Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Surgery > Urology > Flashcards

Urology Flashcards

1
Q

Definition of benign prostatic hyperplasia

A

Nonmalignant proliferation of the epithelial and stromal cells of the prostate gland. It is a gradually progressive histologic change primarily in the transitional zone of the prostate, which leads to enlargement of the prostate especially in older men and causes lower urinary tract symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Risk factors for developing BPH

A 
Advanced age
Obesity
Reduced physical activity
Diabetes
Fatty diet
Diet high in beef
Systemic HTN

Protective factors:
Alcohol, liver cirrhosis (high oestrogen relative to androgen)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Clinical features of BPH

A 
gradual onset and progression
Lower urinary tract symptoms
- inc frequency
- nocturia
- hesitancy
- urgency
- weak urinary stream
- incomplete voiding
- incontinence
- +/- haematuria
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Complications of BPH

A

Acute urinary retention
Recurrent UTIs
Hydronephrosis
Renal failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

BPH on DRE

A

firm, symmetrical enlargement
Non-tender
Normal sphincter tone
No saddle anaesthesia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Grading of BPH

A 
IPSS (international prostate symptom score)
Score of 0-5 for the following topics:
- incomplete emptying
- frequency
- intermittency
- urgency
- weak stream
- straining

0-7 without bother: non-pharmacological
0-7 + bothered about symptoms: nonpharmacological therapies + alpha blocker
9-35: nonpharmacological + alpha blocker and/or 5a-reductase inhibitor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Non-pharmacological management of BPH

A 
Watchful waiting
Life-style modification
- reduce fluid intake
- bladder training exercises
- double voiding
- reduced caffeine and alcohol intake
- monitoring of symptoms for progression
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Pharmacological therapies for BPH

A

Alpha-blockers (e.g. prazosin)
- onset of action 1 week
- red. smooth muscle tone, red. prostatic and bladder neck contraction - reduced symptoms
5a-reductase inhibitors
- e.g. finasteride/dutasteride
- onset of action 3-6m
- reduced conversion of testosterone to DHT - reduced stimulation of prostate tissue - reduced progression of hypertrophy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Side effects of alpha blockers used in BPH e.g. prazosin

A

Orthostatic hypotension
1st dose syncope
Nasal congestion
tachycardia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Side effects of 5a-reductase inhibitors (e.g. finasteride used in BPH)

A

Reduced libido
Erectile dysfunction
Breast tenderness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Surgical therapies for BPH

A 
Minimally invasive:
- TUNA (transurethral needle ablation)
- TUMT (transurethral microwave therapy)
Standard surgical therapies:
- TURP (transurethral resection of the prostate)
- laser prostatectomy
- open prostatectomy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Indications for TURP

A
  • Symptoms of BPH unresponsive to medical therapy
  • Persistent haematuria (other causes excluded)
  • Renal failure
  • Bladder stones
  • recurrent UTI
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

When to refer man with BPH to urologist

A

No improvement within 6 weeks of treatment with best pharmacological regime

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Risk factors for prostate cancer

A

Africa background
high dietary fat
Family history: one 1st degree - 2x risk, two 1st degree - 5x risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Most common types and sites of prostate cancer

A 
Adenocarcinoma (over 95%)
Urothelial carcinoma (4.5% associated with TCC of bladder, not hormone-responsive)

70% arise from peripheral zone (classically posterior)
20% arise in transition zone
10% arise in central zone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Clinical features of prostate cancer

A 
Obstructive voiding symptoms (reflects locally advanced disease into bladder neck or urethra)
- hesitancy
- intermittent urinary stream
- reduced force of stream
Locally advanced tumours:
- haematuria
- haematospermia
- painful ejaculation
Spread to regional LN:
- LL oedema
- discomfort in pelvic/perineal areas
Bony mets:
- severe unremitting pain
- pathological fractures
- spinal cord compression
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Diagnosis of Prostate cancer

A

Made by DRE, PSA and TRUS biopsy

PSA not useful for diagnosis, used to monitor treatment and relapse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Histology of prostate adenocarcinoma

A

Smaller glands lined by single uniform layer of cuboidal or low columnar epithelium
More crowded glands than normal
Lack branching and papillary infolding
Absent basal cell layer typical of benign glands!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Procedure of transrectal ultrasound guided biopsy

A 
Local anaesthetic (lignocaine)
lie in lateral position
US probe inserted into rectum
Take 10-12 core specimens (target peripheral zone, try to avoid transitional zone {BPH} at least on first biopsy)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Complications/risks of transrectal US guided biopsy

A

Bleeding (rarely serious)
Infection - give prophylactic antibiotics in periprocedural time
Missed diagnosis (may require 2nd or 3rd biopsies)

21
Q

Grading and staging of prostate cancer

A

Staging by TNM score
Grading by Gleason’s score:
- score our of 10
- addition of the 2 most predominant patterns

1 - 5 from well differentiated to poorly differentiated (higher score = worse prognosis)

22
Q

management of prostate cancer

A

Watchful waiting:

  • if PCa is slow growing and unlikely to cause problems
  • treat with palliative intent when symptoms arise

Active surveillance:

  • younger men who are candidates for definitive treatment
  • delay curative treatment until evidence of progression
  • Frequent PSA review and biopsy

Radical prostatectomy

Radiotherapy (localised cancer with curative intent - local ductal seeds, external beam)

Hormonal therapy: non-curative intent for metastatic disease
- 3-monthly injection of GnRH agonist

23
Q

Complications of prostatectomy

A

Similar in robotic v laparoscopic v open

  • erectile dysfunction 40% (may be able to manage with viagra, penile injections or vacuum pumps)
  • dry orgasm
  • incontinence
24
Q

Complications of hormonal therapy for prostate cancer

A

GnRH agonist

  • flushes
  • reduced libido
  • DM
  • reduced body fat
  • osteoporosis
  • anaemia
  • muscle atrophy
25
Q

Staging of bladder cancer

A

T1: superficial
T2: into muscle
T3: into perivesicular fat
T4: invasion into another organ

26
Q

Risk factors for bladder cancer

A 
Age
Smoking
Family history (esp. young)
Occupational carcinogens: dyeing, rubber, printing, metal industries
Chronic indwelling foreign body
Chronic cystitis
Chronic analgesic use
Pelvic irradiation
27
Q

Types of bladder cancer

A

Over 90% transitional cell carcinoma

Some squamous cell carcinomas and adenocarcinomas

28
Q

Clinical features of bladder cancer

A

Painless haematuria

  • may be intermittent
  • passing clots MAY BE PAINFUL - needs admission, 3-way catheter for washout

Often associated with UTI/cystitis (irritative symptoms)

29
Q

Investigations in bladder cancer

A 
Cystoscopy and biopsy
Urine cytology (very specific but low sensitivity)
30
Q

Management of bladder cancer

A

Carcinoma in situ:
- high-grade and invasive in bladder cancer
- CTx or Immunotherapy (mitomycin)
- cystectomy if young
- BCG (tuberculosis) - causes huge immune response - reduces recurrence and progression to deeper layer)
Ta: superficial, can burn off TURBT

Muscle-invasive:

  • radical cystectomy
  • radiotherapy or combined treatments
31
Q

What does a radical cystectomy involve

A

In males: bladder and prostate

In females: bladder, urethra, uterus, most of vagina, ovaries, fallopian tubes

Reconstruction: ileal conduit (ureters - bit of bowel)
Use lots of ileum to reconstruct neobladder (absorbs toxins as urine sits waiting to void)

32
Q

Causes of haematuria

A 
Bladder cancer
Renal cancer
Prostate cancer
Renal calculi (painful)
BPH
Ureteric cancer
Infection
Trauma (e.g. catheter)
Renal (glomerular disease, polycystic kidney)
Papillary necrosis
Bleeding disorders or anticoagulants
33
Q

Kidney tumours

A

Renal cell carcinomas - arise from renal cortex (85%)
Transitional cell carcinomas - arise from renal pelvis (8%)
Secondary tumours usually clinically insignificant and discovered post-mortem

34
Q

Risk factors for renal cell carcinoma

A

Cigarette smoking
HTN
Obesity
Acquired cystic disease of the kidney

35
Q

Most common histological group of renal cell carcinoma

A

Clear cell carcinoma

Notoriously resistant to chemotherapy

36
Q

Classic triad of renal cell carcinoma

A

Flank pain, haematuria and palpable abdominal mass (less than 10% of patients, only occurs when locally advanced)

37
Q

Flank pain, haematuria and palpable abdominal mass is the classic triad of what

A

Renal cell carcinoma

38
Q

Symptoms and signs of renal cell carcinoma

A 
Related to invasion of adjacent structures or distant mets
- haematuria
- abdo or flank mass
- scrotal varicoceles (mainly L sided)
- IVC involvement - pitting oedema, ascites, hepatic dysfunction
Paraneoplastic syndromes:
- anaemia
- hepatic dysfunction
- hypercalcaemia
- cachexia
- erythrocytosis
- secondary amyloidosis
- thrombocytosis
- polymyalgia rheumatica
39
Q

Investigations for unexplained haematuria

A

Abdo USS
Abdo CT
MRI

40
Q

Management of renal cell carcinoma

A

Localised (stage I-III):

  • Radical nephrectomy
  • Renal sparing (partial nephrectomy or ablative techniques)
  • -tumours less than 4cm, solitary kidneys, bilateral renal cancer
  • Acute surveillance in elderly or not fit for surgery

Advanced disease: generally unresectable

  • medical therapy (molecularly targeted)
    • bevacizumab (humanised VEGF neutralising monoclonal antibody)
    • tyrosine kinase inhibitors
41
Q

Why does renal cell carcinoma respond poorly to chemotherapy

A

Proximal tubule multiresistance

42
Q

Risk factors of nephrolithiasis

A 
History of nephrolithiasis
Gout - uric acid stones
Hypercalcaemia
Low fluid intake
Occupational exposure to continual high temperature
Obesity
HTN
Diabetes
Excessive physical activity
IBD/bariatric surgery (inc. enteric absorption of oxalate)
43
Q

Types of stones in nephrolithiasis

A

Clacareous stones (calcium containing) - 80%

  • Calcium oxalate (70%)
  • Calcium phosphate (5-10%)
  • Radiopaque on plain film

Noncalcareous Stones:

  • struvite/infection (15-20%)
  • uric acid (10%)
  • Cysteine stones (less than 1%) - associated with autosomal recessive cystinuria
  • all are radiolucent on plain film, can be seen on CT
44
Q

Struvite stones: composition and cause

A

Magnesium, ammonium and calcium phosphate
Leading cause of staghorn stones (occupying entire renal pelvis)
Cause by urea-splitting bacteria - alkalisation of the urine
- Klebsiella
- proteus
- mirabilis

45
Q

Clinical features of nephrolithiasis

A
  • intermittent crampy loin-groin pain
  • paroxysms of severe pain 20-60min
  • passage of stone or gravel
  • haematuria
  • nausea, vomiting
  • dysuria, urgency
  • costovertebral or flank tenderness
46
Q

indications for conservative management of nephrolithiasis

A
  • small stones (under 7mm)
  • no signs of sepsis
  • normal renal function (with 2 kidneys)
  • no ISS
Hydration
Analgesia (indomethacin)
Medical expulsive therapy (relax ureter)
- prazocin, nifedipine
Repeat imaging in 2-3w to ensure pasasge

Stones under 5mm will pass up to 98% of the time, over 5mm will pass less than 50%

47
Q

Indications for urgent urological consultation in nephrolithiasis

A
  • single kidney
  • bilateral calculi
  • pre-existing renal impairment
  • obstructed infected kidney
  • pregnancy (increases risk of miscarriage)
  • ongoing pain with simple analgesia
  • severe sepsis
48
Q

Definitive management of nephrolithiasis

A

If systemically unwell: urgent renal compression (percutaneous nephrostomy, cystoscopy with ureteric stent placement)

Medical: for uric acid stones - allopurinol/ural

Surgical:

  • extracorporeal shock wave lithotripsy
  • ureteroscopy/laser
  • percutaneous nephrolithotomy for larger stones

Surgery (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions