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Medicine > Urology > Flashcards

Urology Flashcards

1
Q

priapism definition

A

prolonged painful erections

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2
Q

prolonged painful erections

A

priapism

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3
Q

causes of priapism

A

HbSS, trauma, ED medication (e.g. sildenafil)

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4
Q

HbSS, trauma, ED medication could be causes of

A

priapism

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5
Q

priapism management

A

requires prompt treatment to prevent ischaemic damage
medical = phenylephrine
surgical = decompression + corporal aspiration

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6
Q 
medical = phenylephrine
surgical = decompression + corporal aspiration
A

priapism management

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7
Q

phenylephrine is

A

an sympathomimetic acting predominantly on a-adrenergic R –> peripheral vasoconstriction

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8
Q

an sympathomimetic acting predominantly on a-adrenergic R –> peripheral vasoconstriction

A

phenylephrine

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9
Q

prostate ca location

A

posterior lobe, peripherally

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10
Q

prostate ca is graded using

A

Gleason score

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11
Q

Gleason score is used to grade

A

prostate ca

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12
Q

Gleason score system

A

the grade of the majority of the cells + the highest other grade seen (3-5)

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13
Q

most common testicular tumour in boys

A

yolk sac

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14
Q

yolk sac tumours

A

most common testicular tumour in boys, elevated AFP + Schiller Duval bodies

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15
Q

most common testicular tumour in boys, elevated AFP + Schiller Duval bodies

A

yolk sac tumours

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16
Q

Schiller Duval body

A

pathognomonic of yolk sac tumour, “resemble the glomerulus”

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17
Q

pathognomonic of yolk sac tumour, “resemble the glomerulus”

A

Schiller Duval body

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18
Q

testicular torsion

A

sudden, severe, testicular pain, tenderness, N+ V, cremasteric reflex may be absent

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19
Q

cremasteric reflex

A

lightly stroke the superior + medial thigh leads to a ipsilateral contraction of the cremaster muscle

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20
Q

lightly stroke the superior + medial thigh leads to

A

cremasteric reflex

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21
Q

absent cremasteric reflex

A

testicular torsion, upper + lower motor neurone disorders, L1/2 spinal injury

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22
Q

testicular torsion, upper + lower motor neurone disorders, L1/2 spinal injury may lead to

A

an absent cremasteric reflex

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23
Q

cryptorchidism

A

undescended testicle

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24
Q

undescended testicle

A

cryptorchidism

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25
Q

cryptorchidism risk factors

A

SGA, prematurity

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26
Q

SGA, prematurity are risk factors for

A

cryptorchidism

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27
Q

complications of cryptorchidism

A

torsion, infertility, testicular (germ cell) cancer

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28
Q

torsion, infertility, testicular cancer are complications of

A

cryptorchidism

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29
Q

cryptorchidism management

A

close monitoring + review at 3/12

>3/12 refer to paediatric surgeon ?orchiopexy

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30
Q

close monitoring + review at 3/12

>3/12 refer to paediatric surgeon is the management for

A

cryptorchidism

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31
Q

dorsal aspect of penis

A

anterior

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32
Q

ventral aspect of penis

A

poster

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33
Q

hypospadia

A

abnormal opening of the urethra on the inferior/ventral side of the penis

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34
Q

abnormal opening of the urethra on the inferior/ventral side of the penis

A

hypospadia

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35
Q

epispadias

A

abnormal urethral opening on the superior/dorsal surface of the penis

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36
Q

abnormal urethral opening on the superior/dorsal surface of the penis

A

epispadias

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37
Q

varicocele most commonly affect

A

the LHS due to increased resistance to flow (L gonadal verin to L renal vein, R gonadal v to IVC)

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38
Q

germ cell testicular cancer risk factors

A

Kleinfelter’s S, cryptorchidism

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39
Q

Kleinfelter’s S, cryptorchidism are risk factors for which type of testicular cancer

A

germ cell

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40
Q

testicular mass is ___ until proven otherwise

A

cancer

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41
Q

epididymal masses are nearly always

A

benign

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42
Q

differentials for scrotal pain

A

testicular torsion, testicular cancer, referred pain from renal colic, trauma, epididymitis, orchitis, strangulated hernia

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43
Q

differentials for scrotal swelling

A

testicular cancer, varicocele, hydrococele, testicular torsion, trauma, hernia, epididymitis/orchitis (STI, TB, mumps), spermatococele

