Urology Flashcards
Most common type of kidney stone
Calcium oxalate
Pain relief in renal colic
IM Diclofenac
Imaging in renal stones
Initially USS
Diagnostically non contrast CT KUB
Stone management
<5mm
Usually pass spontaneously within 4 weeks
Stone management
Stone burden of less than 2cm in aggregate
Lithotripsy
Stone management
Stone burden of less than 2cm in aggregate in pregnant
Ureteroscopy
Stone management
Complex renal calculi and staghorn calculi
Percutaneous nephrolithotomy
Prevention of renal stones
Reducing calcium stones
- High fluid
- Thiazides diuretics
Reducing oxalate stones
- cholestyramine
- pyridoxine
Reducing uric acid stones
- allopurinol
- urinary alkalisation eg oral bicarbonate
Causes of unilateral hydronephrosis
PACT
Pelvic ureteric obstruction
Aberrant renal vessels
Calculi
Tumours of renal pelvis
Causes of bilateral hydronephrosis
SUPER
- Stenosis of the urethra
- Urethral valve
- Prostatic enlargement
- Extensive bladder tumour
- Retro peritoneal fibrosis
Investigation of hydronephrosis
USS
Management of hydronephrosis
Remove obstruction and drainage of urine
Acute upper - nephrostomy
Chronic upper - ureteric stent or pyeloplasty
Renal cell cancer associations
More common in middle aged men
Smoking
Von Hippel Lindau syndrome
Tuberous sclerosis
Features of renal cell cancer
Classical Triad - haematuria, loin pain, abdo mass
Pyrexia Left varicocele Endocrine effects (polycythaemia, hypercalcaemia, renin, ACTH)
Bladder cancer risk factors
Transitional
- smoking
- aniline dyes
- rubber
- cyclophosphamide
Squamous
- schistosomiasis
- BCG treatment
- smoking
BPH ethnicity
Black > white > Asian
First line for BPH
Alpha 1 antagonists - tamsulosin, alfuzosin
Decrease smooth muscle tone
Second line BPH
5 alpha reductive inhibitors eg finasteride
Side effects of alpha-1 antagonists
Dizziness, postural hypotension, dry mouth, depression
Side effects of 5 alpha reductive inhibitors
Erectile dysfunction, reduced libido, ejaculation problems, gynaecomastia
PSA levels may be raised by
BPH Prostatitis and UTI Ejaculation in last 48hrs Vigorous exercise in last 48hrs Urinary retention Instrumentation of the urinary tract
Inguinal hernia
Inguinoscrotal swelling
Cannot get above it
Cough impulse may be present
May be reducible
Testicular tumours
Often discrete nodule
USS scrotum and serum AFP and BHCG
Acute epididymo-orchitis
Often history of dysuria and discharge
Swelling may be tender and eased by elevating testes
Most cases due to chlamydia
Non infective cause - amiodarone