Urology Flashcards
Where do the kidneys, ureters and bladder lie, anatomically speaking?
KIdneys lie between L1-L3.
Ureters insert into the kidneys at renal pelvis and then pass posteriorly into the bladder.
They run over the psoas muscle.
What is the function of the kidneys?
Fluid and electrolyte balance.
Maintenance of BP.
excretion of urea and other toxic products.
Production of EPO and vitamin D.
What are the pre-renal causes of renal failure?
Hypovolemia
Cardiogenic and septic shock
Renal artery stenosis/thromboembolism
Drugs - NSAIDs and ACEis which alter BP maintenance.
What are the renal causes of renal failure?
Acute Tubular Necrosis caused by ischaemia or nephrotoxic agents. Intrinsic renal artery disease. Acute Tubulointerstitial nephritis. Pyelonephritis Glomerulonephritis Diabetic nephropathy Pre/ Eclampsia Hypertension Polycystic kidney disease
What are the post-renal causes of renal failure?
Ureteric obstruction.
Bladder outflow obstruction (eg BPH).
Describe the cause and effects of bladder calculi.
Over 50% are formed from uric acid.
Most common cause is outlet obstruction (BPH, bladder neck elevation, high residual volume, infection, neurogenic bladder, urethral stricture).
Describe the aetiology, pathology of transitional cell carcinoma of the bladder.
Transitional cell carcinoma is the most common, but adeno and squamous also occur.
They can be graded 1-3 with papillary being the less severe and solid being more severe.
Haemorrhage is common.
Describe the symptoms, risk factors and signs of transitional cell carcinoma of the bladder.
Symptoms and signs include: Painless haematuria Obstructive symptoms Sterile pyuria UTIs Nerve impingement and other metastatic symptoms
Risk factors: Age Male smoking dyes drugs (cyclophosphoamide) Chronic inflammation
List common causes of outlet obstruction of the bladder.
BPH Urethral strictures Bladder stones Bladder carcinoma High bladder outlet
List the signs and symptoms of benign prostatic hyperplasia.
Frequency Feeling of incomplete emptying Poor flow Hesitancy Dysuria Abdominal pain Nocturia
List the complications of BPH.
UTIs
Hydronephrosis
Bladder stones
List the pathology and natural history of adenocarcinoma of the prostate gland
Usually occurs in the outer, lateral, posterior parts of the prostate gland.
Elevation in PSA levels.
Malignant cancer very common in older men but they usually die WITH it not FROM it.
Discuss the diagnosis of bladder infection outlining the importance of confirming significant bacteriuria and the importance of white cells in the urine.
A UTI is confirmed with >100,000 organisms/mL.
White cells suggest immune process.
Usually monoclonal - poly suggests infection.
Describe the aetiology of a urethral stricture.
Most are iatrogenic through catheter insertion.
Some may occur through trauma such as malignancy or infections such as gonorrhoea.
Some bulbar or meatal may be congenital.
Describe the clinical presentation of a urethral stricture.
Overflow incontenance
Slow flow of urine.
Spraying or splitting of the urine.
Describe the pathology and clinical presentation of phimosis.
Tight foreskin that cannot be retracted over the glans.
May be caused congenitally or acquired by poor hygeine and balanitis.
Symptoms:
Obstructive symptoms
Pain at prepuce
Describe the pathology and clinical presentation of paraphimosis.
A foreskin that cannot be replaced back over the glans.
Caused either by cathertisation or sexual intercourse.
Symptoms:
Pain
Swelling distal to foreskin
Flacidity proximal to foreskin.
Describe the pathology and clinical presentation of varicoceles.
Varicose veins in the pampiniform plexus.
Generally found on the left side
May be asymptomatic or a dull ache.
Describe the pathology and clinical presentation of hydrocele.
Collection of fluid in tunica vaginalis - sits anterior to testes.
May be caused by trauma, infection or peritoneal dialysis.
Presents with a scrotal swelling with or without pain.
Describe the pathology and clinical presentation of an epididymal cyst.
Collection of spermatic fluid in the epididymis, usually the head.
Scrotal swelling, usually painless.
Discuss the pathology, presentation and diagnosis of testicular torsion
Twisting of the spermatic cord.
Vomiting and/or scrotal swelling
Testes may retract and cremaseter reflex may be absent.
Usually occurs in tunica vaginalis
Diagnosis is made clinically and patient sent to theatre
Usually occurs in patients under the age of 20 yrs.
Discuss the pathology, presentation and diagnosis of epididymo-orchitis.
Presents with scrotal swelling and discomfort and dysuria, pain, urethritis and discharge.
The most common causes are chlamydia and gonorrhoea in young men
In older men usually caused by E.Coli and other UTI causing pathogens.
Discuss the main pathological classification of tumours of the testis and give a brief outline of their biological behaviour.
May be non-germ cell:
Leydig, lymphoma, sertoli cell
Germ cell:
Seminomas or non-seminomas.
What questions do you ask during a scrotal examination and how do they help rule out different DDx?
Can I get above it?
Yes - Tumour, hydrocele, varicocele, epididymal cyst
No - Hernia
Can I palpate the testes
Yes - Tumour, varicocele, hernia, epididymal cyst
No - Hydrocele
Can the testes be transilluminated?
Yes - Hydrocele, epididymal cyst
No - Varicocele, tumour, hernia