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44
Q

differentials for difficulty passing urine

A

BPH, strictures, detrusor dysfunciton, UTI, bladder/prostate ca, neurological cause, retention

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45
Q

differentials for haematuria

A

infection, inflammation, baldder/kidney/ureter/prostate ca, stones, BPH, trauma, beetroot, ketamine abuse

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46
Q

differentials for loin pain

A

stones, MSK, trauma

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47
Q

differentials for urinary incontinence

A

stress (weak sphincter), urge (detrusor overactivity), mixed, functional, continuous (vesicovaginal fistulae), overflow (chronic distended bladder), nocturnal enuresis, post-micturition dribble

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48
Q

differentials for ED

A

age, depression, anxiety, stress, CVS DZ, Peyronie’s DZ, SC DZ, MS, PD, iatrogenic, DM, renal failure, cirrhosis

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49
Q

orchitis

A

less common than epididymo-orchitis, inflammation of just the testis, e.g. mumps orchitis (with parotid swelling)

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50
Q

varicocele

A

ectatic + tortuous v of the paminiform plexus of the spermatic cord, 15% of male adolescents, may cause pain, damage to testes, infertility

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51
Q

Peyronie’s DZ

A

CT DZ, fibrous plaques in the tunica albuginea, abnormal curvature, ED,

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52
Q

epididymo-orchitis

A

acute, ux, 2/3rds = chlamydia, may be urethral discharge, urethritis often asymptomatic

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53
Q

epididymo-orchitis management

A

quinolone ABx, doxy if chlamydia

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54
Q

ectatic + tortuous v of the paminiform plexus of the spermatic cord, 15% of male adolescents, may cause pain, damage to testes, infertility

A

varicocele

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55
Q

CT DZ, fibrous plaques in the tunica albuginea, abnormal curvature, ED,

A

Peyronie’s DZ

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56
Q

acute, ux, 2/3rds = chlamydia

A

epididymo-orchitis

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57
Q

quinolone ABx, doxy if chlamydia is the management for

A

epididymo-orchitis

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58
Q

prostate ca risk factors

A

age, ethnicity, FH

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59
Q

prostate ca presentation

A

PSA, LUTS, mets, malaise, weight loss, SCC, anaemia

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60
Q

prostate ca investigations

A

DRE, PSA, TRUS, MRI/CT, bone scan

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61
Q

PSA pros

A

detect ca, at earlier stage for Rx, serial measurements for progression of DZ

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62
Q

PSA cons

A

not diagnostic, doesn’t detect all ca, detece ca which PT may have died with rather than of (overtreatment)

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63
Q

T1/2 prostate ca

A

confined to prostate gland

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64
Q

prostate ca management

A

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

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65
Q

radical prostatectomy effect on PSA + SE

A

PSA should drop to 0, SE: ED, incontinence

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66
Q

EBRT

A

daily for 4-7.5/52, plus androgen deprivation therapy (LHRH agonist), SE: bowel symptoms, ED, frequency + urgency

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67
Q

brachytherapy

A

radioactive seeds inserted into prostate, SE: frequency + urgency, retention

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68
Q

T3 prostate ca

A

beyond prostate

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69
Q

T4 prostate ca

A

invades adjacent structures

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70
Q

medical castration

A

goserelin acts on pituitary gland to stop LH/FSH release, use cyproterone acetate (testosterone agonist) to prevent tumour flare

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71
Q

finasteride

A

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

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72
Q

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

A

finasteride

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73
Q

confined to prostate gland = Tx

A

1/2

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74
Q

beyond prostate = Tx

A

3

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75
Q

invades adjacent structures = Tx

A

4

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76
Q

AFP is a marker of

A

teratoma, HCC ca

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77
Q

explain TURP

A

NBM 6h prior, camera via penile opening to prostate, removes excess tissue, spinal/GA, overnight stay, catheter removed w/i 24h, OP follow up

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78
Q

alternative to TURP for BPH

A

medical (finasteride, tansulosin), catheterisation

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79
Q

complications of TURP

A

haematuria, injury to bladder/urethra, urinary incontinance, ED, retrograde ejaculation, urine infection, TURP S, urinary retention, recurrence

