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

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2
Q

presentation of acute upper urinary tract obstruction?

A

loin pain -> groin

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3
Q

presentation of acute lower urinary tract obstruction?

A

bladder outflow obstruction precedes severe suprapubic pain w distended palpable bladder

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4
Q

presentation of chronic upper urinary tract obstruction?

A

flank pain

renal failure (may be polyuric)

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5
Q

presentation of chronic lower urinary tract obstruction?

A

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

distended palpable bladder +/- large prostate PR

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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

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7
Q

mx of Upper urinary tract obstruction?

A

nephrostomy

ureteric stent

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8
Q

mx of lower urinary tract obstruction?

A

urethral or suprapubic catheter

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9
Q

complications of ureteric stents?

A

common:

infection, haematuria, trigonal irritation, encrustation

rare:

obstruction, ureteric rupture, stent migration

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10
Q

causes of urethral stricture?

A

trauma e.g. pelvic #, instrumentation

Infection e.g. gonorrhoea

Chemotx

balantitis xerotica obliterans (male lichen sclerosus)

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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

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12
Q

examination of urethral stricture?

A

PR: exclude prostatic cause

Palpate urethra through penis

examine meatus

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13
Q

ix of urethral stricture?

A

urodynamics:

decreased peak flow rate

increased micturation time

urethroscopy and cystoscopy

retrograde urethrogram

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14
Q

mx of urethral stricture?

A

internal urethrotomy

dilatation

stent

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15
Q

complications of obstructive uropathy?

A

Hyperkalaemia

metabolic acidosis

post-obstructive diuresis

Na and HCO3 losing nephropathy

infection

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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

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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

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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

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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

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20
Q

imaging of acute urinary retention?

A

US: bladder volume, hydronephrosis

pelvic XR

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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

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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

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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

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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

