Urology Flashcards
Testicular torsion presentation
Acute excruciating pain
Testicle often moves superior
Can’t do full exam as so painful
Testicular torsion Mx
If suspicious go straight to theatre and try and save testicle (6 hour rule)
Varicocoele presentation
Bag of worms
Arises due to faulty valves
Can be elucidated by valsalva manouevre
Testicular cancer investigations
USS
Bloods
- alpha fetoprotein
- beta HCG
Renal calculi presentation
Excruciatingly painful
Colic pain, which comes and goes in waves and nothing you can do to appease it (whereas peritonitic pain subsides with lying perfectly still)
Risks renal calculi
dehydration
increased incidence in summer
hot countries
high fat, salt and red meat diet
Managing renal calculi
ALWAYS check for concomittent infection
- WBC, vitals, CRP
For pain give rectal diclofenac
<5mm nothing
medium = extracorporeal lithotripsy
large = cut open if stag horn (2+ calyces)
Managing infection
- IV fluids
- ABX
- Nephrostomy to drain pus
Renal calculi investigations
Non contrast CT
UTI presentation
dysuria, frequency and urgency
can have haematuria
usually women
Common cause bacteria UTI
E.coli
When to investigate UTI further
Post menopausal women
Men
Young women with recurrent UTI
This is because of increased risk of cancer
UTI Ix
Urine culture
FBC
CRP
US KUB
Flexible cystoscopy
PSA >20 usually indicates
Cancer
But could just be infection
PSA cut off for further investigation
4
Why is PSA not a routine screen
Low specificity and the diagnostic biopsy is dangerous due to 1-2% risk of septicaemia
MRI now becoming more widely used following PSA
Causes of visible haematuria
Trauma
Infection
Stones
Cancer
visible haematuria is more worrying as 20% risk of cancer
Causes of non-visible haematuria
Renal parenchymal disease
especially if proteinuria as well
1-5% risk of cancer
higher if symptomatic
Hx questions for cause of haematuria
Infection - painful dysuria, frequency, urgency, fever
Stones - colic pain
Cancer- smoking, chemical exposure, cachexia
Trauma- any injuries even if a few weeks ago
Exam for haematuria
Abdo
Genital
Rectal for male if suspect prostate problem
Haematuria Ix
dipstick Creatinine urine culture FBC LFT Ca2+
cystoscopy
USS
CT urogram (10-20 mins)
Symptoms of outflow obstruction
hesitancy
weak stream
terminal dribbling
Managing outflow obstruction
anti-cholinergics (oxybutynin)
- bad side effects so poorly tolerated
- CI in closed angle glaucoma
Alpha blockers (tamsulosin) - smooth muscle relaxant
5alpha reductase inhibitors (finasteride)
- shrink prostate
Transurethral resection
- cores out prostate
