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CP3 Surgery > Urology > Flashcards

Urology Flashcards

1
Q

List the DDx for ureteric obstrn (3; 11)

A 
Luminal:
Calculus
Blood clot
TCC / Bladder tumour
Papillary necrosis (sloughed e.g. from DM/NSAIDs)
Intramural:
Acquired stricture (Post-TB/Op/Calculus)
Congenital neuromusc dysfunc
Structural abn (megaureter) (1o/2o to e.g. post valves)
Extramural:
External tumour
Retroperitoneal fibrosis
Diverticulitis
AAA
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2
Q

What are the features of ureteric obstrn (4)

A

Loin pain (worsens with ↑ urine e.g. alc/diuretics)
Palpable hydronephrotic kidney
Infection
Anuria (bilateral) / Polyuria (in chronic, impaired conc)

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3
Q

What Ix should be done if suspecting ureteric obstrn (4+3)

A 
Bloods: U+Es inc Creatinine
Urine: dip + MCS
Imaging: 
USS
CT (if USS+ve; determines obstrn level)

AXR (?stones)
VCUG (contrast + AXR)
Radionucleotide (functional)

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4
Q

How is ureteric obstrn managed? (2)

A

Stent (idiopathic)

Nephrostomy

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5
Q

List some RFs for kidney stones (4)

A

Obesity
Dehydration
PMH/FH
Structural abn

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6
Q

What are the 3 diff ways in which kidney stones may present?

A

Renal Colic
Dull loin pain (if in calyx)
2º UTI

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7
Q

What Ix should be done if suspecting kidney stones (5)

A

Bloods:
U+Es inc Ca/Phos/Gluc/HCO3/Urate

Urine:
Dip + MCS
bHCG

Imaging:
CT (non-contrast)
AXR (80% show)

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8
Q

Outline the immediate management of kidney stones (4)

A 
A–E inc. IV fluids
IM diclofenac (if not CI)
IM metoclopramide (if severe N+V)
IV Abx (if s/o infection)
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9
Q

What are the indications for admission/active tx with renal stones (5)

A 
Severe pain after 1hr
Ongoing obstrn/ low chance spont. passing
Renal insufficiency / Risk AKI
Dx uncertain
S/o shock/infection
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10
Q

What are the medical tx options for renal stones (2)

What are the surgical options (3)

A

Tamulosin (a-blocker) (1st line - stops ureteric spasms)
Nifedipine

ESWL (shock-wave) ± nephrostomy (if hydronephrosis)
Uretoscopy
Percutaneous nephrolithiotomy

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11
Q

What advice should be given if sending someone home with renal stones (6)

A 
Most (80%) pass naturally
Drink plenty fluids
Return if pain ↑
Return if s/o infection
If 1st stone – try sieve/collect so can analyse
Urology clinic 1wk
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12
Q

List the causes of bladder stones (3)

A

BOO
F.O. e.g. prolonged catheter
Upper tract stone passing

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13
Q

How may bladder stones present? (3)

How are they treated? (2)

A 
Anuria / bladder distention
Perineal pain (trigonitis)
UTI Sx (DDx - males penis tip not general pain)
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14
Q

What are the RFs for renal cell carcinoma (5 common; 4 rare)

A 
Middle-aged male
Smoking
Obesity
HTN
Prolonged haemodialysis

ADPKD (slight ↑ risk)
Tuberous sclerosis
Occupational exposures
von Hippel-Lindau

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15
Q

What is the classic triad of features of renal cell carcinoma
List some other possible features (3)

A

Loin pain
Abdo mass
Haematuria (+ vague B Sx)

Varicocele
Polycythaemia (EPO)
HTN (renin)
Hypercalcaemia

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16
Q

What Ix should be done for RCC?(7)

A

Bloods: FBC / UEs / Ca
Urine: cytology

Imaging
USS: solid vs cystic
CT/MRI
CXR (cannon ball mets)
Renal angiography

Invasive: Biopsy

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17
Q

In RCC, when may a partial nephrectomy be done instead of radical? (3)

A

If tumour <5cm
If bilateral tumours
If contralateral poor kidney func

18
Q

What are the RFs for TCC (4)

A

Smoking
Chronic cystitis
Previous radiation
Aromatics industry (rubbers/plastics/dye)

19
Q

What Sx may be seen in TCC (4)

A

Painless haematuria ± clots
Recurrent UTI
Voiding Sx
Pain (local invasion) (e.g. suprapubic/buttock/perineal)

20
Q

What Ix are done for TCC (3)

A

Urine MCS + Cytology (sterile pyuria)
Cystoscopy + Biopsy
CT/MRI / Lymphangiography (assess extent)

21
Q

Outline the different managements for different T levels of TCC (in-situ/T1; T2/3/high-grade; T4)

A

in-situ/T1: TURBT (trans-urethral resection bladder tumour) + intra-vesical chemo

T2/3/High-Grade:
Pre-Op chemo + Radical cystectomy w. ileal conduit

T4: Palliative

Pts cured all need long-term FU w. cystoscopy

22
Q

List some intra/extraperitoneal causes of bladder trauma

A

Intraperitoneal trauma:
Laparotomy
Suturing

Extraperitoneal:
Prolonged urethral/suprapubic catheter

23
Q

List some intra/extraperitoneal causes of bladder trauma

A

Intraperitoneal trauma:
Laparotomy
Suturing

Extraperitoneal:
Prolonged urethral/suprapubic catheter

24
Q

List the DDx causes for bladder outlet obstrn (3;7)

A

Luminal:
Bladder stones
Bladder tumour

Mural:
Neuropathic bladder
Congenital abn
Urethral stricture

Extramural:
BPH/Cancer
Para/Phimosis

25
Q

What are the possible features of BOO (4)

What may be seen O/E (3)

A

Hesitancy / Poor flow / Post-void dribble
Suprapubic pain
Overflow incontinence
S/o infection

Enlarged prostate on PR
Palpable bladder
Palpable hydronephrotic kidney / loin tenderness

26
Q

What Ix should be done for BOO (4)

How is it managed?

A 
Bedside: PR
Bloods: FBC (infection) / UEs / PSA
Imaging: 
USS (distended/hydronephrosis)
CT/MRI
27
Q

What tissue is involved in BPH?

A

Glandular layers of inner transitional zone

Can be nodular/diffuse prolif

28
Q

What are the symptoms of BPH (3 groups)

A

Storage Sx: Freq/Noct/Dysuria

Voiding Sx: hesitancy / incomplete voiding / strangury / poor stream / post-void dribble

Complication Sx:
Haematuria / Haematospermia
UTI
Overflow incontinence

29
Q

What Ix should be done into BPH (7)

A

Bedside:
Urine diary (freq/vol)
PR

Bloods: FBC (exclude UTI) / UEs / PSA

Urine:
Dip + MCS
Uroflowmetry

Imaging:
USS bladder (pre/post-void)
USS transrectal ± biopsy

30
Q

List some complications of BPH (5)

A 
UTI
Overflow incontinence
Bladder calculi
Bladder diverticulae
Renal failure (bilateral hydronephrosis)
31
Q

Outline the lifestyle management of non-acute urinary retention (4)

A

Dietary: avoid alc/caffeine
Voiding: relax + do twice
Referral: bladder retraining therapy
Watch and wait (for mild sx)

32
Q

What are the medical tx options for BPH (2) + SEs

What are the surgical options (2)

A

Medical:
a-Blockers (e.g. tamulosin, doxazosin)
SEs inc: hypotension / dizzy / drowsy / depression

5a-reductase inhibitors (e.g. finasteride)
SEs inc: impotence / reduced libido

Surgical:
TURP
Holmium laser prostatectomy (endoscopic, for v large)

33
Q

List the post-op risks of a TURP (5)

A 
Retrograde ejaculation (100%)
Recurrence (repeat in 10yrs) (20%)
Impotence (10%)
Bleeding
TURP syndrome: hyponat/seizures
34
Q

List some causes for a raised PSA (7)

A 
Prostate cancer (>10 highly suggestive)
BPH
Vigorous exercise / mountain biking (48hrs)
Intercourse (48hrs)
Infection (prostatitis)
Cystoscopy
Urinary retention
35
Q

How does Gleason scoring of prostate cancer work?

What does D’Amico Risk Stratification of prostate cancer include?

A

Most prevalent pattern + 2nd most prevalent (both/5) =/10

D’Amico = Gleason + Clinical stage + PSA
more accurate prog

36
Q

Outline the management of prostate cancer in:
Localised (T1/2)
Advanced (T3/4)
Metastatic

A

Localised:
Surveillance (reg PSA/PR/Re-biopsy)
Surgery: radical prostatectomy
Radio/Brachytherapy

Advanced: Surgery / Radio (no diff in outcomes)

Metastatic: Hormonal therapy

37
Q

What hormonal therapy is used in prostate cancer?
How does it work
When is it used?

A 
GnRH agonists (inhib pituitary LH ∴ ↓ Testosterone
\+ Anti-androgen (otherwise initial testosterone rise)

Used as adjunct / palliative

38
Q

Outline the management of prostate cancer in:
Localised (T1/2)
Advanced (T3/4)
Metastatic

A

Localised:
Surveillance (reg PSA/PR/Re-biopsy)
Surgery: radical prostatectomy
Radio/Brachytherapy

Advanced:
Surgery / Radio (no diff in outcomes) / Hormonal

Metastatic: Hormonal therapy ± Orchidectomy

39
Q

What hormonal therapy is used in prostate cancer?
How does it work
When is it used?

A 
GnRH agonists (inhib pituitary LH ∴ ↓ Testosterone
\+ Anti-androgen (otherwise initial testosterone rise)

Used as adjunct / palliative

40
Q

List the differentials for erectile dysfunction

A 
Neurogenic:
SC lesion
Post-Op nn damage
Hypothalamus lesion
Cerebral infarct (stroke)

Vascular:
HTN
Arterial disease (Leriche)

Psychogenic

Endocrine:
DM (neuropathy)
Pituitary failure

Drugs:
Alc
Tranquilisers
Anti-HTNs
Oestrogens

CP3 Surgery (10 decks)

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