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80
Q

TURP S

A

rare, but potentially life threatening complication of TURP: hyponatraemia, electrolyte disturbances, fluid overload due to absorption of fluids used in bladder irrigation

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81
Q

hyponatraemia, electrolyte disturbances, fluid overload due to absorption of fluids used in bladder irrigation

A

TURP S

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82
Q

BPH investigations

A

IPSS, DRE, urinalysis (UTI, proteinuria, haematuria), PSA, prostate US, prostate biopsy, flow rate, bladder scan (post-void), urodynamics

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83
Q

IPSS, DRE, urinalysis, PSA, prostate US, prostate biopsy, flow rate, bladder scan, urodynamics

A

BPH investigations

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84
Q

tamsulosin

A

alpha-1-adrenoreceptor antagonist in the prostate causing smooth m relaxation, rapid onset

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85
Q

tamsulosin SE

A

dizziness, postural hypotension, dry mouth, depression, lethagy, GI disturbances, nasal congestion, ED

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86
Q

dizziness, postural hypotension, dry mouth, depression, lethagy, GI disturbances, nasal congestion, ED are SE of

A

tamsulosin

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87
Q

alpha-1-adrenoreceptor antagonist in the prostate causing smooth m relaxation, rapid onset is the method of action of

A

tamsulosin

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88
Q

finasteride SE

A

ED, decreased libido, ejaculatory disorders, gynaecomastia, breast tenderness

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89
Q

ED, decreased libido, ejaculatory disorders, gynaecomastia, breast tenderness are SE of

A

finasteride

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90
Q

which drug may decrease PSA by up to 50%?

A

finasteride

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91
Q

finasteride + PSA

A

may reduce valused by up to 50%

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92
Q

urinary symptoms - ask about

A

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

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93
Q

storage symptoms

A

urgency, urge incontinence, f, nocturia

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94
Q

voiding symptoms

A

hesitation, poor stream, terminal dribble, intermittent stream, post-void residual V, post-void dribble, prolonged voiding, straining

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95
Q

urgency, urge incontinence, f, nocturia

A

storage symptoms

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96
Q

hesitation, poor stream, terminal dribble, intermittent stream, post-void residual V, post-void dribble, prolonged voiding, straining

A

voiding symptoms

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97
Q

LUTS DD

A

BPH, bladder ca, prostate ca, UTI, OAB, urethral strictures, neurological DZ

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98
Q

BPH, bladder ca, prostate ca, UTI, OAB, urethral strictures, neurological DZ are differentials for

A

LUTS

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99
Q

scoring system used for LUTS

A

IPSS (international prostate symptom score)

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100
Q

BPH definition

A

hyperplasia = increase in the number of prostate cells, a histological diagnosis

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101
Q

BPE

A

enlargement of the prostate gland which may be due to BPH

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102
Q

BOO

A

bladder outflow obstruction = regardless of cause

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103
Q

BOO indications for referral + intervention

A

acute urinary retention, bladder stones, large post-void residual leading to obstructive nephropathy/recurrent infections, failing medical management

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104
Q

acute urinary retention, bladder stones, large post-void residual leading to obstructive nephropathy/recurrent infections, failure of medical management are indications for

A

referral + intervention

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105
Q

IPSS questions

A

incomplete emptying, f, intermittency, urgency, weak stream, straining, nocturia

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106
Q

BOO treatment options

A

watchful waiting, a-blockers (tamsulosin), 5a-reductase i (finasteride), combination therapy, phytotherapy, Sx, catheter

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107
Q

watchful waiting/conservative methods for BOO include

A

fluid intake, caffeine, EtOH, bladder retraining, continence pads

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108
Q

phytotherapy is

A

herbal remedy for BPH

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109
Q

herbal remedy for BPH

A

phytotherapy

110
Q

BXO

A

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
Q

associations with BXO

A

phimosis, SCC, infection

112
Q

itchy white spots on penis (foreskin + glans), hyperkeratotic, associated with dysuria, reduction of sensation of the glans

A

BXO balanitis xerotica obliterans

113
Q

BPH risk factors

A

age, ethnicity (black > white > asian)

114
Q

first line medical management of BPH

A

tamsulosin (a1-agonist, smooth m relaxant, quick acting)

115
Q

second line medical management in BPH

A

finasteride (5a-reductase i, slower acting)

116
Q

two types of urethral injury

A

bulbar rupture and membranous rupture

117
Q

bulbar rupture

A

straddle injuries, most common

triad of: urinary retention, perineal haemorrhage, blood at meatus

118
Q

membranous rupture

A

extra/intraperitoneal, pelvic #, penile/perineal oedema/haematoma, prostate displaced upwards

119
Q

investigations for urethral injury

A

ascending urethrogram

120
Q

management of urethral injury

A

suprapubic catheter (Sx placement)

121
Q

bulbar rupture and membranous rupture are two types of

A

urethral injury

122
Q

straddle injuries, most common

triad of: urinary retention, perineal haemorrhage, blood at meatus

A

bulbar rupture

123
Q

extra/intraperitoneal, pelvic #, penile/perineal oedema/haematoma, prostate displaced upwards

A

membranous rupture

124
Q

bladder injury presentation

A

intra/extraperitoneal rupture, haematuria, suprapubic pain, Hx of pelvic #, inability to void

125
Q

bladder injury investigations

A

IVU, cystogram

126
Q

bladder injury manaement

A

laporotomy or conservative management depending on injury

127
Q

most common type of testicular ca

A

germ cell (95%) - of which 60% are seminomas + 40 % are non-seminomas

128
Q

non-germ cell ca of the testis include

A

Leydig cell tumours, Sertoli cell tumours, lymphoma

129
Q

seminoma vs non-seminoma

A

seminoma: less aggressive, radiosensitive, 30-40 y.o.

non-seminoma: AFP + HCG raised, more aggerssive, 20-30 y.o.

130
Q

less aggressive, radiosensitive, 30-40 y.o. type of testicular cancer

131
Q

AFP + HCG raised, more aggerssive, 20-30 y.o. type of testicular ca

A

non-seminoma

132
Q

testicular ca symptoms

A

lump, pain, dragging sensation, inflammation, Hx of trauma, gynaecomastia

133
Q

testicular ca history questions

A

FH, cryptorchidism, previous testicular ca, Kleinfelter’s S, teticular atrophy

134
Q

stage I testicular ca

A

confined to testis

135
Q

stage II and III

A

LN involvement

136
Q

stage IV testicular ca

A

metastatic DZ

137
Q

testicular ca managemet

A

sperm freezing, inguinal orchidectomy, chemotherapy, radiotherapy

138
Q

testicular ca investigations

A

USS, serum AFP, HCG, LDH, CTCAP

139
Q

inguinal hernia

A

can’t get above it, cough impulse, may be reducible

140
Q

testicular tumours

A

may be discrete nodule, may be associated hydrococele, symptoms of metastatic DZ, USS, AFT, HCG

141
Q

acute epididymo-orchitis

A

Hx of dysuria + urethral discharge, tender, chlamydia risk factors,

142
Q

epididymal cyst

A

single or multiple, >40 y.o., painless, above + behind testis, separate from body of testis

143
Q

hydrococele

A

painless, fluctuant, transilluminate (2’ to epididymo-orchitis, tumour, torsion)

144
Q

testicular torsion

A

sudden, severe pain, risk = abnormal testicular lie, adolescents/young males, tender

145
Q

varicocele

A

L > R, affected testis may be smaller, may affect fertility, may be a presenting feature of RCC

146
Q

Sx exploration of suspected testicular torsion w/i

A

4-6hrs of onset of pain

147
Q

Sx for testicular torsion

A

untwisting of torsioned testis, if salvageable fixing to scrotal sac to prevent recurrence, fixation of the other testis too

148
Q

what’s the best modality to visulise urinary calculi

A

non contrast CT

149
Q

urinary calculi have a 10 year recurrence rate of

150
Q

risk factors for stone formation

A

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
Q

how do steroids + chemo for myeloproliferative DZ increase risk of urinary calculi

A

causes release of purines + uric acid

152
Q

how does immobility increase risk of urinary calculi

A

bone demineralisation + raised urinary Ca levels

153
Q

how does IBD/malabsorption increase risk of urinary calculi

A

causes high urinary oxalate levels (hyperoxaluria)

154
Q

stone types

A

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
Q

urinary calculi presentation

A

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
Q

US can be used to detect what type of urinary calculi

A

renal (not ureteric)

157
Q

pros of non contrast CT for detecting urinary calculi

A

high sensitivity (97%), quick, avoids contrast, detects other causes of abdo pain

158
Q

cons of non contrast CT for detecting urinary calculi

A

> 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
Q

management of sm asymptomatic stones

A

observe, if >4mm will likely become symptomatic

160
Q

interventional management of symptomatic stones

A

ESWL (extracorporeal shock wave lithotripsy), flexi uretererenoscopy, PCNL (percutaneous nephrolithotomy), laparoscopy, open Sx

161
Q

what is ESWL

A

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
Q

ESWL is used for

A

stones <2cm, unfit for GA, failure of endoscopic control

163
Q

flexi ureterorenoscopy is used for

A

stones <2cm, failed ESWL

164
Q

flexi ureterorenoscopy is suitable for

A

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
Q

ESWL CI

A

absolute: pregnancy, uncorrected bleeding disorder, anticoagulated PTs
relative: obese, aneurysmal DZ, skeletal abnormalities, unRx’d UTI, obstructed ureter, fertile females

166
Q

what is PCNL

A

percutaneous nephrolithotomy, GA, nephroscope through skin to collecting system + stone, laser/US E used to fragment stone, fragments washed out

167
Q

PCNL is good for

A

large stones >2cm, lower pole stones, trapped stones in caluceal diverticulum, staghorn

168
Q

medical managememt of symptomatic stones

A

antiemetics, NSAIDs (IM ketoprofen, PR diclofenac)

169
Q

investigations in urinary calculi

A

urinalysis, U+E, creatinine, non contrast CT/IVU/plain XR

170
Q

conservative management of sm stones

A

<4-6mm will pass on their own, a-blockers help

171
Q

PTs unsuitable for conservative management

A

> 7mm stone, uncontrolled pain, prolonged obstruction >2/52 that could lead to irreversible nephron loss, fever, solitary kidney, renal impairment, social impact

172
Q

f stone formers/+ve FH need to rule out

A

abnormal Ca metabolism, cytinuria (less common)

173
Q

stones <2cm, unfit for GA, failure of endoscopic control

174
Q

stones <2cm, failed ESWL

A

use flexiureterorenoscopy

175
Q

hard stones (cystine), lower pole stones, obese PTs, skeletal abnormalities, stones trapped in calyceal diverticula, challenging anatomy (pelvic/horeshoe kidney), safe in anticoagulated PTs

A

flexiureterorenoscopy

176
Q

pregnancy, uncorrected bleeding disorder, anticoagulated PTs are CI of

177
Q

shock waves directed under XR/US onto stone, absorption of shock waves leads to break up of stone, fragments passed in urine

A

extracorpal shock wave lithotripsy

178
Q

GA, nephroscope through skin to collecting system + stone, laser/US E used to fragment stone, fragments washed out

A

percutaneous nephrolithotomy

179
Q

large stones >2cm, lower pole stones, trapped stones in caluceal diverticulum, staghorn

180
Q

> 7mm stone, uncontrolled pain, prolonged obstruction >2/52 that could lead to irreversible nephron loss, fever, solitary kidney, renal impairment, social impact

A

unsuitable for medical management

181
Q

abnormal Ca metabolism, cytinuria (less common) needs to be ruled out in

A

f stone formers/+ ve FH

182
Q

types of ca stone

A

Ca oxalate > Ca phosphate

183
Q

types of infection seen with staghorn calculi

A

Proteus mirabilis

184
Q

Proteus mirabilis infection seem with what type of stone

A

staghorn/Struvite/Mg NH4 PO43-

185
Q

paraphimosis occurs in

A

uncircumcised men

186
Q

mechanism of paraphimosis

A

foreskin becomes fixed in the retracted position, cannot be reduced, constricting venous return from the glans, leading to swelling

187
Q

paraphimosis is related to

A

previous phimosis

188
Q

most common cause of paraphimosis

A

iatrogenic - medical staff not replacing the foresking after catheterisation

189
Q

without Rx paraphimosis can lead to

A

ulceration + necrotic changes

190
Q

management of paraphimosis

A

analgesia (nerve block), manual decompression, dorsal slit, formal circumcision

191
Q

phimosis is a risk factor for

192
Q

causes of phimosis

A

lichen sclerosis, balanitis xerotica obliterans

193
Q

foreskin becomes fixed in the retracted position, cannot be reduced, constricting venous return from the glans, leading to swelling describes

A

paraphimosis

194
Q

analgesia (nerve block), manual decompression, dorsal slit, formal circumcision is the managment for

A

paraphimosis

195
Q

BXO balanitis xerotica obliterans increases your risk of

A

SCC (penile ca), infection

196
Q

balanitis is

A

inflammationof the glans + prepuce

197
Q

BXO is a common cause of

198
Q

bladder ca risk factors

A

smoKing (3x risk), analine dye

199
Q

bladder ca presentaiton

A

frank haematuria, painless, dysuria, urgency, bladder pain, loin pain

200
Q

bladder ca investigations

A

urine dip (haematuria > 1+), MSU cytology (infection), flexi cystoscopy, XR/US (stones, masses, hydronephrosis), IVU/non contrast CT, flourescence cystoscopy, rigid cystoscopy

201
Q

most bladder cancers are what type

202
Q

pronounced irritative symptoms of bladder ca may suggest

A

m invasive DZ, or carcinoma in situ

203
Q

loin pain in bladder ca may be a sign of

A

ureteric obstruction

204
Q

flourescent cystoscopy

A

catheter used to insert dye prior to cystoscopy, tumour cells flouresce red under blue light

205
Q

haematuria defined as what on microscopy

A

> 3 RBC/high power field

206
Q

grade of bladder ca indicates

A

how well differentiated it is

207
Q

T staging

A 
T1 = invaded the subepithelial CT
T2 = invades m
T3 = invades the perivesicular tissue
T4 = invades other structures
208
Q

management of low grade bladder ca

A

TURBT + intravesicular mitomycin C (chemotherapy, single vs multiple doses)

209
Q

explaining TURBT

A

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
Q

complications of TURBT

A

infection, haematuria, bladder perforaton, urethral stricture

211
Q

high grade bladder tumour management

A

initial resection may be incomplete + require early 2nd TURBT, repeat intravesicular BCG

212
Q

how does the intravesicular BCG injection work

A

theory = BCG attaches onto the urothelium + mediates an immune response which reduces recurrence + pregression

213
Q

m invasive bladder ca management

A
  1. TURBT (establish diagnosis), 2. CTCAP, bone scan 3. choice: cystectomy +/- orthotopic bladder reconstruction, EBRT, selective bladder preservation dependent on response to chemo
214
Q

neo-adjuvent chemo for bladder ca

A

gemcitabine + cisplatin

215
Q

smoKing (3x risk), analine dye are risk factors for

A

bladder ca

216
Q

frank haematuria, painless, dysuria, urgency, bladder pain, loin pain is the presentation of

A

bladder ca

217
Q

m invasive DZ, or carcinoma in situ bladder ca may present with

A

pronounced irritative symptoms: dysuria, pain

218
Q

ureteric obstruciton 2’ to bladder ca may present as

219
Q

catheter used to insert dye prior to cystoscopy, tumour cells flouresce red under blue light

A

flourescent cystoscopy

220
Q

how well differentiated the bladder ca is is indicated by

221
Q

TURBT + intravesicular mitomycin C (chemotherapy, single vs multiple doses) is the management of

A

low grade bladder ca

222
Q

infection, haematuria, bladder perforaton, urethral stricture are complications of

223
Q

initial resection may be incomplete + require early 2nd TURBT, repeat intravesicular BCG is the management of

A

high grade bladder ca

224
Q
  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
A

m invasive bladder ca

225
Q

gemcitabine + cisplatin are used as

A

neo-adjuvent chemo for bladder ca

226
Q

most common UTI organisms

A

E. coli, Klebsiella, Proteus

227
Q

causes of UTI

A

breach of bladder lining, foreign body, calculi, DM, immunocompromised, urinary track obstruction, pregnancy, post-menopausal

228
Q

uncomplicated UTI definition

A

involving a PT with a structurally + functionally N urinary tract

229
Q

complicated UTI

A

occuring in the presence of an underlying anatomical/functional abnormality

230
Q

management of uncomplicated UTI

A

ABx (trimethoprim, nitrofurentoin, amoxicillin)

231
Q

UTI symptoms (lower tract)

A

f, dysuria, suprapubic pain, haematuria

232
Q

UTI symptoms (upper tract)

A

fever, loin pain, V

233
Q

factors that suggest complicated UTI

A

male, hospital acquired, pregnancy, indwelling urethral catheter, recent UTI, functional/anatomical abnormality of the urinary tract, DM, immunosuppression

234
Q

indications for further investigation in uncomplicated UTI in women

A

signs of upper tract infection, failure to respond to ABx, recurrent infections, factors suggestive of complicated UTI, pregnancy

235
Q

pylonephritis

A

loin pain, fever

236
Q

pylonephritis DD

A

appendicitis, cholecystitis, pneumonia, generalised septicaemia

237
Q

pylonephritis management

A

quinolone for 7/7

238
Q

recurrent UTI

A

> 2 infection in 6/12, or 3 w/i 12/12

239
Q

management of recurrent UTI

A

Rx initial infection, further investigations: bacterial persistence, calculi, poor bladder emptying, neoplasm

240
Q

recurrent UTI investigations

A

plain KUB XR, US, post-void residual, flexi cystoscopy

241
Q

recurrent UTI management

A

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
Q

UTI in pregnancy

A

should be Rx’d with ABx even if asymptomatic

243
Q

UTI in men

A

less common than women, should rule out BOO

244
Q

UTI in men investigations

A

DRE, flow rate, post void residual

245
Q

infectionin the presence of an obstructed upper tract

A

uological emergency, associated with calculus obstructionof the ureter, ABCDE approach, nephrostomy

246
Q

E. coli, Klebsiella, Proteus are the most common causative irganisms for

247
Q

should be Rx’d with ABx even if asymptomatic

A

UTI in pregnancy

248
Q

which ABx should be avoided in the 1st trimester

A

trimethoprim (teratogen)

249
Q

which ABx should be avoided close to term

A

nitrofurantoin (neonatal haemolysis)

250
Q

duration of ABx for pregnanct women

A

7/7, further culture on completion

251
Q

catheterisation complications

A

bleeding, infection, risk of bladder damage

252
Q

causes of urinary retention

A

obstructive: BPH, prostate ca, calculi
iatrogrnic: anticholinergics, opiates, a-agonists
neurological: cauda equina, spinal stenosis

253
Q

underlying mechanism of urge incontinence

A

increasing detrusor P, detrusor overactivity, innapropriate contractions

254
Q

underlying mechanism of stress incontinence

A

weak sphincter, weak pelvic floor m

255
Q

underlying mechanism of necturnal enuresis

A

overactive detrusor m

256
Q

underlying mechanism of post micturition dribble

A

pooling of urine in urether

257
Q

underlying mechanism of overflow incontinence

A

obstrucion + full bladder

258
Q

underlying mechanism of functional incontinence

A

impaired mobility/mental functioning leading to inappropriate urination

259
Q

incontinence Hx

A

mobility, nature, duration, PMH, cultural/social/lifestyle (fluid intake) factors, PSH, cognition, DH, sexual function, bowels, expectations, Sx fitness

260
Q

incontinence O/E

A

general (wellbeibng + fitness for Rx), mobility, abdo, pelvic, PR

261
Q

incontinence Ix

A

bladder diary, urinalysis, flow rates, post-mic scan, urodynamics, cystoscopy

262
Q

main method of diagnosing detrusor overactivity

A

urodynamics

263
Q

urodynamics involves

A

catheter, priobe in rectum, artificially fill bladder + monitor pressures, ask PT to cough etc

264
Q

overactive bladder is a term used to describe

A

overactive detrusor m with or without incontience

265
Q

causes of urge incontinence

A

cystitis, bladder stone, prostate enlargement, idiopathic, neuropathic detrusor overactivity (spinal injury, MS, PD, spina bifida, stroke)

266
Q

Mx of urge incontinence

A

Rx underlying cause, lifestyle changes, anticholinergics, BOTOX, sacral n stimulation, Sx

267
Q

causes of stress incontinence

A

age, childbirth, hysterectomy, obesity, trauma, prostate Sx

268
Q

Mx of stress incontinence (women)

A

pelvic floor exercises, weight loss, stop smoking, avoid constipation, Sx

269
Q

stress incontinence investigations in men

A

video-urodynamics, endoscopy

270
Q

Mx of stress incontinence in men

A

sphincter augmentation, artificial sphincter

271
Q

mixed incintinence investigaitons

A

urodynamics

272
Q

causes of bladder obstruction

A

enlarged prostate, previous Sx, bladder stones, urethral stricture, constipation

Medicine (30 decks)

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