Urology Flashcards
1
Q
priapism definition
A
prolonged painful erections
2
Q
prolonged painful erections
A
priapism
3
Q
causes of priapism
A
HbSS, trauma, ED medication (e.g. sildenafil)
4
Q
HbSS, trauma, ED medication could be causes of
A
priapism
5
Q
priapism management
A
requires prompt treatment to prevent ischaemic damage
medical = phenylephrine
surgical = decompression + corporal aspiration
6
Q
medical = phenylephrine surgical = decompression + corporal aspiration
A
priapism management
7
Q
phenylephrine is
A
an sympathomimetic acting predominantly on a-adrenergic R –> peripheral vasoconstriction
8
Q
an sympathomimetic acting predominantly on a-adrenergic R –> peripheral vasoconstriction
A
phenylephrine
9
Q
prostate ca location
A
posterior lobe, peripherally
10
Q
prostate ca is graded using
A
Gleason score
11
Q
Gleason score is used to grade
A
prostate ca
12
Q
Gleason score system
A
the grade of the majority of the cells + the highest other grade seen (3-5)
13
Q
most common testicular tumour in boys
A
yolk sac
14
Q
yolk sac tumours
A
most common testicular tumour in boys, elevated AFP + Schiller Duval bodies
15
Q
most common testicular tumour in boys, elevated AFP + Schiller Duval bodies
A
yolk sac tumours
16
Q
Schiller Duval body
A
pathognomonic of yolk sac tumour, “resemble the glomerulus”
17
Q
pathognomonic of yolk sac tumour, “resemble the glomerulus”
A
Schiller Duval body
18
Q
testicular torsion
A
sudden, severe, testicular pain, tenderness, N+ V, cremasteric reflex may be absent
19
Q
cremasteric reflex
A
lightly stroke the superior + medial thigh leads to a ipsilateral contraction of the cremaster muscle
20
Q
lightly stroke the superior + medial thigh leads to
A
cremasteric reflex
21
Q
absent cremasteric reflex
A
testicular torsion, upper + lower motor neurone disorders, L1/2 spinal injury
22
Q
testicular torsion, upper + lower motor neurone disorders, L1/2 spinal injury may lead to
A
an absent cremasteric reflex
23
Q
cryptorchidism
A
undescended testicle
24
Q
undescended testicle
A
cryptorchidism
25
cryptorchidism risk factors
SGA, prematurity
26
SGA, prematurity are risk factors for
cryptorchidism
27
complications of cryptorchidism
torsion, infertility, testicular (germ cell) cancer
28
torsion, infertility, testicular cancer are complications of
cryptorchidism
29
cryptorchidism management
close monitoring + review at 3/12
| >3/12 refer to paediatric surgeon ?orchiopexy
30
close monitoring + review at 3/12
| >3/12 refer to paediatric surgeon is the management for
cryptorchidism
31
dorsal aspect of penis
anterior
32
ventral aspect of penis
poster
33
hypospadia
abnormal opening of the urethra on the inferior/ventral side of the penis
34
abnormal opening of the urethra on the inferior/ventral side of the penis
hypospadia
35
epispadias
abnormal urethral opening on the superior/dorsal surface of the penis
36
abnormal urethral opening on the superior/dorsal surface of the penis
epispadias
37
varicocele most commonly affect
the LHS due to increased resistance to flow (L gonadal verin to L renal vein, R gonadal v to IVC)
38
germ cell testicular cancer risk factors
Kleinfelter's S, cryptorchidism
39
Kleinfelter's S, cryptorchidism are risk factors for which type of testicular cancer
germ cell
40
testicular mass is ___ until proven otherwise
cancer
41
epididymal masses are nearly always
benign
42
differentials for scrotal pain
testicular torsion, testicular cancer, referred pain from renal colic, trauma, epididymitis, orchitis, strangulated hernia
43
differentials for scrotal swelling
testicular cancer, varicocele, hydrococele, testicular torsion, trauma, hernia, epididymitis/orchitis (STI, TB, mumps), spermatococele
44
differentials for difficulty passing urine
BPH, strictures, detrusor dysfunciton, UTI, bladder/prostate ca, neurological cause, retention
45
differentials for haematuria
infection, inflammation, baldder/kidney/ureter/prostate ca, stones, BPH, trauma, beetroot, ketamine abuse
46
differentials for loin pain
stones, MSK, trauma
47
differentials for urinary incontinence
stress (weak sphincter), urge (detrusor overactivity), mixed, functional, continuous (vesicovaginal fistulae), overflow (chronic distended bladder), nocturnal enuresis, post-micturition dribble
48
differentials for ED
age, depression, anxiety, stress, CVS DZ, Peyronie's DZ, SC DZ, MS, PD, iatrogenic, DM, renal failure, cirrhosis
49
