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
What are the possible features of BOO (4)
What may be seen O/E (3)
Hesitancy / Poor flow / Post-void dribble
Suprapubic pain
Overflow incontinence
S/o infection
Enlarged prostate on PR
Palpable bladder
Palpable hydronephrotic kidney / loin tenderness
What Ix should be done for BOO (4)
How is it managed?
Bedside: PR Bloods: FBC (infection) / UEs / PSA Imaging: USS (distended/hydronephrosis) CT/MRI
What tissue is involved in BPH?
Glandular layers of inner transitional zone
Can be nodular/diffuse prolif
What are the symptoms of BPH (3 groups)
Storage Sx: Freq/Noct/Dysuria
Voiding Sx: hesitancy / incomplete voiding / strangury / poor stream / post-void dribble
Complication Sx:
Haematuria / Haematospermia
UTI
Overflow incontinence
What Ix should be done into BPH (7)
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
List some complications of BPH (5)
UTI Overflow incontinence Bladder calculi Bladder diverticulae Renal failure (bilateral hydronephrosis)
Outline the lifestyle management of non-acute urinary retention (4)
Dietary: avoid alc/caffeine
Voiding: relax + do twice
Referral: bladder retraining therapy
Watch and wait (for mild sx)
What are the medical tx options for BPH (2) + SEs
What are the surgical options (2)
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)
List the post-op risks of a TURP (5)
Retrograde ejaculation (100%) Recurrence (repeat in 10yrs) (20%) Impotence (10%) Bleeding TURP syndrome: hyponat/seizures
List some causes for a raised PSA (7)
Prostate cancer (>10 highly suggestive) BPH Vigorous exercise / mountain biking (48hrs) Intercourse (48hrs) Infection (prostatitis) Cystoscopy Urinary retention
How does Gleason scoring of prostate cancer work?
What does D’Amico Risk Stratification of prostate cancer include?
Most prevalent pattern + 2nd most prevalent (both/5) =/10
D’Amico = Gleason + Clinical stage + PSA
more accurate prog
Outline the management of prostate cancer in:
Localised (T1/2)
Advanced (T3/4)
Metastatic
Localised:
Surveillance (reg PSA/PR/Re-biopsy)
Surgery: radical prostatectomy
Radio/Brachytherapy
Advanced: Surgery / Radio (no diff in outcomes)
Metastatic: Hormonal therapy
What hormonal therapy is used in prostate cancer?
How does it work
When is it used?
GnRH agonists (inhib pituitary LH ∴ ↓ Testosterone \+ Anti-androgen (otherwise initial testosterone rise)
Used as adjunct / palliative
Outline the management of prostate cancer in:
Localised (T1/2)
Advanced (T3/4)
Metastatic
Localised:
Surveillance (reg PSA/PR/Re-biopsy)
Surgery: radical prostatectomy
Radio/Brachytherapy
Advanced:
Surgery / Radio (no diff in outcomes) / Hormonal
Metastatic: Hormonal therapy ± Orchidectomy
What hormonal therapy is used in prostate cancer?
How does it work
When is it used?
GnRH agonists (inhib pituitary LH ∴ ↓ Testosterone \+ Anti-androgen (otherwise initial testosterone rise)
Used as adjunct / palliative
List the differentials for erectile dysfunction
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
