Urology Flashcards
List the DDx for ureteric obstrn (3; 11)
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
What are the features of ureteric obstrn (4)
Loin pain (worsens with ↑ urine e.g. alc/diuretics)
Palpable hydronephrotic kidney
Infection
Anuria (bilateral) / Polyuria (in chronic, impaired conc)
What Ix should be done if suspecting ureteric obstrn (4+3)
Bloods: U+Es inc Creatinine Urine: dip + MCS Imaging: USS CT (if USS+ve; determines obstrn level)
AXR (?stones)
VCUG (contrast + AXR)
Radionucleotide (functional)
How is ureteric obstrn managed? (2)
Stent (idiopathic)
Nephrostomy
List some RFs for kidney stones (4)
Obesity
Dehydration
PMH/FH
Structural abn
What are the 3 diff ways in which kidney stones may present?
Renal Colic
Dull loin pain (if in calyx)
2º UTI
What Ix should be done if suspecting kidney stones (5)
Bloods:
U+Es inc Ca/Phos/Gluc/HCO3/Urate
Urine:
Dip + MCS
bHCG
Imaging:
CT (non-contrast)
AXR (80% show)
Outline the immediate management of kidney stones (4)
A–E inc. IV fluids IM diclofenac (if not CI) IM metoclopramide (if severe N+V) IV Abx (if s/o infection)
What are the indications for admission/active tx with renal stones (5)
Severe pain after 1hr Ongoing obstrn/ low chance spont. passing Renal insufficiency / Risk AKI Dx uncertain S/o shock/infection
What are the medical tx options for renal stones (2)
What are the surgical options (3)
Tamulosin (a-blocker) (1st line - stops ureteric spasms)
Nifedipine
ESWL (shock-wave) ± nephrostomy (if hydronephrosis)
Uretoscopy
Percutaneous nephrolithiotomy
What advice should be given if sending someone home with renal stones (6)
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
List the causes of bladder stones (3)
BOO
F.O. e.g. prolonged catheter
Upper tract stone passing
How may bladder stones present? (3)
How are they treated? (2)
Anuria / bladder distention Perineal pain (trigonitis) UTI Sx (DDx - males penis tip not general pain)
What are the RFs for renal cell carcinoma (5 common; 4 rare)
Middle-aged male Smoking Obesity HTN Prolonged haemodialysis
ADPKD (slight ↑ risk)
Tuberous sclerosis
Occupational exposures
von Hippel-Lindau
What is the classic triad of features of renal cell carcinoma
List some other possible features (3)
Loin pain
Abdo mass
Haematuria (+ vague B Sx)
Varicocele
Polycythaemia (EPO)
HTN (renin)
Hypercalcaemia
What Ix should be done for RCC?(7)
Bloods: FBC / UEs / Ca
Urine: cytology
Imaging USS: solid vs cystic CT/MRI CXR (cannon ball mets) Renal angiography
Invasive: Biopsy
In RCC, when may a partial nephrectomy be done instead of radical? (3)
If tumour <5cm
If bilateral tumours
If contralateral poor kidney func
What are the RFs for TCC (4)
Smoking
Chronic cystitis
Previous radiation
Aromatics industry (rubbers/plastics/dye)
What Sx may be seen in TCC (4)
Painless haematuria ± clots
Recurrent UTI
Voiding Sx
Pain (local invasion) (e.g. suprapubic/buttock/perineal)
What Ix are done for TCC (3)
Urine MCS + Cytology (sterile pyuria)
Cystoscopy + Biopsy
CT/MRI / Lymphangiography (assess extent)
Outline the different managements for different T levels of TCC (in-situ/T1; T2/3/high-grade; T4)
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
List some intra/extraperitoneal causes of bladder trauma
Intraperitoneal trauma:
Laparotomy
Suturing
Extraperitoneal:
Prolonged urethral/suprapubic catheter
List some intra/extraperitoneal causes of bladder trauma
Intraperitoneal trauma:
Laparotomy
Suturing
Extraperitoneal:
Prolonged urethral/suprapubic catheter
List the DDx causes for bladder outlet obstrn (3;7)
Luminal:
Bladder stones
Bladder tumour
Mural:
Neuropathic bladder
Congenital abn
Urethral stricture
Extramural:
BPH/Cancer
Para/Phimosis