orchitis
less common than epididymo-orchitis, inflammation of just the testis, e.g. mumps orchitis (with parotid swelling)
50
varicocele
ectatic + tortuous v of the paminiform plexus of the spermatic cord, 15% of male adolescents, may cause pain, damage to testes, infertility
51
Peyronie's DZ
CT DZ, fibrous plaques in the tunica albuginea, abnormal curvature, ED,
52
epididymo-orchitis
acute, ux, 2/3rds = chlamydia, may be urethral discharge, urethritis often asymptomatic
53
epididymo-orchitis management
quinolone ABx, doxy if chlamydia
54
ectatic + tortuous v of the paminiform plexus of the spermatic cord, 15% of male adolescents, may cause pain, damage to testes, infertility
varicocele
55
CT DZ, fibrous plaques in the tunica albuginea, abnormal curvature, ED,
Peyronie's DZ
56
acute, ux, 2/3rds = chlamydia
epididymo-orchitis
57
quinolone ABx, doxy if chlamydia is the management for
epididymo-orchitis
58
prostate ca risk factors
age, ethnicity, FH
59
prostate ca presentation
PSA, LUTS, mets, malaise, weight loss, SCC, anaemia
60
prostate ca investigations
DRE, PSA, TRUS, MRI/CT, bone scan
61
PSA pros
detect ca, at earlier stage for Rx, serial measurements for progression of DZ
62
PSA cons
not diagnostic, doesn't detect all ca, detece ca which PT may have died with rather than of (overtreatment)
63
T1/2 prostate ca
confined to prostate gland
64
prostate ca management
active surveillance for low risk
T1/2 = radical prostatectomy, brachytherapy, external beam radiotherapy
T3 = radical prostatectomy + extended pelvic lympadenectomy, external bean radiotherapy + androgen depravation
metastatic DZ: castration
65
radical prostatectomy effect on PSA + SE
PSA should drop to 0, SE: ED, incontinence
66
EBRT
daily for 4-7.5/52, plus androgen deprivation therapy (LHRH agonist), SE: bowel symptoms, ED, frequency + urgency
67
brachytherapy
radioactive seeds inserted into prostate, SE: frequency + urgency, retention
68
T3 prostate ca
beyond prostate
69
T4 prostate ca
invades adjacent structures
70
medical castration
goserelin acts on pituitary gland to stop LH/FSH release, use cyproterone acetate (testosterone agonist) to prevent tumour flare
71
finasteride
5a-reducatse inhibitor, metabolises testosterone to dihydrotestosterone, used in BPH + male pattern baldness, reduces prostate V, may slow DZ progression, takes 6/12 to work
72
5a-reducatse inhibitor, metabolised testosterone to dihydrotestosterone, used in BPH + male pattern baldness, reduces prostate V, may slow DZ progression, takes 6/12 to work
finasteride
73
confined to prostate gland = Tx
1/2
74
beyond prostate = Tx
3
75
invades adjacent structures = Tx
4
76
AFP is a marker of
teratoma, HCC ca
77
explain TURP
NBM 6h prior, camera via penile opening to prostate, removes excess tissue, spinal/GA, overnight stay, catheter removed w/i 24h, OP follow up
78
alternative to TURP for BPH
medical (finasteride, tansulosin), catheterisation
79
complications of TURP
haematuria, injury to bladder/urethra, urinary incontinance, ED, retrograde ejaculation, urine infection, TURP S, urinary retention, recurrence
80
TURP S
rare, but potentially life threatening complication of TURP: hyponatraemia, electrolyte disturbances, fluid overload due to absorption of fluids used in bladder irrigation
81
hyponatraemia, electrolyte disturbances, fluid overload due to absorption of fluids used in bladder irrigation
TURP S
82
BPH investigations
IPSS, DRE, urinalysis (UTI, proteinuria, haematuria), PSA, prostate US, prostate biopsy, flow rate, bladder scan (post-void), urodynamics
83
IPSS, DRE, urinalysis, PSA, prostate US, prostate biopsy, flow rate, bladder scan, urodynamics
BPH investigations
84
tamsulosin
alpha-1-adrenoreceptor antagonist in the prostate causing smooth m relaxation, rapid onset
85
tamsulosin SE
dizziness, postural hypotension, dry mouth, depression, lethagy, GI disturbances, nasal congestion, ED
86
dizziness, postural hypotension, dry mouth, depression, lethagy, GI disturbances, nasal congestion, ED are SE of
tamsulosin
87
alpha-1-adrenoreceptor antagonist in the prostate causing smooth m relaxation, rapid onset is the method of action of
tamsulosin
88
finasteride SE
ED, decreased libido, ejaculatory disorders, gynaecomastia, breast tenderness
89
ED, decreased libido, ejaculatory disorders, gynaecomastia, breast tenderness are SE of
finasteride
90
which drug may decrease PSA by up to 50%?