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25
mx of low pressure chronic urinary retention?
avoid catheterisation if possible -risk of introducing infection early TURP
26
advantages of suprapubic catheterisation?
decreased UTI risk decreased stricture formation TWOC w/o catheter removal Pt preference: increased comfort maintain sexual function
27
disadvantages of suprapubic catheterisation?
More complex: need skills serious complications can occur
28
contraindications of suprapubic catheterisation?
known or suspected bladder carcinoma undiagnosed haematuria previous lower abdo surgery -\> adhesion of small bowel to abdo wall
29
causes of false haematuria? red urine
beetroot rifampicin porphyria PV bleed
30
urethra causes of haematuria?
infection trauma stones tumour
31
prostate causes of haematuria?
BPH prostatitis tumour
32
bladder causes of haematuria?
infection stones tumour exercise
33
general causes of haematuria?
HSP Bleeding diathesis
34
renal causes of haematuria?
infarct trauma infection neoplasm glomerulonephritis polycystic kidneys
35
features of haematuria?
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
36
ix of haematuria?
Bloods: FBC, U+E, clotting Urine: dip, MCS, cytology Imaging: renal US, IVU, flexi cystoscopy + biopsy, CT/MRI, renal angio
37
what is periaortitis?
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
38
what is idiopathic retroperitoneal fibrosis?
autoimmune vasculitis fibrinoid necrosis of vasa vasorum affects aorta and small/medium sized retroperitoneal vessels ureters are embedded in dense, fibrous tissue -\> bilateral obstruction
39
associations of idiopathic retroperitoneal fibrosis?
drugs: BB, bromocriptine, methysergide, methyldopa autoimmune disease: thyroiditis, SLE, ANCA+ vasculitis smoking asbestos
40
presentation of idiopathic retroperitoneal fibrosis?
middle aged male vague loin, back or abdo pain raised BP chronic urinary tract obstruction
41
mx of idiopathic retroperitoneal fibrosis?
relieve obstruction: retrograde stent placement ureterolysis: dissection of ureters from retroperitoneal tissue +/- immunosuppression
42
ix of idiopathic retroperitoneal fibrosis?
bloods: raised urea and creatinine, raised ESP/CRP, low Hb US: bilateral hydronephrosis + medial ureteric deviation CT/MRI: peri aortic mass biopsy: exclude Ca
43
pathophysiology of kidney stones?
increased concentration of urinary solute decreased urine volume urinary stasis
44
common anatomical sites for kidney stones?
pelviureteric junction crossing iliac vessels at pelvic brim under the vas or uterine artery vesicoureteric junction
45
most common type of kidney stone?
calcium oxalate
46
urate kidney stones assoc w which condition?
gout
47
staghorn calculi assoc w proteus infection what type of kidney stone?
triple stones ca, mg, ammonium - phosphate
48
cystine kidney stones assoc w?
Fanconi syndrome
49
kidney stones associated factors??
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
50
presentation of kidney stones?
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
51
ix of kidney stones?
urine: dip - haematuria, MCS bloods: FBC, U+E, Ca, PO4, urate imaging: CT KUB gold standard, USS may show hydronephrosis
52
prevention of kidney stones?
drink plenty treat UTIs rapidly decreased oxalate intake: chocolate, tea, strawberries
53
indications for conservative tx of kidney stones?
stone \< 5mm in size and in lower 1/3 of ureter
54
conservative mx of kidney stones?
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
55
indications of medical expulsive therapy for kidney stones?
stone 5-10 mm stone expected to pass
56
what is medical expulsive therapy for kidney stones?
Nifedipine or tamsulosin (alpha blocker) +/- prednisolone
57
indications for active stone removal of kidney stones?
low likelihood of spontaneous passage e.g. \> 10 mm persistent obstruction renal insufficiency infection
58
indications for percutaneous nephrolithotomy?
1st line if stone \> 20mm in renal pelvis e.g. staghorn calculi
59
indications for extracorporeal shockwave lithotripsy?
1st line for stones \< 20 mm in kidney or proximal ureter side effect: renal injury -\> may increase BP CI: pregnancy, AAA, bleeding diathesis
60
indications for ureteronoscopy + basket removal of kidney stones?
1st line if stone \> 10mm in distal ureter or if shock wave lithotripsy failed or \>20 mm in renal pelvis
61
mx of kidney stones where pt is febrile w renal obstruction?
surgical emergency percutaneous nephrostomy or ureteric stent IV abx e.g. cefuroxime
62
risk factors of renal cell carcinoma?
obesity smoking HTN dialysis heritable syndrome (e.g. VHL)
63
most common subtype of renal cell carcinoma?
clear cell
64
presentation of renal cell carcinoma?
50% incidental finding triad: haematuria, loin pain, loin mass systemic: FLAW clot retention invasion of L renal vein -\> varicocele cannonball mets -\> SOB
65
paraneoplastic features of renal cell carcinoma?
EPO -\> polycythaemia PTHrP -\> high Ca Renin -\> HTN ACTH -\> Cushings syndrome Amyloidosis
66
Robson staging for renal cell carcinoma?
(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
67
medical mx of renal cell carcinoma?
reserved for pts w poor prognosis temsirolimus (mTOR inhibitor)
68
surgical mx of renal cell carcinoma?
radical nephrectomy consider partial if small tumour or 1 kidney
69
2nd most common renal cancer?
transitional cell carcinoma - 50% found in bladder, rest in ureter/ renal pelvis
70
