Urology Flashcards
what spinal level do the kidneys sit at
T12 to L3
which kidney is lower and why?
right
liver above
what hormone is responsible for concentrating urine
ADH
what is an end artery? and an e.g.
the only artery that supplies oxygenated blood to a portion of tissue. e.g. Renal/ splenic artery
where is adh made?
hypothalamus, stored in and released from the pituitary
where in the kidneys do renal stones form?
collecting ducts
classic places where renal stones obstruct?
- pelviureteric junction [betw renal pelvis +ureter]
- pelvic brim
- vesicoureteric junction
most common age + sex for renal calculi
20-40
male
describe characteristic pain of renal colic
v severe
loin to groin
w/ N+V
what can differentiate the pain of peritonitis & renal colic- viewing patient from the end of the bed
renal colic - can’t lie still
peritonitis - lie still
sx of pyelonephritis
loin pain
fever, rigors
N+V
presentation of renal caluli
loin to groin pain N+V infection [fever] haematuria, proteinuria anuria
Ix in renal calculi
U+E, FBC, Ca2+, PO43-, glucose, bicarb, urate
dipstick and MC+S
CT [non-contrast]
KUB XR
Mx of renal calculi
analgesia fluids antibiotics if infection pass spontaneously OR nifedipine/tamsulosin US waves Surgery
Indications for urgent intervention (delay kills glomeruli) in renal calculi
Infection AND obstruction Sepsis Impending AKI Solitary kidney Bi-lateral stones
Risk Factors of renal calculi
Dehydration Drugs (steroids, aspirin) Recurrent UTIs Urinary tract abnormalities Family history
Types of luminal urinary tract obstruction
Stones
Blood clot
Sloughed papilla
Tumour (renal, uriteric, bladder)
Types of mural urinary tract obstruction
Stricture (congenital/acquired)
Schistosomiasis
Neuromuscular disfunction (bladder)
Causes of extra-mural urinary tract obstruction
Abdo/pelvic mass/tumour
Retroperitoneal fibrosis
Post surgery
Causes of lower tract obstruction (urinary retention) - name 4
BPH Prostate CA other pelvic malignancy Urethral stricture Anti cholinergics Blood Clot (from bladder lesion) Constipation Post-op Alcohol Infection Neuro (cauda equina, MS) DM
surgical sieve for differentials
VITAMIN C+D Vascular Infective/Inflammatory Trauma Autoimmune Metabolic Iatrogenic Neoplasia Congenital Degenerative
what are the 2 types of kidney CA + which is the most common
RCC [parenchyma] - 90%
transitional cell carcinoma/ urothelial
name 5 differentials for haematuria
renal calculi bladder CA [squamous/TCC] kidney RCC/TCC cystitis pyelonephritis prostate CA/ BPH/ prostatitis
name the 3 causes of rigors
pyelonephritis
cholecystitis
abscess
important aspects of the social Hx in urology/ haematuria Hx
smoking
occupations [dye]
travel Hx - schisto
Ix in haematuria
dipstick FBC, U+E, clotting, CRP, PSA US kidney cystoscopy CT urogram diffusion weighted MRI [prostate CA]
2 types of drugs used for BPH
Tamsulosin - alpha 1 blocker [relaxes smooth muscle]
Finasteride - 5a-reductase inhibitor [blocks testosterone]
what aspect of a cancer do diffusion weighted MRI and contrast CT pick up
^vascularity compared to normal tissue
how do you differentiate a hydrocoele from a hernia?
can get above hydrocoele
hydrocoele transluminates
Ix in recurrent UTI
cystoscopy
US kidney [scarring]
Sx of chronic lower urinary tract obstruction
frequency
poor stream
terminal dribbling
hesitancy
possible examination findings in chronic lower urinary tract obstruction e.g. Pt with hesitancy, poor stream, terminal dribbling etc.
enlarged prostate on PR
large palpable full bladder
complications of chronic lower urinary tract obstruction e.g. BPH
renal failure
UTI
Ix in urinary tract obstruction
FBC, U+E, PSA
dipstick, MC+S
US [hydronephrosis]
CT
upper urinary tract obstruction Mx
nephrostomy
ureteric stent
+ alpha blocker for stent pain
pyeloplasty to widen PUJ
lower urinary tract obstruction Mx
catheter - urethral or suprapubic
clot retention - 3 way catheter and bladder washout
alpha blocker for BPH
what picture might an ABG show in acute urinary retention
metabolic acidosis
[resp compensated]
sx of BPH
hesitancy frequency urgency terminal dribbling nocturia overflow incontinence poor flow haematuria
which areas of the prostate enlarge in BPH and carcinoma
inner transitional zone in BPH
peripheral layer in CA
Ix in BPH
MSU PSA, U+E PR exam US bladder [residual] US kidney [hydroneph] transrectal US \+/- biopsy
[MRI prostate]
[cystoscopy]
what order should you to PSA venepuncture + PR exam?