finasteride
91
finasteride + PSA
may reduce valused by up to 50%
92
urinary symptoms - ask about
f, nocturia, terminal dribbling, incomplete voiding, straining, hesitancy, urgency, incontinence, haematuria, dysuria, abdo/pelvic pain, constipation, fever, lower back pain, sexual dysfunction, urinary retention, previous Sx/intervention, systemic features: weight loss, appetite, bone pain
93
storage symptoms
urgency, urge incontinence, f, nocturia
94
voiding symptoms
hesitation, poor stream, terminal dribble, intermittent stream, post-void residual V, post-void dribble, prolonged voiding, straining
95
urgency, urge incontinence, f, nocturia
storage symptoms
96
hesitation, poor stream, terminal dribble, intermittent stream, post-void residual V, post-void dribble, prolonged voiding, straining
voiding symptoms
97
LUTS DD
BPH, bladder ca, prostate ca, UTI, OAB, urethral strictures, neurological DZ
98
BPH, bladder ca, prostate ca, UTI, OAB, urethral strictures, neurological DZ are differentials for
LUTS
99
scoring system used for LUTS
IPSS (international prostate symptom score)
100
BPH definition
hyperplasia = increase in the number of prostate cells, a histological diagnosis
101
BPE
enlargement of the prostate gland which may be due to BPH
102
BOO
bladder outflow obstruction = regardless of cause
103
BOO indications for referral + intervention
acute urinary retention, bladder stones, large post-void residual leading to obstructive nephropathy/recurrent infections, failing medical management
104
acute urinary retention, bladder stones, large post-void residual leading to obstructive nephropathy/recurrent infections, failure of medical management are indications for
referral + intervention
105
IPSS questions
incomplete emptying, f, intermittency, urgency, weak stream, straining, nocturia
106
BOO treatment options
watchful waiting, a-blockers (tamsulosin), 5a-reductase i (finasteride), combination therapy, phytotherapy, Sx, catheter
107
watchful waiting/conservative methods for BOO include
fluid intake, caffeine, EtOH, bladder retraining, continence pads
108
phytotherapy is
herbal remedy for BPH
109
herbal remedy for BPH
phytotherapy
110
BXO
balanitis xerotica obliterans (male equivalent of lichen sclerosis) - itchy white spots on penis (foreskin + glans), hyperkeratotic, associated with dysuria, reduction of sensation of the glans
111
associations with BXO
phimosis, SCC, infection
112
itchy white spots on penis (foreskin + glans), hyperkeratotic, associated with dysuria, reduction of sensation of the glans
BXO balanitis xerotica obliterans
113
BPH risk factors
age, ethnicity (black > white > asian)
114
first line medical management of BPH
tamsulosin (a1-agonist, smooth m relaxant, quick acting)
115
second line medical management in BPH
finasteride (5a-reductase i, slower acting)
116
two types of urethral injury
bulbar rupture and membranous rupture
117
bulbar rupture
straddle injuries, most common
| triad of: urinary retention, perineal haemorrhage, blood at meatus
118
membranous rupture
extra/intraperitoneal, pelvic #, penile/perineal oedema/haematoma, prostate displaced upwards
119
investigations for urethral injury
ascending urethrogram
120
management of urethral injury
suprapubic catheter (Sx placement)
121
bulbar rupture and membranous rupture are two types of
urethral injury
122
straddle injuries, most common
| triad of: urinary retention, perineal haemorrhage, blood at meatus
bulbar rupture
123
extra/intraperitoneal, pelvic #, penile/perineal oedema/haematoma, prostate displaced upwards
membranous rupture
124
bladder injury presentation
intra/extraperitoneal rupture, haematuria, suprapubic pain, Hx of pelvic #, inability to void
125
bladder injury investigations
IVU, cystogram
126
bladder injury manaement
laporotomy or conservative management depending on injury
127
most common type of testicular ca
germ cell (95%) - of which 60% are seminomas + 40 % are non-seminomas
128
non-germ cell ca of the testis include
Leydig cell tumours, Sertoli cell tumours, lymphoma
129
seminoma vs non-seminoma
seminoma: less aggressive, radiosensitive, 30-40 y.o.
