Urology Flashcards
Summarise the epidemiology of benign prostatic hyperplasia
50% men >50
80% men >80
black > white > asian
(passmedicine)
Generate a management plan for benign prostatic hyperplasia
- Conservative: if low IPSS score (<7) + manageable sx
- watch + wait: limit fluids, bladder retraining (timed and complete voiding), tx any constipation, optimise medications
- Medical
- 1st line: alpha-blocker (tamsulosin) or PDE-V inhibitor (sildenafil)
- NSAID to improve flow (celecoxib)
- 2nd line (IPSS >7): 5alpha-reductase inhibitor (finasteride)
- 3rd: combine 1 + 2
- 1st line: alpha-blocker (tamsulosin) or PDE-V inhibitor (sildenafil)
- Surgical: if O/E or PSA suggestion of prostate ca
- TURP
(Passmedicine, BMJ)
Identify the possible complications of benign prostatic hyperplasia
- Early:
- UTI, retention, obstructive uropathy
- Tx-related:
- Tamsulosin: dry mouth, depression, dizziness (postural hypotension)
- Finasteride: erectile dysfunction, reduced libido, gynaecomastia
- TURP: erectile dysfunciton. TURP syndrome (blood loss, irrigation fluid absorption)
- Late: malignant change
(passmedicine)
Summarise the indications for renal transplantation
ESRD, often secondary to
- Diabetic nephropathy
- Hypertensive nephropathy
- Glomerulonephritis
- PCKD
(AS)
Identify the possible complications of renal transplantation
- Early (post-op): bleeding, infection (CMV), urinary leaks, graft thrombosis
- Rejection:
- Hyperacute (immediate, ABO incompatibility –> thrombosis, SIRS)
- Acute (<6m, cell-mediated –> graft pain, fever, UO drop, Cr increase)
- Chronic (>6m, interstitial fibrosis + tubular atrophy –> slow Cr increase + proteinuria)
- Drug related
- Immunosuppression –> infections, malignancy
- Ciclosporin: gingival hypertrophy, hirsutism, nephrotoxicity
- Tacrolimus: diabetogenic, cardiomyopathy, neurotoxicity (peripheral neuropathy)
- Cushings
(AS)
How do you manage renal transplant rejection?
- Hyperacute rejection: dx can be made when still in theatre, remove transplant
- Acute rejection: responds well to immunosuppression (IV methylprednisolone 0.5-1g)
- Chronic rejection: supportive (Ato I), no additional immunosuppression
(AS)
What are the absolute contraindications to renal transplant
- Active infection
- Cancer (unless >5y ago and considered cured)
- Severe comorbidity
(OHCM)
If pt has renal transplant O/E, what else should you look for?
Re-check arms, face, chest, abdomen
- Arms: fingerpricks (DM), AV fistula
- Face: cushingoid, gingival hypertrophy, skin tumours (BCC, SCC, MM, AKs)
- Chest: tunelled dialysis scars
- Abdomen: Rutherford-Morrison scars, nephrectomy scars, Tenchkhoff (peritoneal dialysis) scar, lipodystrophy (DM), renal bruit over transplant
(AS)
DDx: gingival hypertrophy
‘DAVE’
- Drugs: ciclosporin, phenytoin, nifedipine
- AML
- Vit C deficiency = scurvy
- Extras: familial, pregnancy
(AS)
What are the different types of renal transplant?
- Cadaveric: brainstem death
- Non-heart beating donor: no active circulation
- Live-related
- Live-unrelated
(AS)
When is renal replacement therapy indicated?
GFR<15 ml/min + symptoms
Or intractable AEIOU
- acidosis
- electrolyte imbalance
- Intoxicants (lithium, salicylates)
- overload of fluid
- uraemia
(AS)
What are the complications of haemodialysis?
‘DEAF’
- Disequilibration Syndrome: usually only 1st time, rapid changes plasma osmolarity –> cerebral oedema –> N/V, headache, reduced GCS
- Electrolyte imbalance (headaches, muscle cramp, itching)
- Aluminium toxicity (in dialysate) –> dementia
- Fluid imbalance –> hypotension, pulmonary oedema
+ psychological factors, inconvenience
(AS)
Outline the mechanism of haemodialysis
- Counter-current flow: diffusion across semi-permeable membrane
- Ultrafiltration: by decreasing the hydrostatic pressure of the dialysate
(AS)
What are the complications of peritoneal dialysis?
‘BLIND’
- BMI increase (due to glucose in dialysate)
- Lump: hernia + back pain
- Infection: peritonitis, exit site infection
- Non-functioning catheter
- Disturbance: inconvenient, psychological impact
(AS)
AV fistula vs tunnelled cuffed catheter: pros and cons for renal access
- AV fistula:
- Pros: low risk infection or stenosis, high flow rate
- Cons: take ~6w to arterialise, affects body image
- Tunnelled cuffed catheter
- Pros: more consealable, immediate
- Cons: lower flow rate, insertion risks (pneumothorax, infection), blockage (thrombosis), retraction
(AS)
