Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Surgery > Urology > Flashcards

Urology Flashcards

1
Q

causes of urinary tract obstruction?

A

Luminal:

stones, blood clots, sloughed papilla

Mural:

congenital / acquired stricture, tumour: renal, ureteric, bladder

neuromuscular dysfunction

extramural:

prostatic enlargement,

abdo/ pelvis mass/ tumour

retroperitoneal fibrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

presentation of acute upper urinary tract obstruction?

A

loin pain -> groin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

presentation of acute lower urinary tract obstruction?

A

bladder outflow obstruction precedes severe suprapubic pain w distended palpable bladder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

presentation of chronic upper urinary tract obstruction?

A

flank pain

renal failure (may be polyuric)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

presentation of chronic lower urinary tract obstruction?

A

frequency, hesitancy, poor stream, terminal dribbling, overflow incontinence

distended palpable bladder +/- large prostate PR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

ix of urinary tract obstruction?

A

bloods: FBC, U+E
urine: dip, MCS

imaging:

US: hydronephrosis or hydroureter

Anterograde/ retrograde ureterograms: allow therapeutic drainage

radionucleotide imaging: renal function

CT/ MRI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

mx of Upper urinary tract obstruction?

A

nephrostomy

ureteric stent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

mx of lower urinary tract obstruction?

A

urethral or suprapubic catheter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

complications of ureteric stents?

A

common:

infection, haematuria, trigonal irritation, encrustation

rare:

obstruction, ureteric rupture, stent migration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

causes of urethral stricture?

A

trauma e.g. pelvic #, instrumentation

Infection e.g. gonorrhoea

Chemotx

balantitis xerotica obliterans (male lichen sclerosus)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

presentation of urethral stricture?

A

hesitancy

poor stream

terminal dribbling

strangury: painful, frequent urination of small volumes that are expelled slowly only by straining and despite a severe sense of urgency, usually with the residual feeling of incomplete emptying.

pis-en-deux: residual urine results in a desire to pass urine soon after voiding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

examination of urethral stricture?

A

PR: exclude prostatic cause

Palpate urethra through penis

examine meatus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

ix of urethral stricture?

A

urodynamics:

decreased peak flow rate

increased micturation time

urethroscopy and cystoscopy

retrograde urethrogram

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

mx of urethral stricture?

A

internal urethrotomy

dilatation

stent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

complications of obstructive uropathy?

A

Hyperkalaemia

metabolic acidosis

post-obstructive diuresis

Na and HCO3 losing nephropathy

infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what is post obstructive diuresis?

A

Kidneys produce a lot of urine in the acute phase after relief of obstruction.

must keep up w losses to avoid dehydration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what is Na and HCO3 losing nephropathy following obstructive uropathy?

A

diuresis may -> loss of Na and HCO3

may require replacement with 1.26% NaHCO3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

causes of urinary retention?

A

mechanical obstruction:

BPH

urethral stricture

clots, stones

constipation

dynamic obstruction: increased smooth muscle tone

post operative pain

drugs

neurological:

sensory/ motor innervation affected

pelvic surgery

MS

DM

spinal injury/ compression

myogenic:

overdistension of the bladder

Post-anaesthesia

High alcohol intake

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

features of acute urinary retention

A

suprapubic tenderness

palpable bladder: dull to percussion, cant get beneath it

large prostate on PR: check anal tone and sacral sensation

<1 L drained on catheterisation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

imaging of acute urinary retention?

A

US: bladder volume, hydronephrosis

pelvic XR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

mx of acute urinary retention?

A

analgesia

catheterise:

use correct catheter, e.g. 3 way if clots

+/- STAT gentamicin cover

hourly UO + replace: post obstruction diuresis

Tamsulosin: decreases risk of recatherisation after retention

TWOC after 24-72ha

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

presentation of chronic urinary retention?

A

insidious as bladder capacity increases (> 1.5L)

typically painless

overflow incontinence/ nocturnal enuresis

acute on chronic retention

lower abdo mass

UTI

renal failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

high vs low pressure chronic urinary retention?