| non-seminoma: AFP + HCG raised, more aggerssive, 20-30 y.o.
130
less aggressive, radiosensitive, 30-40 y.o. type of testicular cancer
seminoma
131
AFP + HCG raised, more aggerssive, 20-30 y.o. type of testicular ca
non-seminoma
132
testicular ca symptoms
lump, pain, dragging sensation, inflammation, Hx of trauma, gynaecomastia
133
testicular ca history questions
FH, cryptorchidism, previous testicular ca, Kleinfelter's S, teticular atrophy
134
stage I testicular ca
confined to testis
135
stage II and III
LN involvement
136
stage IV testicular ca
metastatic DZ
137
testicular ca managemet
sperm freezing, inguinal orchidectomy, chemotherapy, radiotherapy
138
testicular ca investigations
USS, serum AFP, HCG, LDH, CTCAP
139
inguinal hernia
can't get above it, cough impulse, may be reducible
140
testicular tumours
may be discrete nodule, may be associated hydrococele, symptoms of metastatic DZ, USS, AFT, HCG
141
acute epididymo-orchitis
Hx of dysuria + urethral discharge, tender, chlamydia risk factors,
142
epididymal cyst
single or multiple, >40 y.o., painless, above + behind testis, separate from body of testis
143
hydrococele
painless, fluctuant, transilluminate (2' to epididymo-orchitis, tumour, torsion)
144
testicular torsion
sudden, severe pain, risk = abnormal testicular lie, adolescents/young males, tender
145
varicocele
L > R, affected testis may be smaller, may affect fertility, may be a presenting feature of RCC
146
Sx exploration of suspected testicular torsion w/i
4-6hrs of onset of pain
147
Sx for testicular torsion
untwisting of torsioned testis, if salvageable fixing to scrotal sac to prevent recurrence, fixation of the other testis too
148
what's the best modality to visulise urinary calculi
non contrast CT
149
urinary calculi have a 10 year recurrence rate of
50%
150
risk factors for stone formation
male, 20-50 y.o., N Europe/Middle E, Caucasians + Asians > African, high protein diet (western), sedentary work, low fluid intake, iatrogenic (steroids, chemo for myeloproliferative DZ), immobility, systemic DZ (sarcoidosis), IBD/malabsorption, abnormal renal anatomy (pelvi-ureteric junction obstruction + horseshoe kidney), FH
151
how do steroids + chemo for myeloproliferative DZ increase risk of urinary calculi
causes release of purines + uric acid
152
how does immobility increase risk of urinary calculi
bone demineralisation + raised urinary Ca levels
153
how does IBD/malabsorption increase risk of urinary calculi
causes high urinary oxalate levels (hyperoxaluria)
154
stone types
Ca containing stones = 80%, radiopaque
Uric acid = 5-10%, radiolucent
Struvite (Mg NH4 PO43-) = 10-15%, radiopaque (can form staghorn calculi)
Cystine = 1%, faintly radiopaque (occurs in cystinuria)
155
urinary calculi presentation
incidental, severe loin pain (colicy), radiating to groin/genitalia, haematuria (microscopic or macroscopic), recurrent UTI/pyelonephritis (esp if staghorn), restless PT, N+V, f + urgency (depending on position of stone)
156
US can be used to detect what type of urinary calculi
renal (not ureteric)
157
pros of non contrast CT for detecting urinary calculi
high sensitivity (97%), quick, avoids contrast, detects other causes of abdo pain
158
cons of non contrast CT for detecting urinary calculi
> radiation dose than short series IVU, expensive, not available in all units all the t, < easy to interpret, pelvic pheloboliths vs sm distal ureteric stones = difficult to distinguish
159
management of sm asymptomatic stones
observe, if >4mm will likely become symptomatic
160
interventional management of symptomatic stones
ESWL (extracorporeal shock wave lithotripsy), flexi uretererenoscopy, PCNL (percutaneous nephrolithotomy), laparoscopy, open Sx
161
what is ESWL
extracorpal shock wave lithotripsy, shock waves directed under XR/US onto stone, absorption of shock waves leads to break up of stone, fragments passed in urine