venepuncture 1st as PR can increase PSA
tamsulosin / alpha blocker side effects
dizzy
sexual dysfunction
main side effect of finasteride
sexual dysfunction
risks of TURP [transurethral resection of prostate]
impotence incontinence retrograde ejaculation bleeding infection clot retention TURP syndrome [absorption of washout - CNS/CVS/hyponatraemia Sx]
Mx of retroperitoneal fibrosis
surgery/stent
steroids
sx of renal cell carcinoma
loin pain
haematuria
abdo mass
malaise
weight loss
anorexia
pyrexia
[rarely - varicocoele]
Ix in RCC
BP
FBC, ESR, U+E, ALP [mets]
urine dipstick + cytology
US, CT, MRI, CXR
what change might you see in BP of RCC patient + why
^ from renin secretion
FBC findings in RCC
polycythaemia from erythropoetin secretion
RCC lung mets - appearance on CXR
cannon ball mets
Mx of RCC
nephrectomy
[cryotherapy, ablation if unfit for surgery]
metastatic: IL2, temsirolimus
[radio and chemo resistant]
tcc of the bladder presentation
painless haematuria frequency urgency dysuria obstruction recurrent UTIs
Ix in suspected bladder TCC
urine microscopy /cytology cystoscopy + biopsy contrast XR CT urogram MRI [nodes]
sx of prostate CA
asymptomatic
frequency, urgency, hesitancy, nocturia, poor stream etc
obstruction
weight loss
bone pain
Ix in Prostate CA [/exam]
DRE PSA transrectal US + biopsy bone scan CT/MRI
Mx options for prosate Ca
Pt choice,
active surveillance
prostatectomy
radiotherapy [ext/brachy]
hormone therapy
LHRH agonist Goserelin
analgesia
bisphos for ^calc
presentation and examination findings in prostatitis
UTIs retention pain haematospermia boggy prostate of DRE
mx of acute prostatitis
analgesia
levofloxacin for 28 days
risk factors for bladder CA
smoking schisto cysitis rubber industry pelvic irradiation
TCC of bladder Mx
TURBT radical cystectomy in more advanced BCG chemo radio reconstruction or urostomy palliative care
causes of incontinence in men
BPH
pelvic surgery/ TURP
describe the 2 categories of incontinence in women
stress & urge
stress = weak pelvic floor
urge = detrusor overactivity
give 5 risk factors for female incontinence
age obesity prolapse weak pelvic floor muscles pregnancy following childbirth stroke parkinsons dementia
ix in female incontinence
urodynamic studies
Mx of urinary incontinence
rule out UTI + faecal impaction consider diuretic use consider retention overflow [palpable bladder] weight loss pelvic floor exercises
STRESS:
pessary for prolapse
surgery to stabilise urethra
duloxetine
URGE: rule out neuro cause vaginitis > topical oestrogen antimuscarinics [tolterodine] mirbegron botox nerve stimulation surgery - clam ileocystoplasty
side effects of antimuscarinics for incontinence
dry mouth dry eyes/skin constipation drowsy retention ^HR abdo pain sinusitis oedema weight gain
important testicular examination findings:
- testicular lump = what, until proven otherwise?
- acute tender enlarged testis = what, until proven otherwise?
- CA
2. torsion
if you cannot feel above a scrotal mass, what is it likely to be
inguinoscrotal hernia
a scrotal mass that is separate from the testis and feels cystic
epididymal cyst
secondary hydrocoeles occur following….
infection
trauma
tumour
Mx of hydrocoele
resolve on their own
OR
aspiration
surgery
differentials for a solid testicular mass
tumour orchitis haematocoele gumma [syphilis] granuloma
solid scrotal mass, separate from testis, differentials?
epididymitis
varicocoele
causes of epididymo-orchitis
chlamydia e.coli mumps gonorrhoea TB
Sx of epididymo-orchitis
tender swelling of testis
sudden onset
fever
dysuria
Mx of epididymo-orchitis
Abx analgesia STI screen/ treat partners scrotal support drainage of abscess
visible distended scrota blood vessels that feel like ‘a bag of worms’. diagnosis?
varicocoele [dilated veins of the pampiniform plexus]
presentation of testicular tumour
typically painless testis lump haematospermia hydrocoele can have pain SOB [lung mets] abdo mass [nodes]
Ix in testicular CA
CXR
CT
biopsy
tumour markers [AFP, BHCG]
Mx of testicular CA
orchidectomy
radio, chemo
in testicular torsion how long do you have to save the testis?
6 hours
presentation of testicular torsion
sudden onset of pain in one testis
abdo pain
N+V
differentials of testicular torsion
epidiymo-orchitis tumour trauma hydatid torsion idiopathic scrotal oedema acute hydrocoele
complications of maldescended or ectopic testes
infertility ^risk of testicular CA ^risk of torsion ^risk of hernias and other urinary tract abnormalities
name the only type of renal stone that is genetic/ inherited
cystine
