Urology Flashcards
What is the cremasteric reflex?
Stroking the skin on the medial aspect of the superior thigh causes contraction of the cremaster muscle —> elevation of the testes
May be absent in torsion
Remember that testicular torsion is a surgical emergency and needs urgent management
Bot testes have to be fixed to prevent it happening on the ipsilateral side
What is your differential for the acute scrotum?
1) testicular torsion
2) torsion of hydatid of Morgagni (blue dot)
3) orchiits
4) strangulated inguinal hernia
5) testicular tumour
Epididymis orchitis can be caused by an STI such as chlamydia —> full sexual history, 1st pass urine for chlamydia and gonorrhoea testing
In this case, treatment is with doxycycline
In older men, UTI causes such as e.coli are more likely
Treat with ofloxacin
What are the medical options for managing BPH?
1) modify fluid intake
2) alpha blocker e.g. tamsulosim which reduces tone in the bladder neck
3) 5 alpha reductive inhibitors e.g. finasteride which reduces conversion of testosterone to the more potent dihydrotestosterone BUT they take months to work
Always remember that watchful waiting is hugely important - if symptoms are mild and cancer has been excluded, it is highly appropriate
Which drug is associated with intra-operative floppy iris syndorme?
Tamsulosin
Complications of TURP?
- bleeding
- infection
- anaesthetic risk
- retrograde ejaculation
- impotence
- inconvenience
How is suspected prostate cancer investigated?
- trans rectal US guided biopsy (for Gleason score)
- MRI
- bone scan e.g. PET to look for mets
What is Goserelin (brand name Zoladex)?
1) Injection which suppresses the production of androgens and oestrogens and is used in the management of advanced prostate and breast cancer
2) A synthetic analogue of LHRH - stimulates LH/FSH release and ultimately down-regulates it
3) Initial stimulation can cause a flare of bone disease so patients are given an anti-androgen e.g. cyproterone acetate
90% of bladder cancers are TCC. What are the risk factors for an SCC?
- Schistosomiasis
- long term catheterisation
- chronic infection e.g. prostatis
Managment of prostatitis?
Ofloxacin/ ciprofloxacin for 28 days
For bladder cancer superficial disease is up to T1 e.g. Conley invades lamina propria
All other stages are invasive e.g. T2 = muscle invasion, T3 = outside bladder, T4 = adjacent organs
List some causes of renal stones
Infection Dehydration Obesity Hyperparathyroidism Calcium supplements Genetics Congential abnormalities e.g. horseshoe kidney/ duplex kidney
Remember if the stone is stuck in the mid/ distal ureter then penile/ labial pain is likley
What bloods are indicated for ?kidney stones?
FBC UE LFT Ca + Phospahte Urate
80% of small stones (<6mm) will pass spontaenously
For stones not passing:
ESWL for stones >2cm
Large stone >2cm will need a percutaneous nephrolithotomy
A patient is found to have cannonball mets on imaging. What is the most likely diagnosis?
Renal cell carcinoma
What is the TNM staging for the kidney?
T1 = <7cm and in kidney T2 = >7cm and in kidney T3 = extends beyond kidney e.g. IVC or renal vein T4 = beyond Gerota’s fascia (connective tissue capsule of the kidney)
Give a differential for haematuria?
- renal causes e.g. GN, cancer, infection, stone
- ureter causes e.g. cancer, stone, infection, trauma
- bladder causes e.g. infection, tumour, catheter
- urethra causes e.g. trauma, prostate problems, infection,
NMP 22 is a marker for…
Bladder cancer
Remember all pregnant women with a UTI need a urine sample kept for culture
They also need re-culture 7 days after antibiotics to check infection has cleared - test of cure
Which form of imaging is used if there is suspected renal scarring e.g. after UTI?
DMSA - a nuclear medicine scan
List some causes of impotence
Psychological Alcohol Drugs e.g. alpha or beta blocker Vascular e.g. PAD, DM, HT Obesity Neurological e.g. MS or spinal damage Endocrine e.g. hyperprolactinaemia
(always ask if they get spontaneous morning erecions - if so then it is likely to be a psychological cause
In a patient with acute cholecystitis - when should a laparoscopic cholecystectomy be performed?
In most parties within 1 week of diagnosis
Diffuse Axonal injury e.g. due to shear stress caused by acceleration/ deceleration such as RTA is a common brain injury and is the commonest cause…
Of a persistent vegetative state following head injury
