
what effect would a low positive predictive value have on patients
more patients would have to undergo unnecessary secondary investigations for a disease they don’t have
list 4 criteria for a screening programme to be deemed suitable for a population
- known disease course
- acceptable screening test
- early symptoms should be present
- treatment available
- cost effective
- prompt treatment has more benefit than delayed
why is antibiotic cover important for a prostate biopsy
transrectal biopsy risk of bowel flora
score used to evaluate prognosis in prostate cancer
Gleason score
The two most common tumour patterns across all samples are graded based on their
differentiation
The sum of the two grades is the Gleason score
explain the term active surveillance
keeping check on PSA levels to see if disease has progressed
list 2 treatments for more aggressive prostate cancer
radial prostatectomy
chemo/radio
Other than testicular torsion, list 4 other causes of testicular pain
hydrocele
varicocele
testicular cancer
epidiymal cyst
epididymo-orchitis
What are the clinical features of tescticular torsion
sudden-onset (usually unilateral) testicular pain
swollen and hot testis
high-lying transverse testis
What investigation is most likely is testicular torsion is a possibility
urgent surgical exploration
scrotal ischaemia and necrosis is a time-dependent process
Name 3 layers of the testis
Skin
Cremaster muscle
Tunica vaginalis
why does a left orchidectomy and right orchidopexy take place at the same time?
to ensure that the right testis is protected from a later episode of torsion
list 2 long-term sequelae of orchidectomy for testicular torsion
psychological problems a/w operation
emasculation
reduction in fertility
cosmetic deformity
what characteristics of a mass would make you think it was renal in origin?
moves up and down with respiration
palpable on bimanual palpation
able to get above the mass
Malignant renal mass
Likely histology in
a) 55 year old
b) 4 year old
a) RCC
b) Wilm’s tumour (nephroblastoma)
painless testicular mass feels like a bag of worms when he stands up - likely diagnosis
varicocele
Abnormally high Hb in RCC
some renal tumours are a/w increased erythropoeitin release
List 4 risk factors for RCC
smoking
increasing age
male
obesity
long-term dialysis
what factors would affect a patient’s suitability for major surgery in malignancy
stage of tumour
comorbidities: IHD, COPD, obesity
2 a) advantages and b) disadvantages of laparoscopic surgery over open surgery
a) reduced post-op pain, reduced hospital stay, smaller incisions, reduced bleeding
b) increased length of op, poorer operative views
bedside test useful in renal colic
urinalysis
imaging test in renal colic
KUB-CT
why is pain referred to the groin in renal calculi
visceral nerve supply to the ureter and kidneys follows a similar course to somatic nerve supply to the gonads and flank so it is referred to these regions
where are 3 places the ureter is narrowed and more prone to obstruction with a stone?
pelvi-ureteric junction (renal pelvis to ureter)
crossing the pelvic brim
vesico-ureteric junction (ureter enters bladder)
source of fever in renal colic
pyelonephritis
renal calculi + fever
ABC, fluids, ABx - what now?
percutaneous nephrostomy to relieve infected obstruction of urine
name 1 lifestyle measure for the prevention of renal stones forming
increase water intake to keep hydrated
maintain calcium intake to 1-1.2g
reduce oxalate-rich foods
how to distinguish cause of testicular swelling
transillumination with a torch
if light is transmitted it suggests fluid e.g. hydrocele
radiological investigation in testicular swelling
ultrasound testis/scrotum
anatomical basis of hydrocele
arises in the tunica vaginalis, derived from the processus vaginalis
list secondary causes of hydrocele
trauma, infection, tumour
what is a ‘triple diagnossis’
physical
psychological
social
excision and plication of hydrocele - why is it plicated?
to prevent the fluid reaccumulating
hydrocele in infancy is indicative of what anatomical anomoly?
a patent processus vaginalis
management of hydrocele is pt < 1 year old and why
conservative as most resolve spontaneously by 1
name 2 general risks of an operation found on a consent form
infection
bleeding
failure of procedure
VTE
what two specific functions may a pt lose in a TURP
urinary continence
ability to gain an erection
2 risks specific to TURP
clot retention
bladder neck stenosis
bladder wall injury
retrograde ejaculation
TURP syndrome
2 advantages of spinal anaesthetic compared to general
less chance of respiratory complications
quicker time to discharge
costs less
decreased bleeding
how does TURP syndrome arise?
irrigation fluid from operation enters intravascular space, causing fluid overload and hyponatraemia
Explain: a) stress incontinence b) urge incontinence
stress = raised intra-abdominal pressure as pelvic floor and fascia fail to support urethra
urge = involuntary urine leak preceded by a sudden urge to micturate (overactive nerves)
2 things that predispose to stress incontinence
previous childbirth
surgery to pelvic floor
chronic cough
obesity
List 4 lifestyle methods that may help stress incontinence
pelvic floor exercises
weight loss
smoking cessation
avoid caffeine/alcohol
avoid drinks at bed time
How does oxybutynin exert its effect? List 3 side effects
anti-cholinergic
dry eyes, mouth, constipation, drowsiness
Name 2 causes of recurrent UTI in men
bladder outflow obstruction (prostatic enlargement, urethral stricture)
neuropathic bladder
urinary tract surgery
immunosuppression
name 3 common organisms found in UTI
e.coli
klebsiella
enterococcus
2 causes of a urethral stricture
pelvic trauma
perineal trauma
insertion of foreign bodies
gonorrhoea or chlamydia
3 investigations for urethral stricture
cystoscopy
urinalysis (MC&S and cytology)
renal function (U&E)
2 complications of urethral stricture
calculus formation in urinary tract
chronic infection (can spread to prostatitis)
epididymitis or Fournier’s gangrene
renal impairment due to obstruction
stricture in the anterior urethra and large out-pouting of bladder mucosa - what is this?
bladder diverticulum
name a treatment for urethral stricture
internal urethrotomy
Name 2:
a) voiding LUTS
b) storage LUTS
Voiding: hesitancy / weak or intermittent urinary stream / splitting / spraying / straining
/ incomplete emptying / terminal dribbling
Storage: urgency / frequency / nocturia / urinary incontinence / feeling the need to
urinate again immediately after
Which validated screening tool is used to evaluate LUTS and give a symptom
score?
International Prostate Symptom Score
Which zone of the prostate is primarily affected in prostate cancer?
Peripheral zone
Imaging used 1st line for suspected prostate cancer
Multiparametric MRI
Most common composition of a renal tract stone
Calcium oxalate
Preferred management option of large staghorn calculi which fills the renal pelvis?
Percutaneous nephrolithotomy
Pyelonephritis triad
Flank pain
Fever
Nausea and vomiting
