Urology Flashcards
How do you investigate urge incontinence?
Urodynamic studies
How do you treat urge incontinence conservatively?
Behavioural advice - avoid stimulants such as caffeine and alcohol
Acupuncture may work
How do you treat urge incontinence medically?
- anticholinergics = oxybutinin (reduces the para - causing detrusor relaxation)
- B3 agonists = mirabegron
- botulin toxin injections
How do you treat urge incontinence surgically?
Augmentation enterocystoplasty (makes the bladder bigger using bowel - reduces the pressure)
How can you treat stress incontinence conservatively?
Pelvic floor m exercises
Lifestyle modifications
How can you treat stress incontinence medically?
Duloxetine 20-40mg BD
increases the sympathetic stimulation to increase sphincter muscle tone
How can you treat stress incontinence surgically?
- Sling/tape TVT/ TOT
- Retropubic suspension
- Artificial sphincters
(these all prevent the hyper mobility of the uretra by acting as a hammock thus preventing leakage)
+ urethral bulking agents
You have a patient with complaints about their bladder. What is the basic bladder work up?
- Bladder diaries
- Urinalysis +/- culture
- Urodynamics (flow rate or bladder scan)
What are the 3 most important investigations for BPH?
1) DRE (+clinical dx)
2) PSA
3) TRUSS (trans-rectal USS)
Give the c, m and s treatments for BPH
C = avoid caffeine, bladder training // watch and wait
M = aB (tamsulosin), 5a reductase inhibitor (finesteride)
S = TURP// TUVP // open prostectomy
What are the SE of tamsulosin?
Postural hypotension
Headache
Dry mouth
What type of cancer is prostate cancer usually?
Adenocarcinoma
What are the SE when brachytherapy is used to treat prostatic cancer?
Urinary symptoms, bowel and sexual problems
With metastatic prostatic cancer, aside from the usual surgery/chemo/radio, what additional treatment option is there?
80% are androgen sensitive thus hormone therapy/chemical castration can be of benefit
- Goserelin (GnRH analogue)
- Tamoxifen (oestrogen blocker)
Which LN does prostatic ca spread to?
Pelvic
Which LN does bladder ca spread to?
Iliac + parailiac
A 75 yr old smoker presents with LUTS and mild haematuria. What work up do you do if you suspect malignancy?
Urine - dip (confirm the haematuria) + MC+S
Imagining - KUB USS, KUB CT
ST - cystoscopy +/- cytology
What are the treatment options for someone with nocturia?
- fluid restrict (in pm and evening)
- Diuretics
- Desmopressin
What situations constitute as significant haematuria?
- 1 episode of macro
- 1 episode of symptomatic micro
- persistent micro 2/3 +ve dips
Give some urological differentials for haematuria
Infection Trauma - stones Inflam - interstitial cystitis , HSP N - bladder, renal, prostate Renal - renal cystic disease, IgA nephropathy
What are the most common organisms that cause a UTI?
E. coli
Staph saprophyticus
Enterobacteria (klebsiella)
How do you treat acute prostatitis?
A fluroquinolone 2-4 weeks
(ciprofloxacin)
How can you treat interstitial cystitis?
c - Lifestyle modifications
m - analgesics, anti-histamines + amytriptyline