risk factors of transitional cell carcinoma?
smoking amine exposure (rubber industry) cyclophosphamide
71
presentation of transitional cell carcinoma?
painless frank haematuria frequency, urgency, dysuria urinary tract obstruction
72
ix of transitional cell carcinoma?
urine cytology CT/MRI IVU: pelviceal filling defect
73
mx of transitional cell carcinoma?
nephrouretectomy regular follow up
74
What is Wilm's Tumour?
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
presentation of wilms tumour?
2-5 yrs 5-10% bilateral abdo mass haematuria abdo pain HTN
76
most common type of bladder ca?
Transitional cell carcinomas - 90% SCCs: assoc w shistosomiasis
77
Squamous cell carcinoma of bladder assoc w what infection?
schistosomiasis
78
risk factors for bladder ca?
smoking amine exposure (rubber industry) previous renal TCC chronic cystitis schistosomiasis -\> SCC pelvic irradiation
79
presentation of bladder Ca?
painless frank haematuria voiding irritability: dysuria, freq, urgency recurrent UTIs retention and obstructive renal failure
80
examination findings of bladder ca?
anaemia palpable bladder mass palpable liver
81
diagnostic ix of bladder ca?
cystoscopy with biopsy
82
mx of T4 Bladder Ca? T4 - invasion of prostate/ uterus/ vagina
palliative chemo/ radio tx long term catheterisation urinary diversions
83
mx of T2, T3 bladder ca? T2- superficial muscle involved T3 - deep muscle
radical cystectomy w ileal conduit is gold standard adjuvant chemo
84
mx of T1 Bladder Ca? superficial
diathermy via transurethral cystoscopy/ transurethral resection of bladder tumour (TURBT) intravesicular chemo: mitomycin C intravesicular immunotherapy: Bacille Calmette-Guerin
85
examination findings of benign prostatic hypertrophy?
PR exam: smoothly enlarged prostate, definable median sulcus bladder not usually palpable unless acute on chronic obstruction
86
pathophysiology of benign prostatic hypertrophy?
\*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
presentation of benign prostatic hypertrophy?
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
conservative mx of BPH?
decrease caffeine, alcohol double voiding bladder training
89
medical mx of BPH?
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
examples of alpha blockers?
tamsulosin doxazosin
91
surgical mx of BPH?
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
TURP complications
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
commonest male cancer?
prostate 80% of men \> 80yrs
94
examination findings of prostate cancer?
hard irregular prostate on PR loss of midline sulcus
95
what type of bone lesions occur with prostate ca?
sclerotic
96
which lymph nodes may be affected by prostate ca?
para aortic nodes
97
medical mx of prostate ca?
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
radical tx for prostate ca?
radical prostatectomy + goserelin LHRH analogue if node +ve brachytherapy: implantation of palladium seeds
99
symptomatic mx of Prostate Ca?
TURP for obstruction analgesia radiotherapy for bone mets/ cord compression
100
examination findings of prostatitis?
pyrexia swollen/ boggy/ tender prostate on PR examine testes to exclude eipididymo-orchitis
101
Mx of prostatitis?
analgesia levofloxacin for 28d
102
ix of urinary incontinence in women
urodynamic studies
103
mx of stress incontinence?
pelvic floor exercises ring pessary surgery: tension free vaginal tape
104
mx of urge incontinence?
bladder training lifestyle changes, weight loss anti-achm: tolterodine, imipramine surgery: Sacral or Tibial nerve stimulation devices when other tx has failed
105
undescended testes more common in?
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
what is a maldescended testis?
found anywhere along normal path of descent testis and scrotum usually underdeveloped often assoc w patent processus vaginalis
107
what is cryptorchidism?
complete absence of testis from scrotum anorchism = absence of both testes
108
what is retractile testis?
normal development but excessive cremasteric reflex testicle often found at external inguinal ring will descend- no tx required
109
what is ectopic testis?
found outside line of descent usually in superior inguinal pouch (ant to external oblique aponeurosis) abdominal, perineal, penile, femoral triangle
110
complications of undescended testes?
infertility 10 x increased risk of malignancy (remains after surgery) increased risk of trauma/ torsion assoc w hernias (90%) or urinary tract abnormalities
111
mx of undescended testes?
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
presentation of testicular torsion?
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
examination findings of testicular torsion?
inflammation of one testis: hot, swollen, extremely tender testis riding high and lies transversely
114
sudden onset severe pain in one testis tiny blue dot visible on scrotum
torsion of hydatid of Morgagni
115
ix of testicular torsion
Must not delay surgical exploration -\> straight to theatre doppler US may demonstrate absence of flow
116
mx of testicular torsion?
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
features of epididymal cyst?
lies above and behind testis (separate lump from testis) contains clear or milky (spermatocele) fluid remove if symptomatic
118
what is a varicocele?
dilated veins of pampiniform plexus
119
features of varicocele?
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
pathology of varicocele?