A

high pressure:

high detrusor pressure @ end of micturition

typically bladder outflow obstruction ->

bilateral hydronephrosis and decreased renal function

Low pressure:

low detrusor pressure @ end of micturition

large volume retention w very compliant bladder

kidney able to excrete urine

no hydronephrosis -> normal renal function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

mx of high pressure chronic urinary retention?

A

catheterise if

  • renal impairment
  • pain
  • infection

Hourly UO + replace: post obstruction diuresis

consider TURP before TWOC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

mx of low pressure chronic urinary retention?

A

avoid catheterisation if possible

-risk of introducing infection

early TURP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

advantages of suprapubic catheterisation?

A

decreased UTI risk

decreased stricture formation

TWOC w/o catheter removal

Pt preference: increased comfort

maintain sexual function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

disadvantages of suprapubic catheterisation?

A

More complex: need skills

serious complications can occur

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

contraindications of suprapubic catheterisation?

A

known or suspected bladder carcinoma

undiagnosed haematuria

previous lower abdo surgery

-> adhesion of small bowel to abdo wall

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

causes of false haematuria?

red urine

A

beetroot

rifampicin

porphyria

PV bleed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

urethra causes of haematuria?

A

infection

trauma

stones

tumour

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

prostate causes of haematuria?

A

BPH

prostatitis

tumour

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

bladder causes of haematuria?

A

infection

stones

tumour

exercise

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

general causes of haematuria?

A

HSP

Bleeding diathesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

renal causes of haematuria?

A

infarct

trauma

infection

neoplasm

glomerulonephritis

polycystic kidneys

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

features of haematuria?

A

timing:

beginning of stream- urethral

throughout stream: renal/ systemic, bladder

end of stream: bladder stone, schistosomiasis

painful or painless?

obstructive symptoms?

systemic symptoms: weight loss, appetite

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

ix of haematuria?

A

Bloods: FBC, U+E, clotting

Urine: dip, MCS, cytology

Imaging: renal US, IVU, flexi cystoscopy + biopsy, CT/MRI, renal angio

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

what is periaortitis?

A

inflammatory condition which typically involves the infrarenal portion of the abdominal aorta.

various clinical presentations:

idiopathic retroperitoneal fibrosis

inflammatory AAA

perianeurysmal retroperitoneal fibrosis

isolated periaortitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

what is idiopathic retroperitoneal fibrosis?

A

autoimmune vasculitis

fibrinoid necrosis of vasa vasorum

affects aorta and small/medium sized retroperitoneal vessels

ureters are embedded in dense, fibrous tissue -> bilateral obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

associations of idiopathic retroperitoneal fibrosis?

A

drugs: BB, bromocriptine, methysergide, methyldopa

autoimmune disease: thyroiditis, SLE, ANCA+ vasculitis

smoking

asbestos

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

presentation of idiopathic retroperitoneal fibrosis?

A

middle aged male

vague loin, back or abdo pain

raised BP

chronic urinary tract obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

mx of idiopathic retroperitoneal fibrosis?

A

relieve obstruction: retrograde stent placement

ureterolysis: dissection of ureters from retroperitoneal tissue

+/- immunosuppression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

ix of idiopathic retroperitoneal fibrosis?

A

bloods: raised urea and creatinine, raised ESP/CRP, low Hb

US: bilateral hydronephrosis + medial ureteric deviation

CT/MRI: peri aortic mass

biopsy: exclude Ca

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

pathophysiology of kidney stones?

A

increased concentration of urinary solute

decreased urine volume

urinary stasis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

common anatomical sites for kidney stones?

A

pelviureteric junction

crossing iliac vessels at pelvic brim

under the vas or uterine artery

vesicoureteric junction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

most common type of kidney stone?

A

calcium oxalate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

urate kidney stones assoc w which condition?

A

gout

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

staghorn calculi

assoc w proteus infection

what type of kidney stone?

A

triple stones

ca, mg, ammonium - phosphate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

cystine kidney stones

assoc w?

A

Fanconi syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

kidney stones associated factors??

