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Surgery > Urology > Flashcards

Urology Flashcards

1
Q

What are the presenting symptoms and signs of kidney stones?

A
  1. Sudden onset colicky flank pain, usually unilateral sometimes radiating to lateral abdomen, groin, testicle or labia
  2. Often assoc with nausea and vomiting
  3. Gross haematuria and decreased urinary output may occur
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2
Q

What are the most common types of kidney stones? (5)

A 
Calcium oxalate
Mixed calcium oxalate/phosphate
Calcium phosphate
Struvite 
Uric acid
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3
Q

How is renal colic investigated? (4)

A
  1. Blood: FBE, UEC, uric acid, calcium
  2. MSU MC&S Dipstick urinalysis
  3. CT KUB +/- X-ray KUB
  4. Consider IV pyelogram
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4
Q

What is the danger in only using an X-ray in investigating renal colic? (2)

A

Only calcium containing stones are visible on plain KUB X-ray

Calcification may not arise from a calculi by may be due to calcified mesenteric lymph nodes or from the wall of the abdominal aorta

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5
Q

What is involved in the conservative management of renal colic?

A

Majority of stones will pass spontaneously

NSAIDs

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6
Q

What are the indications for surgical removal of kidney stones? (6)

A
  1. Renal failure
  2. Stones + fever (pyelonephrosis)
  3. Stone greater than 6mm, unlikely to pass spontaneously
  4. Single kidney
  5. Unremitting pain
  6. Occupational/social - Patients where colic could be disaster (e.g. pilots)
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7
Q

List 6 complications of renal calculi

A
  1. Renal colic
  2. Pyelonephritis
  3. UTI
  4. Urinary retention and hydronephrosis
  5. Development of bladder stones
  6. Long-term irritation may predispose to squamous carcinoma
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8
Q

What surgical interventions are available for renal calculi?

A

Shock wave lithotripsy

Perutaneous nephrolithotripsy - for stones larger than 2 cm, staghorn calculi

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9
Q

What measures can be taken to reduce the likelihood of nephrolithiasis recurring? (5)

A

Dependent on composition of stone

  1. Increase fluid intake
  2. Avoid added salt, maintaining well balanced diet
  3. Calcium phosphate - thiazides, low Calcium diet (reduce milk and cheese consumption)
  4. Oxalate - reduce chocolate, tea, rhubarb, spinach
  5. Urate - allopurinol, urinary alkalinisation
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10
Q

What are the 3 most likely sites of renal calculi obstruction?

A
  1. Pelvicoureteric junction
  2. Vesicoureteric junction
  3. Ureter crossing into pelvic brim
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11
Q

What are the most common organisms that cause UTIs? (4)

A
  1. E.coli
  2. Proteus mirabilis
  3. Pseudomonas aeruginosa
  4. Strep faecalis
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12
Q

What are the clinical features of pyelonephritis?

A

Pyrexia, loin pain, dysuria, frequency

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13
Q

How is pyelonephritis investigated?

A

Dipstick and MSU MCS

FBE

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14
Q

How is mild pyelonephritis defined and treated?

A

Low-grade fever, no N & V

For empirical therapy while awaiting results of cultures and susceptibility - amox+clavul OR cephalexing OR trimethoprim

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15
Q

How is severe pyelonephritis treated?

A

Gentamicin IV + amox

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16
Q

What complication can occur with acute pyelonephritis? How will this be managed?

A

Pyonephrosis - occurs if coexisting upper tract obstruction

Requires urgent decompression usually by percutaneous nephrostomy; if inadequately treated, can result in perinephric abscess

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17
Q

Which cells do renal cell carcinomas arise from?

A

Proximal tubule cell

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18
Q

What are the clinical features of renal cell carcinoma? (4)

A
  1. 10% present with classical triad of haematuria, loin pain and a mass
  2. Others - pyrexia of unknown origin, hypertension
  3. Polycythaemia due to EPO production
  4. Hypercalcaemia due to production of PTH like hormone
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19
Q

How is renal cell carcinoma investigated? (2)

A
  1. Diagnosis often confirmed by renal US

2. CT scanning allows assessment of renal vein and caval spread

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20
Q

What can blood borne spread of renal cell carcinoma result in ?

A

Cannonball pulmonary metastases

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21
Q

What types of carcinomas can bladder carcinoma be?

A

90% are transitional cell carcinoma
5% are squamous carcinoma
2% are adenocarcinomas

22
Q

What are the aetiological factors that need to be considered in bladder carcinoma? (4)

A
  1. Occupational exposure - aniline dyes, chlorinated hydrocarbons
  2. Cigarette smoking
  3. Pelvic irradiation - for carcinoma of the cervix
  4. Chronic urothelial irritation secondary to UTIs or kidney stones increased risk for bladder SCC
23
Q

Superficial vs high-grade TCC - prevalence and prognosis

A

Superficial TCC = 80%, good prognosis

High-grade TCC = 20%, poor prognosis

24
Q

How does bladder carcinoma usually present?