primary: left side commoner: drain into left renal vein secondary: left renal tumour has tracked down renal vein -\> testicular vein obstruction
121
mx of varicocele?
conservative: scrotal support, simple analgesia refer to a urologist for possible surgery: clipping of testicular vein
122
when to refer to urologist urgently for potential surgery? varicocele
A varicocele appears suddenly and is painful. The varicocele does not drain when lying down. There is a solitary right-sided varicocele.
123
what is a sperm granuloma?
painful lump of extravasated sperm that appears along the vasa deferentia or epididymides in vasectomized men.
124
what is a hydrocele?
collection of serous fluid within tunica vaginalis
125
pathology of primary hydrocele?
assoc w patent processus vaginalis commoner, larger, tense, younger men
126
pathology of secondary hydrocele?
tumour, trauma, infection smaller, less tense
127
ix of hydrocele?
US testicle to exclude tumour
128
mx of hydrocele?
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
what is a haematocele?
blood in the tunica vaginalis hx of trauma may need drainage/ excision
130
features of epididymo-orchitis?
Sudden onset tender swelling dysuria sweats, fever
131
examination findings of epididymo-orchitis?
Tender, red, warm, swollen testis and epididymis Elevating testicle may relieve pain Secondary hydrocele Urethral discharge
132
ix of epididymo-orchitis?
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
complications of epididymo-orchitis?
infertility
134
mx of epididymo-orchitis?
bed rest analgesia scrotal support abx: doxycycline or cipro drain abscess if present
135
risk factors for penile cancer?
HPV (16, 18, 31) infection chronic infection secondary to smegma smoking phimosis
136
presentation of penile cancer?
chronic fungating ulcer bloody/ purulent discharge 50% have inguinal nodes at presentation
137
mx of penile ca?
surgery: Moh's surgery, Laser +/- LN clearance Radiotx Chemotx
138
most common type of penile ca?
squamous cell ca
139
what is a hypospadia?
opening of the urethra is on the underside of the penis. (ventral surface)
140
what is an epispadia?
opening of the urethra is on the dorsal side of the penis.
141
what is phimosis?
foreskin is too tight to be pulled back over the head of the penis (glans)
142
presentation of phimosis in children?
recurrent balanitis (inflammation of head of penis) and ballooning +/- thick discharge underneath foreskin (balanoposthitis)
143
mx of phimosis in children?
gentle retraction, steroid creams, circumcision
144
presentation of phimosis in adults?
dyspareunia, infection mx: circumcision
145
146
what is phimosis assoc w?
STIs balanitis xerotica obliterans: lichen sclerosus- thickening of foreskin and glans -\> phimosis + meatal narrowing
147
what is paraphimosis?
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
causes of paraphimosis?
catheterisation masturbation intercourse
149
mx of paraphimosis?
manual reduction: use lignocaine jelly and ice may require glans aspiration or dorsal slit
150
what is balanitis?
acute inflammation of foreskin and glans
151
risk factors for balanitis?
diabetes mellitus, young children w tight foreskin (phimosis)
152
organisms causing of balanitis?
strep, staph, candida (DM)
153
mx of balanitis?
hygiene advice abx circumcision
154
presentation of testicular cancer?
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
risk factors of testicular tumour?
undescended testis infant hernia infertility
156
which type of testicular tumour secretes oestrogens or androgens?
Leydig cell: androgens or oestrogens Sertoli cell: oestrogens
157
tumour markers of testicular tumours?
raised AFP and HCG in most germ cell tumours
158
most effective analgesia in acute renal colic?
Diclofenac IM
159
initial ix of kidney stones?
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
mx of kidney stones \< 20 mm in pregnant women?
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
future prevention of oxalate kidney stones?
cholestyramine reduces urinary oxalate secretion pyridoxine reduces urinary oxalate secretion
162
future prevention of uric acid kidney stones?
allopurinol urinary alkalinization e.g. oral bicarbonate
163
prevention of calcium kidney stones?
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
best diagnostic ix for hydronephrosis?
US of renal tract
165
mx of hydronephrosis?
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
epididymal cysts are assoc w ?
polycystic kidney disease cystic fibrosis von Hippel-Lindau syndrome
167
what three things u need to know when working out a scrotal swelling?
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
which testicular lump often transilluminates?
hydrocele
169
PSA test, you should not have:
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
tx of children with hydrocele?
trans inguinal ligation of Patent processus vaginalis
171
mx of pt with obstructive kidney stone causing hydronephrosis and pyrexia?
urgent renal decompression and IV antibiotics due to the risk of sepsis via a ureteric stent or percutaneous nephrostomy
172
What is TURP syndrome?
Transurethral resection of the prostate (TURP) syndrome occurs when irrigation fluid enters the systemic circulation. The triad of features are: ## Footnote 1. Hyponatraemia: dilutional 2. Fluid overload 3. Glycine toxicity Management involves fluid restriction and the treatment of the complications associated with the hyponatraemia.
173
Prehn's sign?
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.