A

dehydration

hypercalcaemia: primary hyperPTH, immobilisation

increased Oxalate excretion: tea, strawberries

UTIs

hyperuricaemia e.g. gout

urinary tract abnormalities e.g. bladder diverticulae

drugs: furosemide, thiazides

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

presentation of kidney stones?

A

severe loin pain radiating to groin

N+V

pt cannot lie still

may cause bladder/ urethral obstruction:

bladder irritability: frequency, dysuria, haematuria

strangury: painful urinary tenesmus

suprapubic pain radiating -> tip of penis or in labia

pain and haematuria worse at end of micturition

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

ix of kidney stones?

A

urine: dip - haematuria, MCS
bloods: FBC, U+E, Ca, PO4, urate
imaging: CT KUB gold standard,

USS may show hydronephrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

prevention of kidney stones?

A

drink plenty

treat UTIs rapidly

decreased oxalate intake: chocolate, tea, strawberries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

indications for conservative tx of kidney stones?

A

stone < 5mm in size

and in lower 1/3 of ureter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

conservative mx of kidney stones?

A

give all analgesia e.g. diclofenac or opioids

fluids: IV if unable to tolerate PO

abx if infection: e.g. cefuroxime

90-95% pass stone spontaneously

can discharge pt w analgesia

sieve urine to collect stone for OPD analysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

indications of medical expulsive therapy for kidney stones?

A

stone 5-10 mm

stone expected to pass

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

what is medical expulsive therapy for kidney stones?

A

Nifedipine or tamsulosin (alpha blocker)

+/- prednisolone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

indications for active stone removal of kidney stones?

A

low likelihood of spontaneous passage e.g. > 10 mm

persistent obstruction

renal insufficiency

infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

indications for percutaneous nephrolithotomy?

A

1st line if stone > 20mm in renal pelvis

e.g. staghorn calculi

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

indications for extracorporeal shockwave lithotripsy?

A

1st line for stones < 20 mm in kidney or proximal ureter

side effect: renal injury -> may increase BP

CI: pregnancy, AAA, bleeding diathesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

indications for ureteronoscopy + basket removal of kidney stones?

A

1st line if stone > 10mm in distal ureter or if shock wave lithotripsy failed

or >20 mm in renal pelvis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

mx of kidney stones where pt is febrile w renal obstruction?

A

surgical emergency

percutaneous nephrostomy or ureteric stent

IV abx e.g. cefuroxime

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

risk factors of renal cell carcinoma?

A

obesity

smoking

HTN

dialysis

heritable syndrome (e.g. VHL)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

most common subtype of renal cell carcinoma?

A

clear cell

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

presentation of renal cell carcinoma?

A

50% incidental finding

triad: haematuria, loin pain, loin mass
systemic: FLAW

clot retention

invasion of L renal vein -> varicocele

cannonball mets -> SOB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

paraneoplastic features of renal cell carcinoma?

A

EPO -> polycythaemia

PTHrP -> high Ca

Renin -> HTN

ACTH -> Cushings syndrome

Amyloidosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Robson staging for renal cell carcinoma?

A

(largely replaced by TNM staging)

  1. confined to kidney
  2. involves perinephric fat, but not Garota’s fascia
  3. spread into renal vein
  4. spread to adjacent/ distant organs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

medical mx of renal cell carcinoma?

A

reserved for pts w poor prognosis

temsirolimus (mTOR inhibitor)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

surgical mx of renal cell carcinoma?

A

radical nephrectomy

consider partial if small tumour or 1 kidney

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

2nd most common renal cancer?

A

transitional cell carcinoma

  • 50% found in bladder, rest in ureter/ renal pelvis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

risk factors of transitional cell carcinoma?

A

smoking

amine exposure (rubber industry)

cyclophosphamide

71
Q

presentation of transitional cell carcinoma?

A

painless frank haematuria

frequency, urgency, dysuria

urinary tract obstruction

72
Q

ix of transitional cell carcinoma?

A

urine cytology

CT/MRI

IVU: pelviceal filling defect

73
Q

mx of transitional cell carcinoma?

