Urology Flashcards
Most common cause of epididymo-orchitis
If >35yo - gram -ve enteric organisms - E. Coli, pseudomonas
If <35yo - STIs - chalmydia, gonorrhoea
Causes of acute orchitis
Viral : mumps, coxsackie A, varicella, echovirus
Bacterial : E. Coli, Klebsiella, Pseudomonas, Staphylococcus, Streptococcus
Granulomatous : Syphillis, TB, Leprosy, Actinomyces,
Fungal - rare
Trauma
Idiopathic
Syx of epididymo-orchitis
Unilateral scrotal pain + swelling - acute onset
Bilateral in 10%
If STI - discharge, urethritis
Syx suggesting UTI
Systemic syx of mumps (headache, fever, parotid swelling)
Signs of epididymo-orchitis
Tenderness on plantation Palpable swelling of epididymis \+/- Urethral discharge \+/- secondary hydrocele Erythema of scrotum Pyrexia
What is the time limit for testicular salvage in testicular torsion
6 hours
What age is testicular torsion most common
<20 years
Differential diagnosis of epididymo-orchitis
testicular torsion Trauma Abscess formation Testicular tumour Epididymal tumour Hydrocele
Painless haematuria suggests what?
Bladder cancer
Presentation of acute bacterial prostatitis
Systemically unwell Lethargy Fever Perineal pain Lower back pain (if severe-Urinary retention, urethral discharge, anal discharge)
What might suggest acute prostatitis on digital rectal examination
Inflamed and painful prostate
Common pathogens in acute bacterial prostatitis
E. coli
Strep faecalis
What conditions predispose to pyelonephritis
Urinary reflux
Anatomical abnormality
Urinary stasis
Presentation of acute pyelonephritis
Malaise Fever Rigors Vomiting Dysuria Haematuria Loin pain
Treatment of pyelonephritis
Cefuroxime
+/- gentamicin
Up to 14d
Presentation of epididymo-orchitis
Acutely painful and swollen testicle
Scrotal discolouration
+/- urethral discharge + hx of unprotected sex
Causes of bladder stones
Usually due to another urinary System problem
- Bladder diverticulum
- Enlarged prostate
- Neurogenic bladder
- Urinary tract infection
Almost all bladder stones occur in men.
Symptoms of bladder stones
Abdominal pain / pressure Abnormally coloured / dark-colored urine Haematuria Difficulty urinating Frequency Inability to urinate except in certain positions Interruption of the urine stream Dysuria discomfort in the penis Urinary tract infection Fever urgency Loss of control over urine.
Management of bladder stones
Drinking more water to help pass small stones
cystoscopy to remove stones
Open surgery to remove large stones
Tx cause of bladder stones.
Indications the short term catheterisation
- Treatment of acute urinary retention.
- Preoperative prophylactic emptying of the bladder prior to urological or pelvic surgery
- Monitoring urine output in critically ill patients.
- Checking urinary residual volumes.
Features of a hydrocele
Tense, smooth, fluctuant, trans-illuminating swelling around the testicle
Management of Testicular torsion
Surgical emergency
Surgery within six hours
Reduce and Fix the testis
What is an irregular testicular lump likely to be?
Testicular cancer
- seminoma (60%)
- teratoma (40%)
What patients typically get testicular seminomas
30-40yo M
Arise from seminiferous tubules
What patients typically get testicular teratomas
20-30yo M
arise from germ cells
Management of testicular tumour
Radical inguinal orchidectomy
+ radiotherapy for LN involvement (not teratomas)
+ chemotherapy for extensive node involvement
Indications for long-term catheterisation
Treatment of chronic urinary retention due to bladder outlet obstruction
Neuropathic bladder.
Intractable skin breakdown exacerbated by incontinence.
Terminally ill or very frail incontinent patients where repeated bedding changes would be distressing.
Patient preference after failure of continence interventions.
Management of epididymo-orchitis
Bed rest
Scrotal support
Antibiotics (e.g. Ciprofloxacin+doxycycline)
Most common type of bladder cancer
Transitional cell carcinoma
Squamous cell due to schistosomiasis
Presentation of a varicocele
Scrotal swelling Does not transilluminate No cough impulse Usually L sided 'Bag of worms'
What is a hydrocele
Collection of fluid in the tunica vaginalis
Tumour markers of testicular cancer
Alpha fetoprotein
Beta-HCG
Both suggest teratoma
Management of testicular teratoma
Orchidectomy
Chemotherapy
Management of testicular seminoma
Orchidectomy
Radiotherapy
Presentation of testicular cancer
Painless lump Testicular pain +/- abdominal pain. Dragging sensation. Recent trauma Hydrocele Gynaecomastia Metastasis--> back pain / liver, lung, brain.
What may haematuria after trauma suggest
Renal injury
Needs CT scan
What does blood at the urinary meatus following trauma suggest
Urethral injury
If suspected do anterograde urethrogram
Normal prostate specific antigen levels
<4
What increases prostate specific antigen
Increasing age Prostate cancer Benign prostatic hypertrophy Urinary tract infection Urethral instrumentation Recent ejaculation
What is brachytherapy
Implantation of radioactive seeds in the prostate gland.
For localised prostate cancer
2 drugs used to manage benign prostatic hypertrophy
Doxazosin (or alfuzosin)
Finasteride
Symptoms of phimosis
Non-retraction of the foreskin
E.g. Congenital / scaring / lichen sclerosis / fibrosis
Foreskin becomes white and fixed to glans
The prepuce may balloon on micturation - circumscion not needed.
If urinary obstruction - circumcise
What is Peyronie’s disease + symptoms
Progressive fibrosis of tunica albuginea covering corpus cavernosum.
Pain on erection
Deviation of erection / ventral curvature
Pain on intercourse / becomes impossible
When does priapism become painful
What are possible complications
Pain after 3/4 hrs
Ischaemia + interstitial oedema after 12 hrs
Smooth muscle necrosis after 24 hrs
Can cause long term ED - risk relative to duration
Managment of priapism
Exercise + ice
Oral terbutaline
Intracavernosal phenylephrine