162
ESWL is used for
stones <2cm, unfit for GA, failure of endoscopic control
163
flexi ureterorenoscopy is used for
stones <2cm, failed ESWL
164
flexi ureterorenoscopy is suitable for
hard stones (cystine), lower pole stones, obese PTs, skeletal abnormalities, stones trapped in calyceal diverticula, challenging anatomy (pelvic/horeshoe kidney), safe in anticoagulated PTs
165
ESWL CI
absolute: pregnancy, uncorrected bleeding disorder, anticoagulated PTs
relative: obese, aneurysmal DZ, skeletal abnormalities, unRx'd UTI, obstructed ureter, fertile females
166
what is PCNL
percutaneous nephrolithotomy, GA, nephroscope through skin to collecting system + stone, laser/US E used to fragment stone, fragments washed out
167
PCNL is good for
large stones >2cm, lower pole stones, trapped stones in caluceal diverticulum, staghorn
168
medical managememt of symptomatic stones
antiemetics, NSAIDs (IM ketoprofen, PR diclofenac)
169
investigations in urinary calculi
urinalysis, U+E, creatinine, non contrast CT/IVU/plain XR
170
conservative management of sm stones
<4-6mm will pass on their own, a-blockers help
171
PTs unsuitable for conservative management
>7mm stone, uncontrolled pain, prolonged obstruction >2/52 that could lead to irreversible nephron loss, fever, solitary kidney, renal impairment, social impact
172
f stone formers/+ve FH need to rule out
abnormal Ca metabolism, cytinuria (less common)
173
stones <2cm, unfit for GA, failure of endoscopic control
use ESWL
174
stones <2cm, failed ESWL
use flexiureterorenoscopy
175
hard stones (cystine), lower pole stones, obese PTs, skeletal abnormalities, stones trapped in calyceal diverticula, challenging anatomy (pelvic/horeshoe kidney), safe in anticoagulated PTs
flexiureterorenoscopy
176
pregnancy, uncorrected bleeding disorder, anticoagulated PTs are CI of
ESWL
177
shock waves directed under XR/US onto stone, absorption of shock waves leads to break up of stone, fragments passed in urine
extracorpal shock wave lithotripsy
178
GA, nephroscope through skin to collecting system + stone, laser/US E used to fragment stone, fragments washed out
percutaneous nephrolithotomy
179
large stones >2cm, lower pole stones, trapped stones in caluceal diverticulum, staghorn
use PCNL
180
>7mm stone, uncontrolled pain, prolonged obstruction >2/52 that could lead to irreversible nephron loss, fever, solitary kidney, renal impairment, social impact
unsuitable for medical management
181
abnormal Ca metabolism, cytinuria (less common) needs to be ruled out in
f stone formers/+ ve FH
182
types of ca stone
Ca oxalate > Ca phosphate
183
types of infection seen with staghorn calculi
Proteus mirabilis
184
Proteus mirabilis infection seem with what type of stone
staghorn/Struvite/Mg NH4 PO43-
185
paraphimosis occurs in
uncircumcised men
186
mechanism of paraphimosis
foreskin becomes fixed in the retracted position, cannot be reduced, constricting venous return from the glans, leading to swelling
187
paraphimosis is related to
previous phimosis
188
most common cause of paraphimosis
iatrogenic - medical staff not replacing the foresking after catheterisation
189
without Rx paraphimosis can lead to
ulceration + necrotic changes
190
management of paraphimosis
analgesia (nerve block), manual decompression, dorsal slit, formal circumcision
191
phimosis is a risk factor for
penile ca
192
causes of phimosis
lichen sclerosis, balanitis xerotica obliterans
193
foreskin becomes fixed in the retracted position, cannot be reduced, constricting venous return from the glans, leading to swelling describes
paraphimosis
194
analgesia (nerve block), manual decompression, dorsal slit, formal circumcision is the managment for
paraphimosis
195
BXO balanitis xerotica obliterans increases your risk of
SCC (penile ca), infection
196
balanitis is
inflammationof the glans + prepuce
197
BXO is a common cause of
phimosis
198
bladder ca risk factors
smoKing (3x risk), analine dye
199
bladder ca presentaiton
frank haematuria, painless, dysuria, urgency, bladder pain, loin pain
200
bladder ca investigations
urine dip (haematuria > 1+), MSU cytology (infection), flexi cystoscopy, XR/US (stones, masses, hydronephrosis), IVU/non contrast CT, flourescence cystoscopy, rigid cystoscopy
201
most bladder cancers are what type
TCC
202
pronounced irritative symptoms of bladder ca may suggest
m invasive DZ, or carcinoma in situ
203
loin pain in bladder ca may be a sign of
ureteric obstruction
204
flourescent cystoscopy
catheter used to insert dye prior to cystoscopy, tumour cells flouresce red under blue light
205
haematuria defined as what on microscopy
>3 RBC/high power field
206
grade of bladder ca indicates
how well differentiated it is
207
T staging
```
T1 = invaded the subepithelial CT
T2 = invades m
T3 = invades the perivesicular tissue
T4 = invades other structures
```
208
management of low grade bladder ca
TURBT + intravesicular mitomycin C (chemotherapy, single vs multiple doses)
209
explaining TURBT
GA, short hospital admission, camera through urethra, resect all visible tumour, to m, may take biopsies, cystoscopy follow up (3/12, 9/12, yearly for 5 years)
210
complications of TURBT
infection, haematuria, bladder perforaton, urethral stricture
211
high grade bladder tumour management
initial resection may be incomplete + require early 2nd TURBT, repeat intravesicular BCG
212
how does the intravesicular BCG injection work
theory = BCG attaches onto the urothelium + mediates an immune response which reduces recurrence + pregression
213
m invasive bladder ca management
1. TURBT (establish diagnosis), 2. CTCAP, bone scan 3. choice: cystectomy +/- orthotopic bladder reconstruction, EBRT, selective bladder preservation dependent on response to chemo
214
neo-adjuvent chemo for bladder ca
gemcitabine + cisplatin
215
smoKing (3x risk), analine dye are risk factors for
bladder ca
216
frank haematuria, painless, dysuria, urgency, bladder pain, loin pain is the presentation of
bladder ca
217
m invasive DZ, or carcinoma in situ bladder ca may present with
pronounced irritative symptoms: dysuria, pain
218
ureteric obstruciton 2' to bladder ca may present as
loin pain
219
catheter used to insert dye prior to cystoscopy, tumour cells flouresce red under blue light
flourescent cystoscopy
220
how well differentiated the bladder ca is is indicated by
grade
221
TURBT + intravesicular mitomycin C (chemotherapy, single vs multiple doses) is the management of
low grade bladder ca
222
infection, haematuria, bladder perforaton, urethral stricture are complications of
TURBT
223
initial resection may be incomplete + require early 2nd TURBT, repeat intravesicular BCG is the management of
high grade bladder ca
224
1. TURBT (establish diagnosis), 2. CTCAP, bone scan 3. choice: cystectomy +/- orthotopic bladder reconstruction, EBRT, selective bladder preservation dependent on response to chemo is the management of
m invasive bladder ca
225
gemcitabine + cisplatin are used as
neo-adjuvent chemo for bladder ca
226
most common UTI organisms
E. coli, Klebsiella, Proteus
227
causes of UTI
breach of bladder lining, foreign body, calculi, DM, immunocompromised, urinary track obstruction, pregnancy, post-menopausal
228
uncomplicated UTI definition
involving a PT with a structurally + functionally N urinary tract
229
complicated UTI
occuring in the presence of an underlying anatomical/functional abnormality
230
management of uncomplicated UTI
ABx (trimethoprim, nitrofurentoin, amoxicillin)
231
UTI symptoms (lower tract)
f, dysuria, suprapubic pain, haematuria
232
UTI symptoms (upper tract)
fever, loin pain, V
233
factors that suggest complicated UTI
male, hospital acquired, pregnancy, indwelling urethral catheter, recent UTI, functional/anatomical abnormality of the urinary tract, DM, immunosuppression