A

nephrouretectomy

regular follow up

74
Q

What is Wilm’s Tumour?

A

a nephroblastoma

childhood tumour of primitive renal tubules and mesenchymal cells

may be assoc with Chr11 mutation/ WAGR syndrome (wilms, aniridia, GU abnormalities, retardation)

75
Q

presentation of wilms tumour?

A

2-5 yrs

5-10% bilateral

abdo mass

haematuria

abdo pain

HTN

76
Q

most common type of bladder ca?

A

Transitional cell carcinomas - 90%

SCCs: assoc w shistosomiasis

77
Q

Squamous cell carcinoma of bladder assoc w what infection?

A

schistosomiasis

78
Q

risk factors for bladder ca?

A

smoking

amine exposure (rubber industry)

previous renal TCC

chronic cystitis

schistosomiasis -> SCC

pelvic irradiation

79
Q

presentation of bladder Ca?

A

painless frank haematuria

voiding irritability: dysuria, freq, urgency

recurrent UTIs

retention and obstructive renal failure

80
Q

examination findings of bladder ca?

A

anaemia

palpable bladder mass

palpable liver

81
Q

diagnostic ix of bladder ca?

A

cystoscopy with biopsy

82
Q

mx of T4 Bladder Ca?

T4 - invasion of prostate/ uterus/ vagina

A

palliative chemo/ radio tx

long term catheterisation

urinary diversions

83
Q

mx of T2, T3 bladder ca?

T2- superficial muscle involved

T3 - deep muscle

A

radical cystectomy w ileal conduit is gold standard

adjuvant chemo

84
Q

mx of T1 Bladder Ca?

superficial

A

diathermy via transurethral cystoscopy/ transurethral resection of bladder tumour (TURBT)

intravesicular chemo: mitomycin C

intravesicular immunotherapy: Bacille Calmette-Guerin

85
Q

examination findings of benign prostatic hypertrophy?

A

PR exam: smoothly enlarged prostate, definable median sulcus

bladder not usually palpable unless acute on chronic obstruction

86
Q

pathophysiology of benign prostatic hypertrophy?

A

*DHT (dihydrotestosterone) is a critical mediator.

DHT produced from testosteron in stromal cells by 5a-reductase enzyme

DHT-induced growth factors -> ↑ stromal cells and ↓ epithelial cell death.

-> benign nodular or diffuse hyperplasia of stromal and epithelial cells

affects inner layer of prostate -> may lead to urethral compression

87
Q

presentation of benign prostatic hypertrophy?

A

bladder outflow obstruction:

hesitancy, straining, poor flow, terminal dribbling, urinary tenesmus, incomplete emptying (pis en deux)

storage symptoms: nocturia, freq, urgency, overflow incontinence

bladder stones secondary to stasis

UTI secondary to stasis

88
Q

conservative mx of BPH?

A

decrease caffeine, alcohol

double voiding

bladder training

89
Q

medical mx of BPH?

A

useful in mild disease and while awaiting TURP

1st line: alpha blockers

e.g. tamsulosin

relaxes prostate smooth muscle

2nd line: 5a-reductase inhibitors

e.g. finasterid

inhibits conversion of testosterone -> DHT

preferred if significantly enlarged prostate

90
Q

examples of alpha blockers?

A

tamsulosin

doxazosin

91
Q

surgical mx of BPH?

A

when symptoms affect QOL

TURP

Transurethral incision of prostate (TUIP)

< destruction → ↓ risk to sexual function

Similar benefits to TURP if small prostate (<30g)

Tranurethral ElectroVaporisation of Prostate

Electric current → tissue vaporisation

Laser prostatectomy

↓ ED and retrograde ejaculation

Similar efficacy as TURP

Open retropubic prostatectomy

Used for very large prostates (>100g)

92
Q

TURP complications

A

immediate:

TUR syndrome - absorption of large quantity of fluids -> low Na

haemorrhage

early:

haemorrhage, infection, clot retention

late: retrograde ejaculation, Erectile dysfunction, incontinence, urethral stricture, recurrence

93
Q

commonest male cancer?

