Urology Flashcards
What are the three sites of anatomical ureteric narrowing?
- Ureteropelvic junction
- Ureteral crossing of iliac veins
- Ureterovesicular junction
What are the indications for outpatient treatment of ureteric stones?
First episode
Pain free (or managed with oral NSAIDs)
No evidence of infection
Stone <4mm diameter (90% spontaneously pass)
What is the first-line treatment for the removal or ureteric stones?
Ureteroscopy and laser lithotripsy
What are the differentials for frank haematuria?
Transitional cell carcinoma (bladder or ureters)
Renal cell carcinoma
Trauma (catheter, procedure)
Prostatitis
What are the symptoms of urinary obstruction?
Hesitancy Poor stream & intermittent flow Terminal dribbling Incomplete emptying Overflow incontinence (if severe)
What are the irritative or filling urinary symptoms?
Increased frequency (including nocturia)
Urgency
Painful urination
Which zone of the prostate is affected by prostate cancer?
Peripheral
Which zone of the prostate is affected by BPH?
Transitional
What pharmacological management is available for the treatment of BPH?
Andrenoreceptor blockers (e.g. prazocin) 5-alpha reductase inhibitors (e.g. finasteride)
What pharmacological management is available for the treatment of prostate cancer?
Androgen deprivation therapy (chemical castration)
= LHRH agonist (goserelin), covered with anti-androgen for first 7 days during the flare
How does TCC typically present?
Painless haematuria or recurrent UTIs
What are the components of the spermatic cord?
3 arteries: cremasteric, deferential, testicular
3 nerves: genital branch of genitofemoral, autonomic + visceral afferent fibres
3 fascial layers: external + external spermatic, cremasteric
3 others: pampiniform plexus (venous), vas deferens (sperm), lymphatics
What is the lymph drainage of the testes?
Para-aortic lymph nodes
What are the testicular germ cell tumours
Seminomas (40%)
Non-seminomas/teratomas (10%)
Mixed (40%)
Which testicular tumours can secrete beta-HCG and alpha-fetoprotein?
Non-seminoma germ cell tumours (teratomas)
What are the non-germ cell tumours?
Leydig cell tumour
Sertoli cell tumour
Lymphoma
Which is the more common testicular malignancy: germ cell or non-germ cell tumour?
Germ cell tumour
What is the biggest risk factor for testicular torsion?
Bell-clapper deformity (congenital inadequate testis fixation)
What type of incontinence is tension-free vaginal tape used to treat?
Stress incontinence
What type of incontinence can be treated with antimuscarinics?
Urge and mixed incontinence
Positive alpha-fetoprotein makes which testicular tumour type much less likely?
Seminoma
Are varicocele’s more common in the left or right testicle?
Left (drains to renal vein at a right angle)
What may be the cause of a scrotal lump that becomes more prominent on standing?
This is the classical presentation of a varicocoele
What is the most appropriate treatment for a renal cell carcinoma that does not show any signs of spread?
Nephrectomy
What is the investigation of choice for gross haematuria?
Abdomen + pelvis CT
Why is a pelvic CT indicated before catheterising a patient with a pelvic fracture?
To identify any urethral damage that may have resulted from the fracture
What are the types of urinary incontinence?
Storage Problems: - Urge / Overactive Detrusor - Stress Emptying Problems (overflow): - Obstruction - Underactive Detrusor Functional Problems: - Impaired Mobility - Mental Disorder
What are the potential complications of recurrent UTIs?
Renal scarring and failure (from pyelonephritis)
Staghorn calculi
Perinephric abscess
Prostatitis (males)
What is the definition of recurrent UTIs?
3+ episodes of culture-confirmed UTI in past 12 months OR
2+ episodes of culture-confirmed UTI in past 6 months
Which urological tumour is found in a greater frequency amongst workers in aniline dye industries?
Urothelial tumours