A

Painless haematuria

25
Q

How is superficial TCC treated? (2)

A
  1. Requires transurethral resection and regular cystoscopic follow-up (3 months time)
  2. Consider immunotherapy - BCG
26
Q

How is bladder carcinoma investigated? (4)

A

1, Urine microscopy - at least 2 of 3 tests positive for microscopic haematuria

  1. Urine cytology
  2. Imaging - CT urography OR MRI
  3. Flexible cystoscopy (at which point, patient then put under GA and undergoes transurethral resection if positive superficial TCC lesion)
27
Q

How is invasive bladder TCC treated?

A

Radical cystectomy with urinary diversion achieved by ileal conduit or neo-bladder

OR radiotherapy

OR both

28
Q

What is a varicocoele and where do they commonly occur?

A

Dilatation of veins (pampiniform plexus) draining the testis

95% occur on the left side and are idiopathic. Occasionally assoc. with left renal tumours.

29
Q

What are the clinical features of a varicocoele? (5)

A
  1. Most are asymptomatic
  2. If they do cause symptoms, usually a vague or annoying discomfort
  3. ‘Bag of worms’
  4. Reduce in size in supine position
  5. Occ. assoc. with infertility
30
Q

How are varicocoeles managed? (2)

A
  1. only treated if symptomatic
  2. Veins can be ligated via either a scrotal or inguinal approach - recurrence can occur due to collateral supply via cremasteric vein
31
Q

Which cause of testicular swelling transilluminates?

A

Hydrocoele

32
Q

What four questions need to be asked with any scrotal swelling?

A
  1. Is it confined to the scrotum?
  2. Can the testis and epididymis be defined separately?
  3. Does the swelling transilluminate?
  4. Is the swelling tender?
33
Q

What is the most common malignancy in young men?

A

Testicular tumours

34
Q

What is the peak incidence for different testicular tumours?

A

Teratomas - 25 years

Seminomas - 35 years

35
Q

List 3 scrotal swellings that do not cause tenderness on palpation.

A

Testicular tumour
Epididymal cyst
Gumma

36
Q

List 3 scrotal swellings in which the testis and the epidydimis are easily definable on palpation.

A

Epididymo-orchitis
Testicular tumour
Epididymal cysts

37
Q

Of which cellular origin are prostate cancers?

A

Adenocarcinomas

38
Q

Which is the most common site of prostate cancer?

A

Posterior part of gland

70% arise in peripheral zone
20% originate in transition zone
10% are found in central zone

39
Q

What investigations are ordered in suspected prostate cancer? (3)

A

Blood test - PSA, UEC,FBE, LFT (alk phos may be high in malignant metastates to bone)

Urinalysis - to exclude renal or bladder pathology

Prostate biopsy via TRUS

40
Q

What scoring system is used to assess histology of prostatic adenocarcinoma?

A

Gleason score - looks at prevalence of different types of cellular architecture

41
Q

When is prostate cancer considered to be curable? (3)

A
  1. PSA less than 15
  2. Gleason 7 and under
  3. No evidence of nodal invasion, bone scan disease
42
Q

How is prostate cancer managed?

A

Surgically usually - reasonably high cure rates with radical prostatectomy in early organ-confined disease

43
Q

Which part of the prostate is affected in BPH?

A

Transition zone

44
Q

How is suspected BPH investigated? (3)

A
  1. Urine dipstick, MSU MCS
  2. Blood - FBE, UEC, LFT, PSA
  3. Post-void residual bladder volume OR voiding flow rate
45
Q

How is BPH treated?(4)

A
  1. Herbal remedies (saw palmetto, zinc)
  2. Alpha blockers e.g. prazosin and tamsulosin
  3. 5 alpha reductase inhibitors e.g. finasteride and dutasteride
  4. TURP
46
Q

What is the rationale behind using alpha blockers in BPH?

A

Tone in smooth muscle fibres of bladder neck and prostate are modulated by alpha 1 adrenergic receptors which are blocked by alpha blockers - decreases smooth muscle tone at bladder outlet and in prostate

47
Q

What is the rationale behind the use of 5 alpha reductase inhibitors in BPH?

A

Block the conversion of testosterone into DHT - decreases growth of prostate

48
Q

List 4 complications of TURP

A
  1. Bleeding
  2. Retrograde ejaculation
  3. Erectile dysfunction
  4. Long-term incontinence
49
Q

What is the gold standard treatment in prostate cancer with metastatic disease?

A

Androgen ablation - orchiectomy in particular.

Can use things like exogenous estrogens and LHRH and its analogues as well

50
Q

When is external beam radiation therapy used in prostate cancer?

A

It is the preferred local treatment for men with significant medical comorbidity and a life expectancy (less than 5-10 years)

Surgery (6 decks)

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