A

prostate

80% of men > 80yrs

94
Q

examination findings of prostate cancer?

A

hard irregular prostate on PR

loss of midline sulcus

95
Q

what type of bone lesions occur with prostate ca?

A

sclerotic

96
Q

which lymph nodes may be affected by prostate ca?

A

para aortic nodes

97
Q

medical mx of prostate ca?

A

used for metastatic or node +ve disease

LHRH analogues

e.g. goserelin

inhibit pituitary gonadotrophins -> decrease testosterone

anti-androgens:

e.g. cyporterone acetate, flutamide

98
Q

radical tx for prostate ca?

A

radical prostatectomy

+ goserelin LHRH analogue if node +ve

brachytherapy: implantation of palladium seeds

99
Q

symptomatic mx of Prostate Ca?

A

TURP for obstruction

analgesia

radiotherapy for bone mets/ cord compression

100
Q

examination findings of prostatitis?

A

pyrexia

swollen/ boggy/ tender prostate on PR

examine testes to exclude eipididymo-orchitis

101
Q

Mx of prostatitis?

A

analgesia

levofloxacin for 28d

102
Q

ix of urinary incontinence in women

A

urodynamic studies

103
Q

mx of stress incontinence?

A

pelvic floor exercises

ring pessary

surgery: tension free vaginal tape

104
Q

mx of urge incontinence?

A

bladder training

lifestyle changes, weight loss

anti-achm: tolterodine, imipramine

surgery: Sacral or Tibial nerve stimulation devices when other tx has failed

105
Q

undescended testes more common in?

A

premies

(testes remain in abdomen until 7mo)

unilateral more common than bilateral

  • should have genetic testing if bilateral
    e. g. Noonan’s, prader-willi
106
Q

what is a maldescended testis?

A

found anywhere along normal path of descent

testis and scrotum usually underdeveloped

often assoc w patent processus vaginalis

107
Q

what is cryptorchidism?

A

complete absence of testis from scrotum

anorchism = absence of both testes

108
Q

what is retractile testis?

A

normal development but excessive cremasteric reflex

testicle often found at external inguinal ring

will descend- no tx required

109
Q

what is ectopic testis?

A

found outside line of descent

usually in superior inguinal pouch (ant to external oblique aponeurosis)

abdominal, perineal, penile, femoral triangle

110
Q

complications of undescended testes?

A

infertility

10 x increased risk of malignancy (remains after surgery)

increased risk of trauma/ torsion

assoc w hernias (90%) or urinary tract abnormalities

111
Q

mx of undescended testes?

A

restrores potential for spermatogenesis + makes ca easier to detect

surgical: orchidopexy

+ dartos pouch procedure to prevent future retraction

hormonal: BHCG may be tried if testis is in inguinal canal

112
Q

presentation of testicular torsion?

A

usually 10-25 yrs

sudden onset severe pain in one testis

may have lower abdo pain (testis supplied by T10)

N+V

may have hx of previous testicular pain/ torsion

113
Q

examination findings of testicular torsion?

A

inflammation of one testis: hot, swollen, extremely tender

testis riding high and lies transversely

114
Q

sudden onset severe pain in one testis

tiny blue dot visible on scrotum

A

torsion of hydatid of Morgagni

115
Q

ix of testicular torsion

A

Must not delay surgical exploration -> straight to theatre

doppler US may demonstrate absence of flow

116
Q

mx of testicular torsion?

A

surgical emergency

4-6h window from onset of pain to salvage testis

inform senior

NBM + IV access: bloods (FBC, U+E, Clotting, G+S, Cross match), Analgesia, IV Fluids

surgery: consent for possible orchidectomy, bilateral orchidopexy

117
Q

features of epididymal cyst?

A

lies above and behind testis

(separate lump from testis)

contains clear or milky (spermatocele) fluid

remove if symptomatic

118
Q

what is a varicocele?

A

dilated veins of pampiniform plexus

119
Q

features of varicocele?

A

bag of worms in scrotum

may be visible dilated veins

decrease in size on lying down

pt may c/o dull ache

may -> oligospermia (decreased fertility)

120
Q

pathology of varicocele?

A

primary: left side commoner: drain into left renal vein
secondary: left renal tumour has tracked down renal vein -> testicular vein obstruction

121
Q

mx of varicocele?

A

conservative: scrotal support, simple analgesia

refer to a urologist for possible surgery:

clipping of testicular vein

122
Q

when to refer to urologist urgently for potential surgery?

varicocele

A

A varicocele appears suddenly and is painful.

The varicocele does not drain when lying down.

There is a solitary right-sided varicocele.

123
Q

what is a sperm granuloma?

A

painful lump of extravasated sperm that appears along the vasa deferentia or epididymides in vasectomized men.

124
Q

what is a hydrocele?

A

collection of serous fluid within tunica vaginalis

125
Q

pathology of primary hydrocele?

A

assoc w patent processus vaginalis

commoner, larger, tense, younger men

126
Q

pathology of secondary hydrocele?

A

tumour, trauma, infection

smaller, less tense

127
Q

ix of hydrocele?

A

US testicle to exclude tumour

128
Q

mx of hydrocele?

A

may resolve spontaneously

surgery:

Lord’s Repair: plication of the sac

Jaboulay’s Repair: eversion of the sac

aspiration: recurs so not 1st line, send fluid for cytology and MCS

129
Q

what is a haematocele?

A

blood in the tunica vaginalis

hx of trauma

may need drainage/ excision

130
Q

features of epididymo-orchitis?

A

Sudden onset tender swelling

dysuria

sweats, fever

131
Q

examination findings of epididymo-orchitis?

A

Tender, red, warm, swollen testis and epididymis

Elevating testicle may relieve pain

Secondary hydrocele

Urethral discharge

132
Q

ix of epididymo-orchitis?

A

Blood: FBC, CRP
Urine: dip, MC+S (fist catch may be best)

Urethral swab and STI screen
US: may be needed to exclude abscess

133
Q

complications of epididymo-orchitis?

A

infertility

134
Q

mx of epididymo-orchitis?

A

bed rest

analgesia

scrotal support

abx: doxycycline or cipro

drain abscess if present

135
Q

risk factors for penile cancer?

A

HPV (16, 18, 31) infection

chronic infection secondary to smegma

smoking

phimosis

136
Q

presentation of penile cancer?

A

chronic fungating ulcer

bloody/ purulent discharge

50% have inguinal nodes at presentation

137
Q

mx of penile ca?

A

surgery:

Moh’s surgery, Laser

+/- LN clearance

Radiotx

Chemotx

138
Q

most common type of penile ca?

A

squamous cell ca

139
Q

what is a hypospadia?

A

opening of the urethra is on the underside of the penis.

(ventral surface)

140
Q

what is an epispadia?

A

opening of the urethra is on the dorsal side of the penis.

141
Q

what is phimosis?

A

foreskin is too tight to be pulled back over the head of the penis (glans)

142
Q

presentation of phimosis in children?

A

recurrent balanitis (inflammation of head of penis) and ballooning

+/- thick discharge underneath foreskin (balanoposthitis)

143
Q

mx of phimosis in children?

A

gentle retraction, steroid creams, circumcision

144
Q

presentation of phimosis in adults?

A

dyspareunia, infection

mx: circumcision

145
Q
A
146
Q

what is phimosis assoc w?

A

STIs

balanitis xerotica obliterans: lichen sclerosus- thickening of foreskin and glans -> phimosis + meatal narrowing

147
Q

what is paraphimosis?

A

urologic emergency in which the retracted foreskin of an uncircumcised male cannot be returned to its normal anatomic position

decreased venous return -> oedema and swelling of glans

-> gangrene and amputation of the glans penis.

148
Q

causes of paraphimosis?

A

catheterisation

masturbation

intercourse

149
Q

mx of paraphimosis?

A

manual reduction:

use lignocaine jelly and ice

may require glans aspiration or dorsal slit

150
Q

what is balanitis?

