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Finals Revision > Urology > Flashcards

Urology Flashcards

1
Q

What does the prostate secrete?

A

An alkaline fluid with clotting enzymes and zinc

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2
Q

What is the approximate size of a normal prostate?

A

Walnut shaped, around 20g

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3
Q

What is benign prostatic hyperplasia?

A

Irregular proliferation of glandular and stromal tissue of the prostate

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4
Q

Where does BPH commonly occur?

A

Transitional zone

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5
Q

What are risk factors for developing BPH?

A

Age, black ethnicity

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6
Q

How does BPH present?

A

Poor flow, straining, hesitancy, incomplete emptying, urgency, frequency, dribbling, recurrent UTI, retention

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7
Q

What investigations should you do if you suspect BPH?

A

PR exam, MSSU, U&Es.

PSA, Transrectal USS +/- biopsy

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8
Q

Why should you do bloods for PSA before a PR exam?

A

PR exam can falsely elevate the PSA

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9
Q

What is PSA?

A

An enzyme produced by the secretory cells of the prostate

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10
Q

What can elevate the PSA?

A

Malignancy, BPH, UTI, ejaculation, vigorous exercise, urinary retention

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11
Q

What is a normal PSA?

A

Less than or equal to 4

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12
Q

What are some conservative management options for BPH?

A

Decreasing alcohol and caffeine intake

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13
Q

What is the first line medical treatment for BPH?

A

Alpha blocker - tamsulosin

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14
Q

How does tamsulosin work?

A

Decreases smooth muscle tone

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15
Q

What are some side effects of tamsulosin?

A

Dizziness, postural hypotension, dry mouth, depression

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16
Q

What is the second line medical treatment for BPH?

A

5-alpha-reductase inhibitor - finasteride

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17
Q

How does finasteride work?

A

Blocks conversion of testosterone to DHT which reduces prostate volume

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18
Q

How long may finasteride take to work?

A

A few months but slows the progression of BPH

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19
Q

What are some side effects of finasteride?

A

Erectile dysfunction, reduced libido, ejaculation problems, gynaecomastia

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20
Q

What surgical option is there for BPH?

A

TURP (transurethral resection of prostate)

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21
Q

Is BPH pre-malignant?

A

No

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22
Q

When is the peak incidence of prostate cancer?

A

60-80 years

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23
Q

What is the tumour type of most prostate cancers?

A

Adenocarcinoma

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24
Q

Where do most prostate cancers arise in the prostate?

A

Peripheral zone

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25
Q

Where is common sites of metastases in prostate cancer?

A

Pelvic lymph nodes, bone (sclerotic lesions)

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26
Q

What are symptoms of prostate cancer?

A

Asymptomatic or nocturia, hesitancy, poor stream, dribbling, weight loss, bone pain

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27
Q

What investigations should you do for prostate cancer?

A

PR exam, PSA, Transrectal USS +/- biopsies

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28
Q

What may be felt on a PR exam in prostate cancer?

A

A fixed hard craggy mass

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29
Q

What scoring system is used to grade prostate cancer?

A

Gleason’s score

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30
Q

What system is used to stage prostate cancer?

A

TNM

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31
Q

What are the management options if the cancer is confined to the prostate?

A

Watch and wait
Radical prostatectomy
Radiotherapy

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32
Q

What are the management options if prostate cancer is locally advanced?

A

Watch and wait
Radical prostatectomy
Hormone therapy

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33
Q

What two types of hormone therapy are used?

A 
GnRH analogues (Goserelin)
Anti-androgens (cyproterone)
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34
Q

What are the management options for metastatic prostate cancer?

A

Hormones
Steroids
Chemotherapy

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35
Q

What are the side effects of a radical prostatectomy?

A

Erectile dysfunction, incontinence, bladder neck stenosis

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36
Q

What are the side effects of radiotherapy for prostate cancer?

A

Irritative LUTS, haematuria, GI symptoms, erectile dysfunction, incontinence

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37
Q

What are the side effects of GnRH agonists (Goserelin)?

A

Loss of libido, hot flushes, sweating, weight gain, osteoporosis

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38
Q

What are the side effects of anti-androgens (Cyproterone)?

A

Loss of libido, erectile dysfunction, gynaecomastia, cardiac and liver toxicities

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39
Q

What is the bladder pressure during the storage phase of micturition?

A

Low to allow passive filling

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40
Q

What muscle increases the intravesicular pressure during the voiding phase of micturition?

A

Detrusor muscle

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41
Q

What nerves are involved in the micturition reflex?

A

Pelvic parasympathetic nerves

Pudendal

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42
Q

What are some risk factors for urinary incontinence?

A

Advancing age, previous pregnancy, childbirth, high BMI, FH, hysterectomy

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43
Q

What causes overflow incontinence?

A

Bladder outlet obstruction

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44
Q

What are the causes of overflow incontinence?

A

BPH, prostate cancer, urethral narrowing

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45
Q

How does overflow incontinence present?

A

Chronic retention, incontinence, wet at night, huge palpable bladder

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46
Q

How is overflow incontinence managed?

A

Assess renal function, try address underlying cause

Intermittent self-catheterisation to retrain the bladder

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47
Q

What is urge incontinence?

A

Sudden urge to empty the bladder often followed by uncontrollable and complete emptying

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48
Q

What can precipitate urge incontinence episodes?

A

Sound of running water, lock in door, obesity, caffeine

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49
Q

What is the underlying cause of urge incontinence?

A

Detrusor instability (due to stress, infection, tumour, paraplegia, pelvic surgery)

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50
Q

What investigations should you do for urge incontinence?

A

Bladder diary, MSSU, urodynamic studies

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51
Q

How is urge incontinence managed conservatively?

A 
Diet and weight loss
Bladder retraining (minimum of 6 weeks)
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52
Q

How is urge incontinence managed medically?

A

Anti-muscarinics (e.g. oxybutynin and tolterodine)

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53
Q

How is urge incontinence managed surgically?

A

Botox, neuromodulation, surgery on detrusor muscle

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54
Q

What is stress incontinence?

A

Involuntary leakage of urine when intra-abdominal pressure is increased e.g cough sneeze

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55
Q

Does stress incontinence involve the detrusor muscle?

A

NO - leakage of urine occurs without detrusor contraction

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56
Q

What are some causes of stress incontinence?

A

Pregnancy, child birth, postmenopause

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57
Q

What investigations should you do for stress incontinence?

A

Bladder diary
PV exam (check for prolapse)
MSSU
Urodynamic studies

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58
Q

How is stress incontinence managed conservatively?

A

Weight loss, stop smoking, pelvic floor physiotherapy and biofeedback

59
Q

How can stress incontinence be managed medically?

A

Duloxetine - only offered second line when woman does not want surgery

60
Q

What is mixed urinary incontinence?

A

Features of both stress and urge incontinence

61
Q

What causes mixed urinary incontinence?

A

Often mutlifactorial - immobility, dementia, neuropathy, pelvic floor weakness

62
Q

What are extra-urethral causes of urinary incontinence?

A

Ectopic ureter

Vesico-vaginal fistula

63
Q

What is defined as a complicated UTI?

A

UTI with systemic symptoms or there is a structural abnormality

64
Q

What are risk factors for UTI?

A

Female sex, sexual intercourse, incontinence

65
Q

What are some common organisms causing UTI?

A

E.Coli, Klebsiella, Enterococcus, Proteus, Staph saphrophyticus, pseudomonas

66
Q

What are signs and symptoms of UTI?

A

Dysuria, frequency, nocturia, haematuira, loin pain, fever, rigors

67
Q

What would an MSSU in UTI show?

A

Leukocytes and nitrites +ve - pure growth of organism

68
Q

What is the treatment of an uncomplicated female UTI?

A

Nitrofurantoin or trimethoprim (3 days)

69
Q

What is the treatment of an uncomplicated male UTI?

A

Nitrofurantoin or trimethoprim (7 days)

70
Q

How is UTI treated in the first 2 trimesters of pregnancy?

A

Nitrofurantoin (7 days)

71
Q

How is UTI treated in the 3rd trimester of pregnancy?

A

Trimethoprim (7 days)

72
Q

How is a complicated UTI treated in the community?

A

Co-trimoxazole/co-amoxiclav (7 days)

73
Q

How is a complicated UTI treated in the hospital?

A

IV amoxicillin + gentamicin step down to PO co-trimoxazole (IV/PO 7 days)

74
Q

What is a recurrent UTI defined as?

A

2 or more UTIs in 6 months or 3 or more UTIs in one year

75
Q

How can recurrent UTI be treated?

A

Nitrofurantoin or trimethoprim taken every evening or post coital (review after 6 months)

76
Q

What are some causes of acute urinary retention?

A

Obstruction (e.g. BPH, tumour)

Decreased detrusor power

77
Q

What are some symptoms of acute urinary retention?

A

Pain, distention

78
Q

What examinations should you do on someone with acute urinary retention?

A

Abdominal exam

PR and perineal sensation to rule out cauda equina

79
Q

How is acute urinary retention treated?

A

Catheterise patient. Trial without catheter done after 7 days - can give alpha blocker prior to this to aid success

80
Q

What is the commonest type of renal stone made of?

A

Calcium oxalate

81
Q

Where are the commonest sites for kidney stones to get stuck?

A

Vesio-ureteric junction (COMMONEST)
Pelvicureteric junction
Pelvic brim

82
Q

What are some risk factors for kidney stones?

A

Recurrent UTIs, metabolic abnormalities, urinary tract abnormalities, FH, foreign bodies, some drugs (diuretic, antacids, aspirin, allopurinol)

83
Q

What are symptoms of kidney stones?

A

Renal colic, loin to groin pain, nausea and vomiting, haematuria, proteinuria, anuria

84
Q

What may be found on examination of a patient with kidney stones?

A

Renal angle tendernes

MSSU - Blood ++

85
Q

What is the imaging of choice for kidney stones?

A

Non-contrast CT KUB

86
Q

What is the imaging of choice for kidney stones during pregnancy?

87
Q

How are kidney stones managed initially?

A 
NSAID for pain relief (IM Diclofenac)
Anti-emetic
Hydration
Alpha blocker for small stones to help them pass
If not passed in 1 month - intervene
88
Q

What surgical options can be given to remove kidney stones?

A

Ureteric stent + fragmentation
Shockwave lithotripsy
Percutaneous nephrolithotomy
Percutaneous nephrostomy

89
Q

At what age is testicular torsion commonest and why?

A

Puberty due to increase in size of testes

90
Q

What are some causes of testicular torsion?

A

Trauma, athletic injury, spontaneous

91
Q

What are symptoms of testicular torsion?

A

Sudden onset pain, walking uncomfortable, abdominal pain, nausea and vomiting

92
Q

What are signs of testicular torsion?

A

Tender, hot, swollen testis
High in scrotum, lying transversely
Cremasteric reflex absent

93
Q

How is testcular torsion investigated?

A

Colour doppler USS - lack of blood flow to testis

94
Q

How is testicular torsion treated?

A

Prompt exploration
Surgery to expose testes and untwist
If necrotic - remove
If good colour return and fix BOTH testes to the scrotum

95
Q

How does torsion of the appendage present?

A

More insidiously than testicular torsion
Testis mobile
Present cremasteric reflex
Blue dot sign

96
Q

What is priapism?

A

Prolonged erection (>4hrs) often painful and not associated with sexual arousal

97
Q

What can cause priapism?

A

Erectile dysfunction drugs, trauma, haematological conditions, sickle cell crisis, idiopathic

98
Q

What is ischaemic priapism due to?

A

Venous stasis - essentially compartment syndrome

99
Q

What is non-ischaemic priapism due to?

A

Traumatic disruption of penile vasculature

100
Q

What is Fourniers gangrene?

A

Form of necrotizing fasciitis occurring around the male genitalia

101
Q

What are risk factors for Fourniers gangrene?

A

Diabetes, trauma, perineal infection

102
Q

How does Fourniers gangrene present?

A

Often starts as a cellulitis (erythematous, swollen, tender)
Swelling and crepitus of the scrotum
Dark purple areas

103
Q

What are the pathogens of Fourniers gangrene?

A

Aerobes and anaerobes

Often beta-haemolytic strep

104
Q

How is Fourniers gangrene diagnosed?

A

Plain X-ray or USS to confirm gas in the tissues

105
Q

How is Fourniers gangrene treated?

A

Antibiotics and debridement

106
Q

What are some types of benign renal tumours?

A

Cysts, angiomyolipomas

107
Q

What condition are angiomyolipomas associated with?

A

Tuberous sclerosis

108
Q

What are angiomyolipomas composed of?

A

Tumours composed of blood vessels, smooth muscle and fat

109
Q

What can rupture of an angiomyolipoma lead to?

A

Wunderlich’s syndrome

110
Q

What is the commonest type of renal cancer?

A

Renall Cell Carcinoma

111
Q

Where do renal cell carcinomas arise from?

A

Proximal renal tubular epithelium

112
Q

What are renal cell carcinomas associated with?

A

Smoking, Von-Hippel-Lindeau, Tuberous Sclerosis

113
Q

What is the classic triad of symptoms of renal cell carcinoma?

A

Haematuria
Loin Pain
Loin Mass

114
Q

What other symptoms are associated with RCC?

A

Pyrexia of unknown origin, left varicocele, polycythaemia, symptoms of hypercalcaemia

115
Q

How does RCC spread?

A

Haematogenously

116
Q

Where are common metastases sites for RCC?

A

Lung - Cannon Ball Mets

117
Q

What is the definitive imaging for RCC?

A

CT with triple phase contrast

118
Q

What staging system is used in RCC?

A

Robson’s staging

119
Q

How is RCC treated?

A

Radical/partial nephrectomy

Adjuvant biologics, interferon alpha

120
Q

What other type of cancer can arise in the kidneys?

A

Transitional cell carcinoma

121
Q

What is transitional cell carcinoma of the kidney associated with?

A

Industrial dyes/rubber

122
Q

How is transitional cell carcinoma of the kidney treated?

A

Radical nephroureterectomy

123
Q

What is Wilm’s tumour

A

Nephroblastoma - renal tumour of childhood

124
Q

How does Wilm’s tumour present?

A

Abdominal mass, haematuria, high BP, fever

125
Q

How is a Wilm’s tumour treated?

A

Resection + chemotherapy

126
Q

Which demographic commonly get bladder cancer?

A

Males aged 50-80

127
Q

What are risk factors for bladder cancer?

A

Smoking, exposure to rubber/dyes/hydrocarbons, schistosomysis

128
Q

What is the commonest histological type of bladder cancer?

A

Transitional cell carcinoma (>90%)

129
Q

How does bladder cancer present?

A

Painless, macroscopic haematuria, recurrent UTI, voiding irritability

130
Q

What imaging modality is used to diagnosed bladder cancer?

A

Cytoscopy with biopsies

131
Q

What imaging modality is used to stage bladder cancer?

132
Q

How is bladder cancer treated?

A

TURBT (transurethral resection of bladder tumour) - if superficial
Radical cystectomy + ileal conduit +/- radiotherapy
If recurs or is high grade - chemotherapy

133
Q

What is the commonest malignancy in men aged 20-30?

A

Testicular cancer

134
Q

What are risk factors for testicular cancer?

A

Cryptodorchidism, infertility, FH, Kleinfelters, mumps orchitis

135
Q

How does testicular cancer present?

A

Painless lump, gynaecomastia, hydrocele

136
Q

How is testicular cancer investigated?

A

USS

Tumour markers

137
Q

What are the two main types of testicular tumours?

A

Seminoma

Teratoma

138
Q

Which testicular tumour occurs in older men around 40?

139
Q

Which testicular tumour causes a raised AFP and HCG?

140
Q

Which testicular tumour has a homogenous potato like appearance?

141
Q

Which testicular tumour has a heteregenous texture with ectopic tissue?

142
Q

How is a seminoma treated?

A

Chemo and radiotherapy

143
Q

How is a teratoma treated?

A

Surveillance and chemotherapy

Finals Revision (22 decks)

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