234
indications for further investigation in uncomplicated UTI in women
signs of upper tract infection, failure to respond to ABx, recurrent infections, factors suggestive of complicated UTI, pregnancy
235
pylonephritis
loin pain, fever
236
pylonephritis DD
appendicitis, cholecystitis, pneumonia, generalised septicaemia
237
pylonephritis management
quinolone for 7/7
238
recurrent UTI
>2 infection in 6/12, or 3 w/i 12/12
239
management of recurrent UTI
Rx initial infection, further investigations: bacterial persistence, calculi, poor bladder emptying, neoplasm
240
recurrent UTI investigations
plain KUB XR, US, post-void residual, flexi cystoscopy
241
recurrent UTI management
lifestyle: increase fluid intake, double voiding, omitting bath products, topical oestrogen cream in post menopausal women, voiding after sex
medical: low dose prophylactic ABx
242
UTI in pregnancy
should be Rx'd with ABx even if asymptomatic
243
UTI in men
less common than women, should rule out BOO
244
UTI in men investigations
DRE, flow rate, post void residual
245
infectionin the presence of an obstructed upper tract
uological emergency, associated with calculus obstructionof the ureter, ABCDE approach, nephrostomy
246
E. coli, Klebsiella, Proteus are the most common causative irganisms for
UTI
247
should be Rx'd with ABx even if asymptomatic
UTI in pregnancy
248
which ABx should be avoided in the 1st trimester
trimethoprim (teratogen)
249
which ABx should be avoided close to term
nitrofurantoin (neonatal haemolysis)
250
duration of ABx for pregnanct women
7/7, further culture on completion
251
catheterisation complications
bleeding, infection, risk of bladder damage
252
causes of urinary retention
obstructive: BPH, prostate ca, calculi
iatrogrnic: anticholinergics, opiates, a-agonists
neurological: cauda equina, spinal stenosis
253
underlying mechanism of urge incontinence
increasing detrusor P, detrusor overactivity, innapropriate contractions
254
underlying mechanism of stress incontinence
weak sphincter, weak pelvic floor m
255
underlying mechanism of necturnal enuresis
overactive detrusor m
256
underlying mechanism of post micturition dribble
pooling of urine in urether
257
underlying mechanism of overflow incontinence
obstrucion + full bladder
258
underlying mechanism of functional incontinence
impaired mobility/mental functioning leading to inappropriate urination
259
incontinence Hx
mobility, nature, duration, PMH, cultural/social/lifestyle (fluid intake) factors, PSH, cognition, DH, sexual function, bowels, expectations, Sx fitness
260
incontinence O/E
general (wellbeibng + fitness for Rx), mobility, abdo, pelvic, PR
261
incontinence Ix
bladder diary, urinalysis, flow rates, post-mic scan, urodynamics, cystoscopy
262
main method of diagnosing detrusor overactivity
urodynamics
263
urodynamics involves
catheter, priobe in rectum, artificially fill bladder + monitor pressures, ask PT to cough etc
264
overactive bladder is a term used to describe
overactive detrusor m with or without incontience
265
causes of urge incontinence
cystitis, bladder stone, prostate enlargement, idiopathic, neuropathic detrusor overactivity (spinal injury, MS, PD, spina bifida, stroke)
266
Mx of urge incontinence
Rx underlying cause, lifestyle changes, anticholinergics, BOTOX, sacral n stimulation, Sx
267
causes of stress incontinence
age, childbirth, hysterectomy, obesity, trauma, prostate Sx
268
Mx of stress incontinence (women)
pelvic floor exercises, weight loss, stop smoking, avoid constipation, Sx
269
stress incontinence investigations in men
video-urodynamics, endoscopy
270
Mx of stress incontinence in men
sphincter augmentation, artificial sphincter
271
mixed incintinence investigaitons
urodynamics
272
causes of bladder obstruction
enlarged prostate, previous Sx, bladder stones, urethral stricture, constipation