A

acute inflammation of foreskin and glans

151
Q

risk factors for balanitis?

A

diabetes mellitus, young children w tight foreskin (phimosis)

152
Q

organisms causing of balanitis?

A

strep, staph, candida (DM)

153
Q

mx of balanitis?

A

hygiene advice

abx

circumcision

154
Q

presentation of testicular cancer?

A

Painless testicular lump
Often noticed after trauma

Haematospermia

2O hydrocele

Mets: SOB from lung mets

Abdo mass: para-aortic lymphadenopathy

Hormones: gynaecomastia, virilisation

Contralateral tumour in 5%

155
Q

risk factors of testicular tumour?

A

undescended testis

infant hernia

infertility

156
Q

which type of testicular tumour secretes oestrogens or androgens?

A

Leydig cell: androgens or oestrogens

Sertoli cell: oestrogens

157
Q

tumour markers of testicular tumours?

A

raised AFP and HCG in most germ cell tumours

158
Q

most effective analgesia in acute renal colic?

A

Diclofenac IM

159
Q

initial ix of kidney stones?

A

urine dipstick and culture

serum creatinine and electrolytes: check renal function

FBC / CRP: look for associated infection

calcium/urate: look for underlying causes

also: clotting if percutaneous intervention planned and blood cultures if pyrexial or other signs of sepsis

160
Q

mx of kidney stones < 20 mm in pregnant women?

A

Ureteroscopy

A ureteroscope is passed retrograde through the ureter and into the renal pelvis. It is indicated in individuals (e.g. pregnant females) where lithotripsy is contraindicated and in complex stone disease. In most cases a stent is left in situ for 4 weeks after the procedure.

161
Q

future prevention of oxalate kidney stones?

A

cholestyramine reduces urinary oxalate secretion

pyridoxine reduces urinary oxalate secretion

162
Q

future prevention of uric acid kidney stones?

A

allopurinol

urinary alkalinization e.g. oral bicarbonate

163
Q

prevention of calcium kidney stones?

A

high fluid intake

low animal protein, low salt diet (a low calcium diet has not been shown to be superior to a normocalcaemic diet)

thiazides diuretics (increase distal tubular calcium resorption)

164
Q

best diagnostic ix for hydronephrosis?

A

US of renal tract

165
Q

mx of hydronephrosis?

A

Remove the obstruction and drainage of urine

Acute upper urinary tract obstruction: Nephrostomy tube

Chronic upper urinary tract obstruction: Ureteric stent or a pyeloplasty

166
Q

epididymal cysts are assoc w ?

A

polycystic kidney disease

cystic fibrosis

von Hippel-Lindau syndrome

167
Q

what three things u need to know when working out a scrotal swelling?

A

if the swelling involves the testicle, if the swelling trans-illuminates when a pen torch is placed below it and if it is possible to palpate above the swelling.

168
Q

which testicular lump often transilluminates?

A

hydrocele

169
Q

PSA test, you should not have:

A

ejaculated in the past 48 hours

exercised heavily in the past 48 hours

4 weeks following a urinary infection

had a prostate biopsy in the past 6 weeks

1 week after DRE

prostatitis (delay for 1 month)

170
Q

tx of children with hydrocele?

A

trans inguinal ligation of Patent processus vaginalis

171
Q

mx of pt with obstructive kidney stone causing hydronephrosis and pyrexia?

A

urgent renal decompression and IV antibiotics due to the risk of sepsis via a ureteric stent or percutaneous nephrostomy

172
Q

What is TURP syndrome?

A

Transurethral resection of the prostate (TURP) syndrome occurs when irrigation fluid enters the systemic circulation. The triad of features are:

  1. Hyponatraemia: dilutional
  2. Fluid overload
  3. Glycine toxicity

Management involves fluid restriction and the treatment of the complications associated with the hyponatraemia.

173
Q

Prehn’s sign?

A

relief of pain on elevation of the testis

+ve in epididymo-orchitis

importantly is negative (i.e. the pain is not relieved) in cases of testicular torsion.

Surgery (17 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions