Urology Flashcards
What type of cancer is prostate cancer?
Adenocarcinoma
What are some risk factors for prostate cancer?
Age
Family history
Afro-Caribbean descent
What is the tumour level for prostate cancer?
PSA
Levels depend on age
How would an abnormal prostate feel on DRE?
Enlarged, hard, irregular
What are some symptoms of local prostate cancer?
Urinary symptoms e.g. hesitant starting, increased frequency, urgency, UTI, incomplete emptying
How could symptoms of locally invasive prostate cancer present?
Haematuria Dysuria Ureteric obstruction (causing loin pain/ anuria/ signs of AKI/ CKD) Tenesmus Suprapubic pain
Other than prostate cancer, what else can PSA be raised in?
BPH Exercise UTI Ejaculation Instrumentation of urinary tract eg catheter
What scoring system is used to grade prostate cancer?
Gleason scoring (6 to 10 cancer, 10 being worst differentiated)
A painless lump is felt in a 28 year old males testicle, what is the most likely to be?
Testicular cancer
Which prostatic zones enlarge in prostate Ca and in BPH?
In prostate Ca the peripheral zone is affected
In BPH the inner transitional zone enlarges
What is tamsulosin and when may it be indicated?
It is an alpha blocker
So causes smooth muscle relaxation in the bladder neck and the prostate
Can be used in urinary retention, BPH, to help with passage of renal stones
What drugs are first line in BPH?
Alpha blocker e.g. tamsulosin
If there is a scrotal mass, and on palpating you cannot get above it, what diagnosis does this suggest?
Inguinalscrotal hernia
What is epididymo-orchitis?
Acute inflammation of the epididymis often caused by a bacterial infection
(Chlamydia/ gonorrhoea if <35)
What are epididymal cysts?
Cyst containing clear or milky fluid that lies above and behind the testis, can be removed in symptomatic
What is a varicocele?
Dilated veins of the pampiniform venous plexus that feels like a bag of worms
Associated with infertility
Which side are varicoceles more common in?
Left
Severe and sudden onset of pain in one testis indicates what?
Testicular torsion
When in testicular torsion most common?
Ages 10 to 30
What is a hydrocele?
Accumulation of fluid within the tunica vaginalis
Presents as a mass that transluminates
Soft, non tender swelling that is anterior to and below the testis
May occur in children due to patent processus vaginalis
What are some causes of haematuria?
Infection Trauma Tumours Stones Nephropathies
What are the 3 most common locations where renal stones are deposited?
PUJ
Pelvic brim
Vesicoureteric junction
What are most renal stones formed from?
Calcium oxalate
What type of renal stones form staghorn calculus?
Struvite (triple phosphate) stone that form in alkaline urine
Which renal stones are radiolucent?
Urate stones
What is Renal colic?
Excruciating ureteric spasms eliciting pain from loin to groin
Associated with nausea and vomiting
Often cannot lie still
What investigations would you want for a px with ?renal stones?
FBC U&Es (may have raised calcium/ phosphate/ bicarbonate/ urate) Urine dip (usually +ve for blood) MSU (culture) USS non-contrast CT KUB to confirm diagnosis
How would you initially managed a px with renal colic?
- NSAID diclofenac IM
- Hydration! (IV fluids if not P.O.)
- Antiemetics
- Alpha blocker e.g. tamsulosin to aid stone passage
- Abx e.g. gentamycin if infection
- Then can try ECSWL/ ureteroscopy/ nephrolithotomy etc
What is ECSWL?
Extracorpeal shockwave lithotripsy
Use if stone <1cm
Uses laser to break up the stones
What is percutaneous nephrolithotripsy and when would it be indicated?
Keyhole surgery to gain access to Renal collecting system
Used to remove large/ multiple/ complex stones e.g. staghorn calculus
When will urgent surgery be indicated for a px with renal stones?
If infection + obstruction present
Can lead to urosepsis
Urgent percutanoues nephrolithotripsy or stent, and IV Abx
Why may a thiazide be used for patients with calcium renal stones?
To reduce calcium excretion and prevent further stones
What advice would you give to prevent further renal stones?
- drink plenty of fluids
- avoid foods high in oxalate e.g. coffee, beetroot, spinach, chocolate
When would antimuscarinics be contraindicated?
Glaucoma (Can cause dry eyes)
Myasthenia gravis
How would stress incontinence be managed?
1st line: pelvis floor exercises (8 contractions 3xday for 3/12), also conservative management eg reduce caffeine, modify fluid intake
Surgery: vaginal tape or urethral fascial sling or intramural bulkin injections
If surgery CI, try Duloxetine
How would urge urinary incontinence be managed?
1st line bladder training programme
2nd line: antimuscarinics e.g. oxybutynin
Can also try intravesical Botox, Beta 3 agonist, tropical Oestrogens if lost menopausal
What is oxybutynin?
Antimuscarinic often used in urge incontinence
What is a likely diagnosis for a px presenting with haematuria, loin pains and an abdominal mass?
Renal cell carcinoma
Which cancer can a left varicocele be a symptom for and why?
Renal cell carcinoma
If it invades the left Renal vein it can compress the left testicular vein
Why does RCC cause hypertension?
Due to increased renin secretion
Why can RCC present with polycythaemia?
Increased EPO production
What is polycythaemia?
Elevated haematocrit (volume % of RBCs in the blood)
Which cancer often presents with lots of paraneoplastic syndromes?
RCC
Why can RCC present with hypercalcaemia?
More activated vitamin D
Why are renal cell carcinomas not managed with radio and chemo therapy?
Radio and chemo resistant
So tyrosine kinase inhibitor biological therapies are given to inhibit angiogenesis
How is renal cell carcinoma managed?
T1 can have partial nephrectomy
T2-4 radial nephrectomy
What is Wilms tumour?
Childhood nephroblastoma
Presents with abdominal mass and haematuria
What type of cancers are most bladder cancers?
Transitional cell carcinomas
What are some risk factors for bladder Ca?
Male
Smoking
Aromatic amine exposure (rubber industry)
Schistosomiasis (risk of SCC not TCC)
How does bladder cancer present?
Painless haematuria
Recurrent UTIs
Voiding irritation
How is bladder cancer diagnosed?
Flexible cystoscopy with biopsy
CT urogram
How is bladder Ca managed?
Transurethral resection of bladder tumour BCG regimen (stimulates immune response)
If superficial eg Ta/T1 can have intravesical mitomycin
For T2-3 radical cystectomy, with chemo
T4 usually palliative chemo and radiotherapy
What ethnic group is prostate Ca more common in?
Afro Caribbean
